Duodenal Switch Procedure

What is The Duodenal Switch Procedure?

The Duodenal Switch procedure is a major surgery that rearranges the intestines so that the majority of food calories are not absorbed, resulting in progressive, long-term weight loss in most obese persons. It is important to be aware that many physical, social, and emotional changes occur as a result of this surgery.

The risks as well as the benefits must be understood.

Our staff will gladly discuss variations for your individual situation, along with any other questions you may have.

Normal Digestion - How Our Bodies Process Food

Duodenal Switch Procedure - BeforeThe food you ingest first enters your stomach, where hydrochloric acid and some enzymes begin the digestive process. In the next stage, the food enters the duodenum, the first portion of the small intestine, where it mixes with bile and additional enzymes produced by the intestinal lining and the pancreas.

The complex fats, proteins, and carbohydrates are broken down into simpler fatty acids, amino acids, and sugars. Only the simple "building blocks" are then absorbed as they continue to pass through the small intestine. These basic end products of digestion are then absorbed as they continue to pass through the small intestine. These basic end products of digestion are then used for fuel or stored as fat.

How the Duodenal Switch Procedure is Performed

  1. The duodenum is divided between the point where it connects to the stomach and where it connects to the bile ducts. The purpose is to divert pancreatic juice and bile. The lower end of the duodenum is then closed.
  2. A portion of the stomach is removed to create a pouch with a capacity of about six-ounces.
  3. A segment of the small intestine is divided. Note that no portion of the intestine is removed. Using this separated section of small intestine, a new connection is made to the open end of the duodenum.

Duodenal Switch Procedure

  1. The remaining end of the divided small intestine is reattached approximately 30 inches from the colon. This biliopancreatic segment now carries the digestive enzymes and bile. Thus, food travels along one section of intestine and the digestive juices (enzymes and bile) travel along a separate section of the intestine. The food and digestive juices now mix in a short 30-inch section of the intestine where most of the digestion and absorption of nutrients will take place. This significantly reduces the amount of fat emulsification and absorption, and reduces calories absorbed as well.
  2. The food then moves into the large intestine (colon). Absorption of calories has been essentially completed; mainly water is absorbed during this final stage.
  3. The gallbladder is removed if still present because many people who don't already have a diseased gallbladder tend to form gallstones while they lose weight.
  4. The appendix, if present, is often removed. Note that the gallbladder, appendix and a portion of stomach cannot be put back as they are permanently removed. However, none of the small or large intestine is removed, and therefore the intestinal rearrangement is completely reversible.

How Does the Surgery Work?

The immediate result of the surgery is a restriction of food intake due to the smaller stomach size; this assists the initial weight loss. Within 18 months the stomach pouch will gradually stretch to hold a normal-size meal. Weight loss will taper off and stabilize. An added benefit of stomach size reduction is decreased stomach acid production, thereby reducing the chances of ulcer formation.

Additionally, fewer calories are absorbed in the abbreviated 30-inch section of small bowel where food and digestive juices combine. This results in continued weight loss due to malabsorption. In the first 18 months after surgery, fats are incompletely absorbed, proteins are somewhat more absorbed, and simple sugars are completely absorbed. As the bowel naturally accommodates the surgery, fats will continue to be incompletely absorbed, but both protein and carbohydrate absorption generally increase over time.

Beneficial Effects

Besides the previously listed effects, blood levels of cholesterol and triglycerides will be reduced, often to normal or even lower levels, due to the reduced absorption of fats. In diabetes, blood sugar levels will often become normal, and insulin requirements reduced or eliminated altogether. Similarly medication for high blood pressure can often be discontinued as weight is lost.

All abdominal operations carry the risks of bleeding, infection in the incision, thrombophlebitis of legs (blood clots), lung problems (pneumonia, pulmonary embolisms), strokes or heart attacks, anesthetic complications, and blockage or obstruction of the intestine. These risks are greater in morbidly obese patients. Effective medical and nursing procedures used during and after the surgery have contributed to a successful outcome in the majority of obese patients.

In addition, several problems related to this specific surgical procedure are possible, although uncommon. One of these is injury to the spleen during surgery, which could require removal of the spleen. Leakage of fluid from the stomach or intestine through the staples or sutures may occur which may result in abdominal infection; this could require additional surgery for repair and for drainage of infection. Narrowing of intestinal connections may occur, which could require a second surgery to widen the opening.

Possible late complications related to this surgery could include peptic ulcer; intestinal obstruction due to adhesions; vitamin deficiencies or anemia from insufficient absorption of iron or vitamins, low blood proteins from malabsorption, resulting in fluid retention; hernia in the abdominal incision; temporary hair thinning due to changes in protein metabolism. Specific diet, physical activity, vitamin supplements, and medications may be recommended.

Morbidly obese patients are at higher risk for all surgical and anesthetic complications. Accordingly, extra precautions are taken before, during, and after the operation. Historic data show an approximately 0.5% (1 in 200) chance of death from obesity surgery nationally.

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