DUODENAL SWITCH

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DUODENAL SWITCH

DUODENAL SWITCH It is the most effective surgery for type 2 diabetes provides the most effective treatment of diabetes. It is similar to gastric bypass, but the junction of the stomach and small intestine is different.

DUODENAL SWITCH

 

It is the most effective surgery for type 2 diabetes provides the most effective treatment of diabetes. It is similar to gastric bypass, but the junction of the stomach and small intestine is different.

 

Biliopancreatic diversion with duodenal switch (BPD/DS)

 

What is BPD/DS?

 

A biliopancreatic diversion with duodenal switch (BPD/DS) is a less-common weight-loss procedure that entails two major steps.

The first step is sleeve gastrectomy in which about 80 percent of the stomach is removed, leaving a smaller tube-shaped stomach, similar to a banana. However, the valve that releases food to the small intestine (the pyloric valve) remains, along with a limited portion of the small intestine that normally connects to the stomach (duodenum).

The second step bypasses the majority of the intestine by connecting the end portion of the intestine to the duodenum near the stomach. A BPD/DS both limits how much you can eat and reduces the absorption of nutrients, including proteins and fats.

BPD/DS is generally performed as a single procedure; however, in select circumstances, the procedure may be performed as two separate operations — sleeve gastrectomy followed by intestinal bypass once weight loss has begun.

While a BPD/DS is very effective, it has more risks, including malnutrition and vitamin deficiencies. This procedure is generally recommended for people with a body mass index (BMI) greater than 50.

 

How to Lose Weight With BPD/DS?

 


A tube-shaped stomach pocket is prepared and the remaining stomach tissue is removed. Small intestine is divided into two parts

The last part of the small intestine is connected to the small pocket, so that food passes directly from the stomach pocket to the last part of the small intestine (the small intestine is bypassed) Bypassed small intestine carrying important digestive enzymes is combined with the last part of the small intestine.

Enzymes combine with food from the stomach pocket starts digestion.

Patients consume less food at a meal, less digestion and hormonal secretion increases.

 

What are the Health Benefits of BPD/DS?

 


Clinically, patients have been shown to provide significant postoperative benefits.

  • Nearly 100% after the first year gives 75-85% of their excess weight
  • After the third year, 65% of patients lose 75% of their weight.
  • After the fifth year, 35% of patients lose 81% of their excess weight.
  • BPD/DS is the most effective type of surgery for the treatment of Type 2 diabetes.
  • Increase in physical activity, productivity, well-being, economic opportunities and self-confidence.
  • Short hospital stay due to laparoscopic method

 

Advandages and Disadvantages of BPD/DS

 

Advantages

  • Causes significant long-term weight loss.
  • Causes significant improvement in type 2 diabetes.
  • Foreign body is not used
  • Restricts the amount of food taken and increases the effectiveness of digestion
  • Causes changes in the digestive organs and hormones, hunger decreases and metabolism increases.
  • It is permanent.

 

 

Disadvantages

 

  • A proper nutrition program and routine exercise program should be continued throughout life.
  • Irreversible
  • Vitamins, minerals and protein deficiencies will be seen and lifelong vitamin, mineral and protein support must required to avoid life-threating vitamine-deficiency complications 

 

Possible Complications

  • Associated with obesity (possible complications when performing any surgery in each obese patient regardless of the operation)
  • Deep vein thrombosis (thrombosis of leg veins)
  • Pulmonary embolism (thrombosis of the lungs)
  • Wound site infection
  • Lung infection
  • Anesthesia complications
  • İncisional hernias
  • Surgery related (complications specific to this surgery)
  • Bleeding (3-5%). Blood thinners may be caused by cuts of the stomach or other organs in the abdomen.
  • Leakage (3-5% in old technology stapler group, 0.1% in new technology stapler group. More than 90% of patients can be treated with endoscopic stent implantation and feeding tube insertion)
  • Vitamins, protein and mineral deficiencies (Patients begin life-long protein, vitamin supplementation)
  • Dumping Syndrome (rich in carbohydrates and nausea, vomiting and discomfort if ingested)
  • Ulcer

 

Risks

 

Obesity and metabolic surgery is a safe surgery. It is as safe as other surgical procedures, such as gall bladder surgery. In experienced obesity and metabolic surgery specialists, the life-risk associated with obesity surgery is about 0.13%, while the life-risk of gall bladder surgery in an obese individual is 0.4%.

All surgical methods include risks. These risks vary according to weight, age and comorbidities. Each patient should have a specific risk assessment. A clearer interpretation cannot be made until the patient and the physician come together and make a preliminary assessment interview and conduct an examination evaluation.

But safe surgey is based on three main points.

1. Preoperative Evaluation: This includes routine blood tests, ultrasonography, endoscopic examination, chest disease evaluation, and cardiology evaluation. The patient should not be operated on unless the deficiencies (diabetes control, iron deficiency, vitamin B12 deficiency, vitamin D deficiency) that affect the wound healing are eliminated. Smoking should be discontinued. Preoperative diet should be applied.


2. Surgery: The appropriate surgical procedure should be selected for the patient. Surgical experience is required. The most current stapler technology should be used during surgery. Preventing clotting in the operating room measures should be taken.


3. Postoperative: A good follow-up after surgery is very important for complication management.