Loop Duodenal Switch Procedure (bpd-ds)
What is Loop Duedonal Switch?
The surgical method,
known as switch or duodenal switch, is a surgical operation that combines both
sleeve gastrectomy and gastric bypass qualities. The operation is
performed in two steps. First, a sleeve gastrectomy is performed, in which
about 80% of the stomach is removed and the rest is made into a thin
tube.
It is a complex procedure that causes weight
loss with pancreatic diversion, sleeve gastrectomy and intestinal bypass with
duodenal switch (also called duodenal switch). This approach causes
reduced absorption of food as mentioned.
With this surgery, it is ensured that the
stomach takes the form of a tube by removing about 60-70% of the stomach
(sleeve gastrectomy). Then the lower intestine is bypassed by two-thirds
or more. So that only a few cm of intestines remain, where food and digestive
enzymes meet. This is the intestinal bypass part of the
operation. The name Duodenal is due to the fact that in this operation the
intestinal bypass begins in the duodenum. The first part of the intestine,
the duodenum, is separated and re-attached to the lower part of the intestine. Dumping
syndrome is not seen because the exit muscle called the pyloric muscle, which
controls the emptying of the stomach after duodenal switch surgery, is
protected. Since this process causes a condition in which absorption decreases,
patients will most likely experience more frequent and looser bowel movements
and will need to be monitored very closely for vitamin, mineral and protein
levels. Most patients can approximately lose between 60 to 80% of their excess
weight in 2 years of period of time.
This method, which is usually applied in
diabetic patients with high body mass index, can be performed in a single
surgery, but it is also possible to apply it gradually. At the first
stage, a different surgery can be performed for bypass 6-18 months after sleeve
gastrectomy is performed.
How is surgery performed?
In the first stage of
Duodenal Switch surgery, 85% of the stomach is removed and the stomach is made
into a tube shape as in the stomach. This part facilitates weight loss by creating
the effect that restricts food intake. In the second step, twelve fingers are
separated from the forward part of the ring-shaped muscle layer at the exit of
the stomach, called pylori, and further back where bile-pancreas fluids are
poured.
The gastric outlet is
combined with the intestine at a distance of 250 cm from the small large
intestinal bile. Thanks to this process, the absorption of fat and
calories from foods is further reduced compared to bypass surgery. By in
vitrifying the stomach, both food intake is restricted and absorption decreases
as the last 250 cm of the small intestines are used in food
transition. Thus, more effective weight loss is achieved. Since the valve
at the exit of the stomach is not disturbed, there is no bile escape to the
stomach and the stomach ulcers due to it. Since this valve is preserved,
Dumping Syndrome, which is accompanied by symptoms such as low blood pressure,
vomiting and fainting due to the passage of nutrients to the lower intestine,
is not seen.
As with bypass
surgeries, a dysfunctional piece of stomach that cannot be reached with
endoscopy is not left in the body. It is very difficult to diagnose
situations such as ulcers and cancers that may occur in the blind stomach
section left in bypass surgeries. It is one of the most effective methods of
treating morbidity and controlled diabetes. The transition to this surgery is
extremely simple in those who gain weight in the long term after gastric
surgeries.
What does Absorption (Malabsorption) Mean?
Intestinal absorption
disorder, which occurs due to the line-working of the digestive system, is also
known as malabsorbtion. Absorption restriction occurs when problems occur in
the small intestines where absorption occurs. The main cause of absorption
disorder, which is manifested by symptoms such as diarrhea, is a different
disease. The restriction of absorption, which usually occurs after celiac
disease, can be determined by changes in the stool. The change in the
color and fat ratio of the stool is a sign of absorption
restriction. Accordingly, gas problems and bloating also
occur. Absorption disorder disease, which also leads to vitamin and
mineral deficiency in the body, can be treated.
Who is duodenal switch surgery applied to?
It is a surgery performed in patients where the stomach volume is not severely
reduced, but the small intestine is also to be treated. For the patient
with a high body mass index, called super obese, is the most effective obesity
surgery for patients 50 and above. Since it is a surgical operation
performed by shortening the intestines and not on the stomach, the patient is
unlikely to gain weight again after surgery. Therefore, it is not required
to stick to any postoperative dietary program. In particular, it is recommended
to consume foods that are high in fat. Since the absorption of fats is
restricted thanks to surgery, it is necessary to increase the absorption of
vital vitamins from fat by consuming fatty foods a lot. Thanks to duodenal
switch surgery without changing the way of life, super obesity patients who
lose weight can stop their weight gain for life.