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.