The duodenal switch (DS) may be the most effective bariatric treatment for improving diabetes, hyperlipidemia, high cholesterol, high triglycerides and sleep apnea. It also results in more weight loss than any other procedure. The Duodenal Switch has been around and performed for over twenty years. The DS has shown a 98% cure rate for Type II diabetes. A Brief overview of the procedure is listed herein. As with any bariatric surgery, the best procedure for you is to be discussed with your surgeon and based on many factors for the safest and most effective outcome for you.
The Duodenal Switch combines Two Surgical Techniques: Restrictive and Malabsorptive
The Restrictive component involves reducing the size of the stomach. We divide the stomach vertically and remove more than 85 percent of it. The stomach that remains is shaped like a banana and is about 100 to 150 milliliters or 6 ounces.
The Malabsorptive component of duodenal switch surgery involves rearranging the small intestine to separate the flow of food from the flow of bile and pancreatic juices. The food and digestive juices interact only in the last 18 to 24 inches of the intestine, allowing for malabsorption.
Unlike the restrictive part of the surgery, the intestinal bypass part of the duodenal switch is partially reversible if you are one of the people who experience malabsorptive complications. With the duodenal switch, you consume less food than normally, but it is still more than with some other weight loss surgeries. Even this amount of food cannot be digested as normal, so a large amount of food passes through the shortened intestines undigested
Gastric Bypass is major abdominal surgery. In the average patient the surgery takes 90 minutes to 2 hours. Most patients are in the hospital 2-3 days. The surgery involves reducing the size of the stomach from 32 ounces to about 2 ounces. In addition the intestines are then re-routed, which will decrease the absorption of food, and finally re-attached to the new, smaller stomach. The surgery therefore has 2 components it is “restrictive” because it reduces the size of the stomach. Also it is “malabsorptive” which means it will cause less efficient absorption of nutrients. For both of these reasons, the weight loss after gastric bypass tends to be more rapid then after gastric banding also gastric bypass patients on average will tend to lose more of their excess weight than band patients. This malabsorption means that post operative nutritional follow up is absolutely critical for all patients undergoing Roux-en-Y Gastric Bypass. The malabsorptive part of the surgery can lead to something called “dumping syndrome”. While this is not considered to be medically dangerous it can be extremely unpleasant. It is usually caused by eating sugary foods or drinks and can lead to cramping, nausea/vomiting, and diarrhea. It will generally resolve itself after 1-3 hours. While the symptoms of dumping syndrome are very unpleasant you should note that it is caused by eating sugary foods which you should avoid anyway if you are trying to lose weight. In that sense the surgery can keep you “honest” and eating the proper foods.
- “Permanent” solution
- Both restrictive and malabsorptive
- More rapid weight loss
- Studies show greater percentage of excess body weight lost (80-90 percent)
- Greater percentage of weight kept off with long term follow-up (5-10 years)
- Greater risk of vitamin and nutritional deficiencies if not properly managed with your surgeon
- Risk of “dumping syndrome” – not pleasant if you eat wrong foods – no health risk to DS
- 1-2 day hospital stay
- Not easily reversed
- Increased chance of ulcers especially in smokers; if taking aspirin and/or anti-inflammatory drugs
The Sleeve Gastrectomy works by two different mechanisms, the first is restriction and the second is a “chemical/hormonal” effect. The Sleeve Gastrectomy reduces the size of the stomach from about 32 ounces (a quart) to about 4 ounces (the size of a banana). This restricts the amount of food a person can consume (similar to a band); however the surgery has an additional effect. This additional effect (what we call the “chemical/hormonal” effect) is to significantly reduce a person’s appetite for a prolonged period of time after the surgery, anywhere from one to three years. The reduction in appetite supports ongoing weight loss as it is much easier to keep food intake to a minimum when a person doesn’t feel hungry. Bariatric patients (who have struggled with their weight and appetite, in many cases, for their entire lives) are often amazed by this aspect of the surgery. This reduction in appetite is one of the main differences between the sleeve and the band.
The Sleeve Gastrectomy is a permanent procedure; once the portion of your stomach is removed, it cannot be “undone.” The gastric sleeve has been around since the 1970s and was originally part of a 2-part surgery called the duodenal switch. Patients were having provocative results in rapid weight loss on part “1” of the duodenal switch and were not going back for the 2nd part of the surgery. After years of study and validating the sustained weight loss results, the gastric sleeve was approved as a stand-alone bariatric procedure. The advent of the gastric sleeve, as an insurance-approved procedure for weight loss surgery, took place in early 2010. Our office has offered the gastric sleeve since being approved by COE for use in weight loss surgery in 2010.
- Same Day/overnight stay in hospital
- No Dumping Syndrome (see Gastric Bypass for details for “Dumping Syndrome”
- Significant decrease in appetite
- On average – more weight loss than gastric band
- No Dumping Syndrome
- Rate of Type II Diabetes resolution may not be as great as with the gastric bypass
- Medicare does not currently cover the gastric sleeve
- On average, less weight loss than the gastric bypass