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Duodenal Switch Surgery
Relevant information about Duodenal Switch Surgery.
- What does the surgery consist on
Duodenal Switch Surgery, also known by the longer name of Gastric Reduction Duodenal Switch, is a weight loss surgical procedure. This operation is used to treat obesity by reducing the stomach size and the small intestine, thus limiting food intake and calories absorption. The surgery’s main goal is to help seriously obese individuals to achieve and maintain significant weight loss.
- Which problems does the surgery solve
Duodenal Switch Surgery is one of the possible treatments for obesity. Obesity is a condition in which excess body fat has accumulated in an individual, causing adverse effects on health. An individual is considered obese when his body mass index is greater than 30 kg/m2. Various diseases are associated with obesity, particularly heart disease, type 2 diabetes, breathing difficulties during sleep, certain types of cancer and osteoarthritis. These problems usually greatly reduce life expectancy of an obese individual.
Obesity tends to be caused by a combination of excessive dietary calories, a lack of physical activity and genetic susceptibility. However in a few cases it may be caused by endocrine disorders, medications or psychiatric illness.
- How is the surgery performed
The Duodenal Switch Surgery is composed of two parts. During the first part, which is called restrictive, the surgeon removes at least the 70% of the patient’s stomach. During the second part, which is called malabsorptive, a part of the small intestine is rerouted, creating two different pathways and one common channel.
The restrictive part begins with the patient being put lying on his back. First of all, an incision is made in order to reach the stomach. Once the stomach is reached, it is partially removed, always leaving part of the right side intact. This is done in order to keep the pylorus, which is the stomach valve that controls when food leaves the stomach and enter the intestines. The percentage of the stomach removed tends to vary from patient to patient. It is expected that after the removal the stomach will have the size and shape of a banana.
The malabsorptive part of the surgery begins with the small intestine, which measures about 20 feet, being cut at two locations. The first cut is made about one to two inches past the pylorus, in the part of the small intestine which is called duodenum. The second cut is made eight feet from the lower end of the small intestine, which is called the alimentary limb. The alimentary limb is then connected to the beginning of the duodenum near the stomach outlet. The cut out section of the small intestine, which is called the biliopancreatic limb, is reconnected on one side at the beginning of the alimentary limb, and on the other side, near the end of the small intestine. The biliopancreatic limb is where most digestion occurs. This last section of the small intestine, which is called the common limb, is where food and digestive enzymes finally meet. After the malabsorptive part is complete, digestion will be made at the common limb, leaving the biliopancreatic limb only to transport bile and pancreatic secretions.
- Anesthesia: This type of procedure is done under general anesthesia. This means that the patient will be asleep during the procedure.
- Surgery length: The surgery usually takes from 3 to 4 hours. Some surgeons may also choose to do it in two parts, being the malabsorptive part the longest.
- How is the post-surgery process
This operation requires a hospital stay of at least 5 days. After this, there is a three to four weeks recovery period during which the patient must get reaccustomed to eat solid food and liquids. The first thing that will be consumed after the surgery are liquids, then it is expected a progress to pureed foods, and finally to solid food. Nutritional supplements will be taken for life in order to prevent nutritional deficiency caused by the consequences of the malabsorptive part of the operation.
There are three main possible complications. The first one may happen shortly after the operation and it is called leakage. Leakage happens when a perforation occurs in the stomach or in the stitched parts of the small intestine and causes all the stomach fluids to leak outside. The second complication is brittle bone disease osteoporosis, due to malabsorption of calcium and vitamin D, which are needed to maintain bone strength. The third is malabsorption of protein, leading to malnutrition. This usually requires a second operation. The last two complications are long term problems and it is required a certain amount of time until the patient realizes of their existence.
- What does the treatment do
The surgery allows the patients to lose weight and highly reduces the possibilities of regaining it.
- What does the treatment not do
The procedure eliminates the possibility of having a normal diet. A strict alimentary regime will have to be followed for life.
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