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Obesity Surgery
Duodenal Switch
Gastric bypass surgeries are a category of combined malabsorptive and restrictive weight loss surgeries. Commonly known as a Duodenal Switch or DS Gastric Bypass, these surgeries decrease both the quantity of food that is eaten and the quantity that is able to be processed and used by the body are decreased.
Biliopancreatic diversions, a type of gastric bypass surgery, combine the creation of a moderately sized stomach pouch and the bypassing of part of the small intestine to allow the patient to lose weight without significantly altering eating habits. This leaves the stomach able to hold approximately five to six ounces of food, while other common procedures typically leave it able to hold one half to one full ounce.
The Biliopancreatic Diversion Gastric Bypass Surgery (BPD or DS)
This surgery, sometimes referred to as a mini bypass, is typically performed in a hospital or a surgery center using general anesthesia. Most surgeries are performed laparoscopically , meaning the surgeon inserts long instruments into incisions that are only a few centimeters in length. In some cases, the surgery will require a larger, traditional incision (open surgery). A surgery that begins laparoscopically may also be converted to an open procedure if and when the surgeon determines it is necessary.
The surgery begins with multiple half-inch incisions in the area of the stomach and middle of the abdomen. The instruments are inserted through these incisions, and the surgeon begins by removing a portion of the stomach, decreasing its size until it holds less than one cup of fluid. The pyloric sphincter muscle, which holds food in the stomach, is removed. A new exit is created.
Once the stomach has been sutured closed, the lower third of the small intestine (ileum) is attached to the pyloric sphincter, which allows food to exit the stomach the same way it did prior to surgery. The first two segments of the intestine, the duodenum and jejunum , are completely bypassed. Those segments of the small intestine remain in the body, but food will no longer passes through them. Because food will now pass into the colon prior to being absorbed as nutrients, the body's ability to absorb nutrients into the blood stream is decreased by more than 50%.
During the final stage of surgery, the bypassed section of small intestine is attached to the large intestine. This allows secretions from the gallbladder to move out of the body in feces. Once the small intestine is rerouted and the surgeon determines there are no areas that leak, the instruments are withdrawn and the incisions are closed, typically with absorbable sutures and sterile tape.
Biliopancreatic Diversion With Duodenal Switch(BPDWS)
The biliopancreatic diversion with duodenal switch procedure (BDPWS) is very similar to biliopancreatic diversion (BPD). BDPWS is also performed in a hospital or a surgery center, using general anesthesia. A laparoscopic procedure, surgery begins with multiple half-inch long incisions in the area of the stomach and middle of the abdomen. In this procedure, the stomach pouch is larger than in the BPD surgery.
The stomach remains attached the first segment of the small intestine, the duodenum, which is then separated from the rest of the small intestine. The duodenum is then attached to the lowest part of the small intestine, bypassing the majority of the second and third segments of the small intestine.
As in the BPD procedure, the small intestine is rerouted. The surgeon determines that there are no areas that leak, the instruments are withdrawn and the incisions are closed, typically absorbable sutures with sterile tape.
Outcomes After Duodenal Switch and Biliopancreatic Diversion
Biliopancreatic diversion surgery has excellent results, with the average patient losing of his excess weight in the two years that follow the procedure. However, patients who choose this type of surgery are at much higher risk for nutritional deficiencies than with other types of weight loss surgery. Nutritional supplements, including vitamins and minerals, will be necessary for the lifetime of the patient.
The BPDWS procedure was expected to be an improvement on BPD, the older procedure. Surgeons believed that by preserving the pyloric sphincter that closes the bottom of the stomach, food would have an opportunity to be better digested, decreasing the level of malnutrition and vitamin deficiencies and preventing dumping syndrome after surgery. Studies have shown that there is no difference in the rates of malnutrition between the two groups.
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(Only for international patients seeking treatment in India)
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