Duodenal Switch Surgery in India

Duodenal Switch Surgery

Duodenal Switch surgery is an efficient weight-loss surgery performed by number of surgeons worldwide. It is one of the most knotty weight loss surgeries, is also referred as vertical gastrectomy with duodenal switch, DS or BPD-DS, biliopancreatic diversion with duodenal switch. Surgery helps patients to lose a substantial amount of surplus weight and maintain successful weight loss eventually.

History of Duodenal Switch Surgery

The standalone Duodenal Switch procedure (without the accompanying gastric bypass as used in weight-loss surgery) was originally devised by Tom R. DeMeester, M.D. to treat bile gastritis, a condition in which the stomach and esophagus are burned by bile. In 1988, Dr. Douglas Hess of Bowling Green, Ohio, was the first surgeon to combine the DS with the Biliopancreatic Diversion (BPD) form of obesity surgery. This hybrid procedure, known as the Biliopancreatic Diversion with Duodenal Switch (or the Distal Gastric Bypass with Duodenal Switch), solves many nutritional problems associated with other forms of weight loss, and allows a magnificent eating quality when compared to other weight loss procedures.

Duodenal Switch Surgery Candidates

Specific requirements to become a surgical candidate vary amongst bariatric surgeons, but there are general criteria that candidates for duodenal switch need to meet.

Candidates are required to have a body mass index (BMI) of 40 or greater. In cases where the patient has co-existent health problems such as heart disease, sleep apnea, diabetes, or mobility impairment, a BMI of 35 or greater may be considered.
Candidates should be medically healthy enough to withstand surgery.
Candidates should be able to demonstrate a past history of failure with conventional diet and weight loss programs.
Candidates must demonstrate an understanding of the risks of the procedure and a commitment to long term maintenance of healthy eating and lifestyle habits after the surgery is complete.

Success Rate of Duodenal Switch Surgery

A person who undergoes a Duodenal switch surgery can expect to loose between 29% and 37% of their pre surgery weight during the first 3 months alone.

Following the first three months the patient should expect to have lost between 51% and 55% of their pre surgery weight by month 6 and 80% to 91% of that weight by the end of their second year.
Furthermore the duodenal switch offers a 97% success rate for resolving diabetes and 96% success at resolving high cholesterol.
90% of all patients who have undergone a duodenal switch procedure have seen their sleep apnea disappear.
You have roughly a 85% chance of ridding yourself of hypertension as well as 60% of all duodenal switch patients noticed their asthma disappeared. The duodenal switch has also been recorded at resolving almost 47% of arthritis issues.

Duodenal Switch Surgery Preparations

Before going for Duodenal Switch Surgery you need to do some preparations those include:

Meeting with a registered dietician to discuss how your diet needs to change both before and after weight loss surgery.
Upper endoscopy exams to make sure no polyps, tumors, ulcers or bacteria that cause ulcers are in the stomach prior to surgery.
Additional pre-operative evaluations may be necessary for the heart and lungs.
It's also wise to tell your surgeon about any medications you are taking or plan to take throughout recovery. Vitamins, minerals and herbs also interact with medications, so don't leave anything out.
Quitting smoking for at least 30 days before and after weight loss surgery. Smoking can increase the risk of complications, including potentially fatal blood clots. What's more, smoking also increases the risk of pneumonia and other lung problems after surgery.
Not drinking alcohol for at least 48 hours before weight loss surgery.
Losing 5 to 10 percent of excess body weight. People who lose a moderate amount of weight before weight loss surgery have a shorter hospital stay and more rapid postoperative weight loss, according to a study in Archives of Surgery.

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Duodenal Switch Surgery Procedure

The procedure involves the surgeon removing a large portion of the stomach. This is done as a ‘sleeve gastrectomy’: the surgeon will remove up to 85% of the stomach and reshape the remaining section so that it forms a tube or banana shape.
He/she will also ensure that the pyloric valve – the opening from the stomach which controls the flow of food into the small intestine - is left intact. This is the restrictive half of the procedure.
The surgeon will then take the small intestine and reroute this so that one end is attached to the pyloric valve and the other into the large intestine. This forms a shorter channel called the ‘digestive’ channel.
Surgeon will take another section of this small intestine which forms the longer channel or ‘biliopancreatic loop’.
This channel is where bile and pancreatic juices travel through. These travel down this channel until the reach the start of the large intestine.
The bottom of this channel joins the bottom of the digestive loop. This third channel or junction is where the bile, pancreatic juices and food mix together.
This reduces the amount of time that the body has in which to break down this food. The process means that fewer calories are absorbed into the bloodstream, and most importantly, less fat. Smaller portions and fewer calories mean that weight will be lost. This is the malabsorptive half.

Recovery after Duodenal Switch Surgery

Most people typically stay in the hospital for 4 days or less after duodenal switch surgery, followed by a stay in a nearby hotel for 4-7 days. Your doctor will approve your return back home once you can do the following:
Move without too much discomfort
Eat liquid and/or pureed food without vomiting
No longer require pain medication given by injection
You will remain on liquid or pureed food for several weeks after the surgery.
Even after that time, you will feel full very quickly, sometimes only being able to take a few bites of solid food. This is because the new stomach pouch initially only holds a tablespoonful of food. The pouch eventually expands. However, it will hold no more than about one cup of thoroughly chewed food (a normal stomach can hold up to one quart).
Once your diet begins to consist of more solid food, remember to chew each bite very slowly and thoroughly. You will be instructed on eating small meals frequently throughout the day, rather than large meals that your stomach cannot accommodate.
Exercise and the support of others (for example, joining a support group with people who have undergone weight loss surgery) are extremely important to help you lose weight and maintain that loss following gastric bypass.
You can generally resume exercise 6 weeks after the operation. Even sooner than that, you will be able to take short walks at a comfortable pace, with the approval and guidance of your doctor. Exercise improves your metabolism, while both exercise and attending a group support can boost your self-esteem and help you stay motivated.

Advantages of Duodenal Switch Surgery

Quicker weight loss and fewer chances of gaining weight back. The Duodenal Switch combines moderate intake with substantial calorie malabsorption. This results in a very high percentage of excess weight loss for obese individuals.
Significant reduction in excess body fat.
No dumping syndrome, that is, patients do not feel nauseous.
Patients can eat a normal balanced meal.
No risks of staple line problems, clogging of the anastomosis, or ulcers at the stoma, because there are no pouches or stomas. The natural stomach is still there, only smaller, and is connected to the duodenum in the same as it was before the surgery.

Risks of Duodenal Switch Surgery

The short-term surgical risks of duodenal switch are similar to those of gastric bypass. These include the risk of infection and leakage of gastrointestinal contents. These complications may require a return to the operating room for repair. Rate of complications are very low.

Alternatives to Duodenal Switch Surgery

Surgical procedure options to consider as an alternative for Duodenal switch may include these surgeries:

Adjustable gastric banding
Gastric bypass surgery
Biliopancreatic diversion surgery