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Restriction (Vertical Gastrectomy): The stomach is restricted by dividing it vertically
and removing more than 85% of it. This part of the procedure is
not reversible. The stomach that remains is shaped like a banana
and measures from 4-7 ounces (120-250cc) depending on the
surgeon performing the procedure. The nerves to the stomach and
the outlet valve (pylorus) remain intact with the idea of
preserving the functions of the stomach while reduing the
volume. By comparison, in a Roux-en-Y gastric bypass, the
stomach is divided, not removed, and the pylorus is excluded.
The Roux-en-Y gastric bypass stomach can be reconnected(reversed)
if necessary.
Duodenal Switch: What is Malabsorption?
Malabsorption (Duodenal Switch):
The intestines are divided and rearranged to separate food from
the digestive juices, thereby creating malabsorption. The food
limb is attached to the duodenum and receives food from the
stomach. This limb is 150 cm long. The digestive juices are now
separated from the food and travel for over 500 cm in the
bypassed small intestine. Both food and digestive juices mix
together and travel together for 100 cm in the common limb.
Thus, food and digestive juices are separated for most of the
length of the intestines. This prevents you from absorbing all
of the calories that you eat. By comparison, the intestinal
bypass in a Roux-en-Y gastric bypass is much less extensive, and
the common limb for digestive juices and food to mix is
approximately 5 times longer. Therefore, the Roux-en-Y gastric
bypass has minimal malabsorption compared to the Duodenal Switch
procedure.
The Advantages of the Duodenal Switch Weight Loss Surgery
Procedure
The more normal stomach allows for better eating quality but may
possibly result in more diarrhea and foul smelling bowel
movements and gas
No dumping syndrome because the pylorus is preserved
Minimizes the chance of an ulcer occurring
Very effective for high BMI patients (BMI>55 kg/m2)
The intestinal bypass is partially reversible for those having
malabsorptive complications
Laparoscopic approach is offered by some surgeons
The Disadvantages of the Duodenal Switch Weight Loss Surgery
Procedure
Greater chance of chronic diarrhea
Significant malabsorption leads to anemia, protein deficiency
and metabolic bone disease in up to 5% of patients
More foul smelling stools and gas
Carbohydrates can be well absorbed and lead to inadequate weight
loss
This procedure is the most complex surgical weight loss
procedure and may yield an unacceptable level of complications
in high risk patients(heart failure, sleep apnea)
Duodenal Switch: Risks and Complications
As with any surgery, there can be complications. This list can
include:
Deep vein thrombophlebitis 0.7%
Non-fatal pulmonary embolus 0.5%
Pneumonia 0.5%
Acute respiratory distress syndrome 0.25%
Splenectomy 0.9%
Gastric leak and fistula 2.0%
Duodenal leak 1.5%
Distal Roux-en-Y leak 0.25%
Postoperative bleeding 0.5%
Duodenal stomal obstruction 0.75%
Small bowel obstruction 2.0%
Death 1.0% |
