Recently, Dr. Gagner was featured in a General Surgery News article entitled “Stomach Intestinal Pylorus-Sparing Surgery” also known as SIPS. The article is a round-table style interview with physicians, surgeons and experts on the topic, a surgery that has been at the forefront of discussion in the field. This new technique is based on a modification of the duodenal switch procedure, and in some practices it accounts for more than 40% of bariatric surgeries performed based on information presented at the 2016 Minimally Invasive Surgery Symposium.
What is the duodenal switch?
The duodenal switch (DS) is composed of a restrictive part, a gastric sleeve reduction procedure, and a malabsorptive part also known as a biliopancreatic diversion, which decreases absorption of fat mainly. Both components help those with obesity and remove excess weight, especially the body fat compartment.
Dr. Gagner’s Key Points
Dr. Gagner states that in the U.S there are many variations of the duodenal switches and that SIPS is just another variant being performed, which is very similar to what has been done for the last 25 years. In SIPS, there is only one anastomosis (connection), and therefore technically simpler and shorter in anesthesia duration.
SIPS, preserves a normal emptying of the stomach, because the pyloric valve, a muscle sphincter between the stomach and intestine is intact. This avoids dumping syndromes and severe swings in blood sugar. It is a procedure that is either done in super-obese, diabetics (Type-2) or in those who have weight regain after the popular sleeve vertical gastrectomy. The procedure was initiated by surgeons in Madrid more than 5 years ago, and now is becoming more and more popular in the USA and Canada.
He also explains informed consent in the interview – the concept of explaining what you intend to do with the patient. It is important to have written informed consent whether a classic intestinal reconstruction approach is being taken or a SIPS procedure, as the two procedures could present different side effects. However, Dr. Gagner states that the slight modifications between the two procedures will not make a big difference to the overall outcome.
For instance, the classic duodenal procedure might affect the frequency and quality of bowel movements (being more frequent and looser) but in terms of micronutrient deficiencies, it will provide the same results as SIPS .This makes the difference between the two procedures such a small change that it should not need approval from the institutional review board.
Dr. Gagner offers SIPS as part of his services at Clinique Michel Gagner. If you or anyone you know could benefit from this procedure, get in contact with us to make an appointment today.