Types of Surgeries

Duodenal Switch

Overview

Dr. Gagner was the first surgeon to perform the Duodenal Switch (DS) laparoscopically during the summer of "99. Since then, he has continued to innovate with this surgery. He was the first surgeon to perform a DS in two stages in "00. He was also the first surgeon to convert a gastric Lap Band and a gastric bypass into a DS.

The duodenal switch primarily depends on intestinal malabsorption, but also utilizes gastric reduction to achieve weight loss. Patients with BMIs above 60 are often operated in two independent stages performed at different times. The first consists of a sleeve gastrectomy, a procedure that reduces the size of the stomach.

The second stage is technically complex. The lowest part of the intestines, the ileum, is divided from the rest and the upper part of the intestines, the duodenum, is divided, leaving a small segment attached to the stomach and a longer free-hanging segment to which the liver and pancreas are attached. The ileum is brought up and re-connected to the small segment of duodenum left attached to the stomach. The lower part of the free-hanging intestines is then connected to the ileum. The result is similar to the gastric bypass in that two intestinal limbs persist, one for food and the other for digestive juices. Digestion of protein and fat only occurs where both limbs meet. Thus, nutrient absorption is limited to a very small portion, about 3 feet long, of the lower intestines.

On average, the surgery takes two hours to complete; patients are discharged 2 or 3 days post-op, and can return to work after 2-4 weeks.

Candidate characteristics

Advantages and Disadvantages

Advantages

  • Greatest weight loss results of all weight loss procedures
  • Most effective procedure to lower cholesterol and triglycerides
  • Most effective procedure in alleviation of type-II diabetes

Disadvantages

  • Increased nutritional problems, such as low absorption of proteins
  • Necessity for a high protein diet
  • Lifelong dependence on vitamin and mineral supplements

Risks

Risks of Surgery

  • Bowel obstruction, 3-5% in collective studies
  • Need for reversal or reoperation due to malnutrition, 2-5% in collective studies
  • Leakage, less than 1% in collective studies
  • Bleeding, less than 1% in collective studies


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