Duodenal Switch Advantages

Advantages of Duodenal Switch Surgery

In the duodenal switch, the stomach is made into a narrow tube, which empties into the first part of the duodenum in the normal physiologic manner via the pyloric muscle.  The function of this muscle it to monitor the contents of the stomach and regulate the emptying of the contents.  If the food is not digested properly or is too concentrated, it is not allowed to empty and must undergo more digestion by the stomach.  Again, the stomach still functions like a normal stomach and digestion does take place with the duodenal switch where in the laparoscopic adjustable gastric band pouch and the roux-en-y gastric pouch, digestion is significantly diminished and food will exit out of the pouch in much the same way it entered the pouch.

This allows people who have had the duodenal switch to eat much more normally than those who have had the other two weight loss operations (laparoscopic adjustable gastric band or roux-en-y gastric bypass ).  In fact it is entirely normal for these people to be able to eat a small steak, chicken, salad, or pasta without difficulty where it is a rare person that can do this with the other two weight loss operations.

Greater loss of excess weight: The duodenal switch is the most complex of the three major weight loss operations, the others being the roux-en-y gastric bypass and the laparoscopic adjustable gastric band. Duodenal Switch has the best overall long-term weight loss of the three with the average weight loss being about 85% of the patient's excess weight. This is considerably greater excess weight loss than the two other surgeries; for laparoscopic adjustable gastric band the average excess weight loss is about 45% and for roux-en-y gastric bypass the excess weight loss is about 65%.

Other diseases may be relieved: There are a whole host of medical diseases which are obesity related. This means that as one loses weight these medical diseases will improve or resolve. Medical co-morbities (diseases) involve almost every system in the body and they include hypertension, high cholesterol and high triglycerides, snoring, obstructive sleep apnea, diabetes mellitus, gastro esophageal reflux disease, asthma, arthritis, and urinary stress incontinence to name the most common. Also, there are many cancers, which are more prevalent with obesity in which the risk is reduced with weight loss.

Additional medical benefits: With this weight loss, the above-mentioned co-morbidities will improve and/or resolve. In addition, diabetes mellitus will improve as a result of weight loss but will also improve with an entirely different mechanism. When the food is diverted away from the duodenum and beginning of the jejunum, and as a result reaches the terminal ileum more quickly, feedback mechanisms are altered by changes in gastrointestinal hormone production which allows immediate improvement in ones blood sugar and lowering of ones hemoglobin A1C levels. This is why diabetics will leave the hospital after duodenal switch surgery with much reduced needs of insulin or oral hypoglycemic medicine even without much weight loss.

Disadvantages

a. Potential protein malnutrition (needs continued long term follow up)
b. Excess gas with eating too many carbohydrates
c. Diarrhea if eating too many fats
d. Can develop osteoporosis like the gastric bypass
e. Potential fat soluble vitamin deficiency (A,D,E,K)