Bariatric Procedures

 

Duodenal Switch

A variation of BPD includes a “duodenal switch,” which leaves a larger portion of the stomach intact, including the pyloric valve that regulates the release of stomach contents into the small intestine. It also keeps a small part of the duodenum in the digestive pathway.

This weight loss surgical procedure is an improvement of the BPD. Here again, there is a significant malabsorptive component which acts to maintain weight loss long term. The patient must be closely monitored to guard against severe nutritional deficiencies. This procedure, unlike the BPD, keeps the pyloric valve intact. That is the main difference between the BPD and the DS.

 

Weight Loss Surgery - Duodenal Switch
Advantages & Disadvantages

Advantages

• More "normal" absorption of many nutrients than with BPD, including calcium, iron and vitamin B12
• Better eating quality when compared to other WLS procedures
• Eliminates or greatly minimizes most negative side effects of the original BPD
• Essentially eliminates stomal ulcer and dumping syndrome

Disadvantages

• Greater chance of chronic diarrhea
• Significant malabsorptive component
• More foul smelling stools and flatus, but less than with the BPD alone

Gastric Bypass Roux-en-Y

This operation is the most common and successful malabsorptive surgery.

First, a small stomach pouch is created to restrict food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum (the first segment of the small intestine), and the first portion of the jejunum (the second segment of the small intestine). This bypass reduces the amount of calories and nutrients the body absorbs.

 

 

 

 

 

 

 

 

Weight Loss Surgery - Roux-en-Y Gastric Bypass (RGB)
Advantages & Disadvantages

Advantages

 

• Greatly controls food intake
• Reversible in an emergency - though this procedure should be thought of as permanent

Disadvantages

• Staple line failure
• Ulcers
• Narrowing/blockage of the stoma
• Vomiting if food is not properly chewed or if food is eaten to quickly

 

Gastrointestinal Surgery - "Dumping Syndrome"

Both operations may also cause “dumping syndrome.” This means that stomach contents move too rapidly through the small intestine. Symptoms include nausea, weakness, sweating, faintness, and sometimes diarrhea after eating. Because the duodenal switch operation keeps the pyloric valve intact, it may reduce the likelihood of dumping syndrome.

The more extensive the bypass, the greater the risk for complications and nutritional deficiencies. Patients with extensive bypasses of the normal digestive process require close monitoring and life-long use of special foods, supplements, and medications.

 

Special thanks to the Cumberland Center for Obesity Surgery for allowing us to use the animations above.