Duodenal Switch

The most known obesity surgery before Biliopancreatic Diversion (BPD) was Jejuno-Ileal Bypass (JIB). However, JIB surgery was abandoned in 1970s, as the JIB surgery caused severe nutritional disorders, liver failure and fatal organ damage for these reasons, despite good weight loss. . However, an operation that had positive effects of this surgery but would eliminate negative and fatal tissue damage was required. Biliopancreatic Diversion (BPD) was derived from this requirement.

Biliopancreatic Diversion (BPD) was first established in 1979 by Italian surgeon Dr. It was implemented by Scopinaro. Dr. The number of patients Scopinaro underwent BPD surgery is more than 2500.

The Duodenal Switch describes the connection of the lower part of the small intestine to the two centimeters of the small intestine (duodenum) after the stomach and pylorus muscle after the stomach is reduced in a different way to protect the pylorus muscle at the exit of the stomach. For this, the duodenum is closed and cut. In other words, the duodenal closure part is called the duodenal switch. The small intestine at the lower level is mouthed to the closed duodenum part at the stomach outlet. In other words, Biliopancreatic Diversion (BPD) surgery is applied after the duodenal switch is made. Together, these two are called Biliopancreatic Diversion-Duodenal Switch (BPD / DS).

The main effect of Biliopancreatic Diversion (BPD) surgery is a significant restriction of the absorption of foods taken. The effect of both restricting food intake and slowing fat absorption is the basis of weight loss. In the surgery, 75-85% of the stomach volume is removed (Tube stomach). The volume of the remaining stomach is 200-500 cc. Compared to Gastric Bypass, this volume is quite high, it does not reduce the quality of life in terms of food like Gastric Bypass. The main effect of the surgery occurs with the restriction of the absorption of nutrients.

In Biliopancreatic Diversion (BPD) surgery, the stomach nerves are preserved and the pyrolic valve is preserved. The intestines are calculated and divided into sections and the relationship of the intestines is rearranged.

By restricting the absorption of food, it is meant that not all of the foods taken can be completely taken into the body. In order for fat and carbohydrates to become absorbable, pancreatic enzymes and bile must meet with food, so that these enzymes break down the food and be reduced enough to be absorbed. Surgery reduces this meeting area towards the last part of the small intestine. Foods taken in BPD surgery are directly transmitted to the lower parts of the small intestine. Food encounters bile and pancreatic enzymes only in the last part of the small intestine. Thus, the carbohydrates and fats we take with meals are prevented from breaking into very small pieces. In this half-meter small intestine section, those that are completely broken down are absorbed, this section is only a small part of the food taken.

In Biliopancreatic Diversion (BPD) surgery, very strong weight loss is achieved due to absorption restriction effect. This surgery is also very effective in solving additional diseases and problems related to obesity such as diabetes, high cholesterol or hypertension.

In Biliopancreatic Diversion-Duodenal Switch (BPD / DS) surgery, a tube stomach is created by cutting the stomach longitudinally (SleeveGastrectomy) similar to tube stomach surgery. However, this gastric tube is much wider than conventional tube stomach surgery. In other words, the new stomach volume is less than Biliopancreatic Diversion (BPD) surgery, but much larger than Roux-N-Y Gastric Bypass, tube stomach or other obesity surgeries.

The intervention in the small intestines is also different, such as extended gastric surgery. In Biliopancreatic Diversion (BPD) surgery, the small intestines carrying bile and pancreatic fluids are transported to the last half meter of the small intestines. In other words, the anastomosis is made there, and in BPD / DS surgery, it is moved to the last 100 cm. Thus, according to Biliopancreatic Diversion (BPD) surgery, the following is provided in BPD / DS surgery:

✓ Less absorption restriction is provided.

✓ A smaller stomach

In Biliopancreatic Diversion-Duodenal Switch (BPD / DS) surgery, since the intestine is involved in absorption twice more than standard BPD surgery, that is, absorption is better, there is less malabsorption in Duodenal Switch surgery and thus vitamin and mineral deficiency is less common.

The most important difference of Duodenal Switch surgery is that the pyloric muscle is preserved. Dumping Syndrome is rarely seen due to the protection of the pyloric muscle. Less incidence of Dumping Syndrome increases postoperative life comfort. However, the majority of physicians dealing with metabolic surgery do not perceive Dumping Syndrome as a problem. Because, thanks to Dumping Syndrome, our patients avoid excessive calorie and fatty meals. In this way, weight loss will be better and they can protect it much better.

In standard BPD surgery, the small intestine is directly connected to the stomach. Therefore, ulcers in the stomach and anastomosis line are more common. On the other hand, the pylorus is preserved in Biliopancreatic Diversion-Duodenal Switch (BPD-DS) surgery. Likewise, a small intestine (duodenum) of about 2-3 cm at the exit of the stomach is also protected. It is also performed at the stomach outlet. The small intestine is pulled from below for the anastomosis and this is connected to the protected duodenum. Since the duodenum is resistant to the burning effect of stomach acid and bile, ulceration is usually not seen in this area.

DS, which is the best weight loss method among surgical procedures, can be said to be the most powerful surgical method in controlling diabetes, high blood pressure, high cholesterol and high triglycerides. Since the "pyrolic valve" of the stomach is protected, compared to other surgeries without pylorus, the effects of diarrhea, etc. For patients who cannot change their diet with high calories, choosing this method of surgery will be more appropriate than other surgical methods. Overweight patients will also allow you to lose more weight than Gastric Bypass methods. Since tube stomach surgery is definitely performed in this surgery, the release of hunger hormone (GHRELIN) in the stomach is controlled and this effect causes a feeling of hunger and a decrease in appetite.

This surgery slows the absorption of fat and therefore its effects on metabolism are much more pronounced than other surgeries. Reducing fat absorption makes it easier to lose weight in the long term. In summary, what does Duodenal Switch Surgery provide?

✓ Duodenal Switch surgery is an effective and permanent method that provides long-term weight loss. The rate of weight loss is more than 90%. Compared to other surgical methods such as Gastric Sleeve, Gastric Bypass, Duodenal Switch surgery provides better weight loss.

✓ Patients can eat much more than Roux-N-Y Gastric Bypass, Sleeveyada Stomach Band.

✓ It is very effective in controlling diabetes and hypertension and reducing high cholesterol and high triglyceride levels to normal levels.

✓ The control rate of diabetes reaches up to 98%

✓ Obesity-related lung problems The solution rate for breathing problems, shortness of breath and shortness of breath: 98%

✓ High cholesterol and other blood fat ratio: 92%

✓ High blood pressure solution rate: 91%

✓ Since the pylorus is protected, the person does not have indigestion and DUMPING SYNDROME after surgery.

✓ It is the most suitable method for patients who cannot improve their lifestyle and eat excessive calorie and fatty foods.

✓ In this surgery, the feeling of hunger decreases as the part of the stomach producing GHRELIN (hunger hormone) is removed.

✓ "Quality of life" is high since there is no need to diet like fat restriction.

✓ Diarrhea: The whole situation usually occurs in the musculoskeletal system during malabsorptive surgeries (ie operations with partial absorption disorders). Frequent and watery stool, which may continue in the first year, decreases over time, but can continue in this way for life.

✓ Removing Bad Smelling Gas
Lifelong vitamin and mineral supplements may be required:
✓ In particular, iron and vitamin B12 deficiency may cause anemia, ie anemia.
✓ It can be Vitamin D and Calcium. Calcium deficiency can cause osteoporosis.
✓ The risk of developing gallstones and bile sludge is much higher than normal.
✓ Rarely Dumpings syndrome
✓ Fatigue and excessive fatigue may occur due to decreased energy due to fat and carbohydrates