Highlights
- The Loop Duodenal SwitchDuodenal switchA more powerful bypass procedure reserved for very high BMI, with the greatest weight loss but the highest nutritional monitoring needs. combines a sleeve gastrectomySleeve gastrectomyRemoval of roughly 75-80% of the stomach, leaving a narrow tube. Reduces both capacity and hunger hormone production. with an intestinal bypass to restrict food intake and significantly reduce calorie absorption.
- Patients can expect to lose 60% to 80% of their excess weight within two years, making it highly effective for treating morbid obesityMorbid obesityObesity severe enough to threaten health, usually defined as BMI 40 and above, or 35 and above with related conditions. and diabetes.
- The procedure preserves the stomach valve to prevent Dumping SyndromeDumping syndromeCramping, sweating and palpitations after eating sugary food, caused by rapid emptying into the intestine. Most common after gastric bypass. and allows for easier endoscopicEndoscopicPerformed with a camera through small incisions, as in endoscopic brow lift or keyhole abdominal surgery. monitoring compared to traditional bypass surgeries.
Loop DuodenalDuodenumThe first section of the small intestine, where iron and calcium are mainly absorbed. Bypassing it explains the need for supplements. Switch is a complex procedure that causes weight loss with pancreatic diversion, sleeve gastrectomyGastrectomySurgical removal of part or all of the stomach; sleeve gastrectomy removes about 80% of it. and intestinal bypass with duodenal switch (also called duodenal switch). This approach causes reduced absorptionMalabsorptionReduced uptake of nutrients from food, an intended effect of bypass procedures that makes lifelong supplements essential. of food as mentioned.
With this surgery, it is ensured that the stomach takes the form of a tube by removing about 60-70% of the stomach (sleeve gastrectomy). Then the lower intestine is bypassed by two-thirds or more. So that only a few cm of intestines remain, where food and digestive enzymes meet. This is the intestinal bypass part of the operation. The name Duodenal is due to the fact that in this operation the intestinal bypass begins in the duodenum.
The first part of the intestine, the duodenum, is separated and re-attached to the lower part of the intestine. Since this process causes a condition in which absorption decreases. Patients will most likely experience more frequent and looser bowel movementsBowel functionDigestive rhythm, which changes after bariatric surgery and needs attention to fluid and fibre intake.. Thus, patient will need to be monitored very closely for mineral and protein levels. Most patients can approximately lose between 60 to 80% of their excess weight in 2 years of period of time.
This method, which is usually applied in diabetic patients with high body mass indexBody mass indexWeight in kilograms divided by height in metres squared. Used to classify weight categories and to assess surgical suitability.. Also, can be performed in a single surgery, but it is also possible to apply it gradually. At the first stage, a different surgery can be performed for bypass 6-18 months after sleeve gastrectomy is performed.
How is Loop Duodenal Switch performed?
85% of the stomach is removed and the stomach is made into a tube shape as in the stomach. This part facilitates weight loss by creating the effect that restricts food intake. Afterwards, twelve fingers are separated from the forward part to the layer at the exit of the stomach. Also, surgeon places it further back where bile-pancreas fluids are poured.
The gastric outlet is combined with the intestine at a distance of 250 cm from the small large intestinal bile. Thanks to this process, the absorption of fat and calories from foods is further reduced compared to bypass surgery. By in vitrifying the stomach, both food intake is restricted and absorption decreases as the last 250 cm of the small intestines. Thus, more effective weight loss is achieved. The valve at the exit of the stomach is not disturbed. Thus, there is no bile escape to the stomach and the stomach ulcers due to it. Since this valve is preserved, Dumping Syndrome is not seen. Along with symptoms such as low blood pressure, vomiting and fainting.
A dysfunctional piece of stomach that cannot be reached with endoscopyEndoscopyExamination of the stomach with a flexible camera passed through the mouth. Used before and after bariatric procedures. is not left in the body. It is very difficult to diagnose situations. Such as ulcers and cancers that may occur in the blind stomach section left in bypass surgeries. It is one of the most effective methods of treating morbidityMorbidity and mortalityStandard measures of surgical safety: morbidity means complications, mortality means death rate. Both are published for each procedure. and controlled diabetes. The transition to this surgery is crucially simple in those who gain weight in the long term after gastric surgeries.
