Duodenal Switch Surgery

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Childhood Obesity News has not yet discussed the duodenal switch, which has both a restrictive and a malabsorptive aspect. It is usually reserved for patients who are well into the super-obese category, with a BMI of over 50, although it is sometimes deployed on the morbidly obese, or those with a BMI of more than 40.

Compared with other types of bariatric surgery, the weight loss is greater and the likelihood of regaining it is less. For instance, with gastric bypass surgery, first-year weight loss averages 55%. The Biliopancreatic Diversion with Duodenal Switch (BPDDS) brings the number up to 66% or even 69%. That spectacular efficacy comes with a caveat.

The surgery only works if the patient makes sweeping lifestyle changes and adheres to them strictly. Among other issues, there is the malabsorption problem. When vitamins can’t be properly taken into the body, malnutrition is a very real concern, as are osteoporosis and blindness.

More than with any other type of bariatric surgery, supplementation is a make-or-break factor. The patient must be serious about having nutritional followup tests forever. The vitamins cost money too. On the other hand, BPDDS could eliminate the need for the meds that combat diabetes, dyslipidemia, and hypertension. When it comes to eliminating obesity-related illnesses, it is the clear winner.

A prominent patient

Remember Justin Williamson, the young and promising singer we wrote about last summer? The size of two kids as a toddler, he later weighed as much as 640 pounds and became known as America’s largest teenager. The good news is:

[…] after months of working out and having a duodenal switch, Justin now weighs in at 495 lbs… Justin hopes to attend college in Florida next fall.

For anyone who wants to roll the dice, the average cost of BPDDS is $20,000, although good luck getting the insurance company to pay for it if they are one of the insurers who consider the technique to be experimental. It is the most complicated bariatric surgery to perform, although it can be done laparoscopically. “My Bariatric Life” says:

The first part is to create a gastric sleeve. Normally, after food passes through the stomach it enters the duodenum where it mixes with digestive juices from the pancreas and bile from the gall bladder. This is the second part of the revised digestive process. Duodenal switch separates the digestive process. Food travels down undigested, bypassing a large part of the intestine and mixes with bile and digestive juice in the last 18-24 inches of the intestine.

As might be expected with a procedure so extreme, BPDDS is not reversible, or rather, is partially reversible if the inability to absorb nutrients threatens the patient’s life. Experts say it has the highest early mortality rate compared with other bariatric surgeries.

A consecutive series of 1000 patients who underwent BPDDS found that perioperative serious complications occurred in 7% of the patients, with the most common major complications being anastomotic leak, anastomotic stenosis/small bowel obstruction, and GI abdominal hemorrhage. Late complications (>30 days) most commonly involved small bowel obstruction, malnutrition, and incisional hernias. The majority of patients had long-term complaints of diarrhea, abdominal bloating, and malodorous flatus/stool.

That’s right, part of the admission price is the expectation of lifelong painful and “unusually foul” gas.

Your responses and feedback are welcome!

Source: “Justin’sJourney,” NewsChannel10, 02/24/16
Source: “Duodenal Switch Surgery Facts,” MyBariatricLife.org, 10/26/15
Source: “Gastrointestinal Complications After Bariatric Surgery,” Gastroenterologyandhepatology.net, August 2015
Photo credit: dalehugo via Visualhunt.com/CC BY

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