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Duodenal Switch - Barbara's WLS Journey & Resources |
Not sure what
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WLS Comparison Charts
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Type of Operation |
RNY, Gastric Bypass, Roux-en-Y, LAP, RNY |
Duodenal Switch, |
VBG |
Lap Band |
|
Modality of Weight Loss |
Restrictive 1-3 ounce stomach |
Restrictive & Malabsorptive |
Restrictive |
Restrictive 1-3 ounce stomach (15cc) |
|
Description |
A very small pouch of fundus connected to a limb of small bowel. Pyloric Valve is bypassed. |
Sleeve gastrectomy, with 4- 6 ounce pouch. Pyloric valve remains functional. The bilio-pancreatic secretions are kept separated from food to limit absorption except the last ~75cm of small bowel. |
A silastic ring is used to create a small pouch of stomach. |
An adjustable silicone constricting band is place completely around the very top part of the stomach creating a very small pouch. |
|
Long term success |
Average.
|
Above
Average. |
Poor. |
No long
term studies yet available. |
|
Complications |
68.8% “continued” problem with vomiting, 42.7% plugging of the gastric pouch outlet.[13] 12% stenosis & 12% ulceration, with over all stomac complication in 20%.[14] Up to 76% of Patients develop Dumping Syndrome, with no association between severity of Dumping Syndrome and weight loss.[15] |
Fat soluble vitamin deficiency- Rarely seen with adequate dietary supplements, in addition to a normal healthy diet. Protein malabsorption- again with healthy well balanced diet far less common than seen in VBG or RNY patients with stenosis or who only consume high sugar/calorie drinks. |
21% Vomit more that once a week. 14% have heartburn.[1] Binging and purging very common secondary to pain. |
89% of
patients have at least one side effect. |
|
Opinion |
“Gold standard” with frequent complications and hospital visits for patients 8. |
Technically a difficult operation to perform. Division of the post pyloric duodenum is a difficult step and could be dangerous in an inexperienced hand. |
Poor long term results with VBG[2] |
Actually not a new idea and was abandoned years ago. Some top surgeons in the field feel its resurgence will give bariatric surgery a bad reputation [18] |
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Summary |
A restrictive procedure rendering a patient to a very limited diet, with significant complications. Long term results acceptable. |
The best surgical solution available for treatment of Morbid obesity. Allows a patient to lead a normal life with normal dietary intake of meals in smaller volume, without the side effect of dumping syndrome, continued vomiting, plugging, etc. |
A restrictive operation with poor long term track record and numerous complications. |
Restrictive procedure with no long term studies. Preliminary results disappointing.[19] |
|
Long Term Dietary Modification |
Significant dietary restriction. The unhealthiest diet after any weight loss surgery. Meat intolerance in majority of Pt.[16]Patients resort to high calorie drinks because can not tolerate “regular” meals |
Most balanced diets tolerated well with no adverse effects. Patients tolerate “normal” diet. |
Extremely poor diet- Patients are not able to consume any solids since it plugs the opening at the silastic ring.
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The same as VBG |
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Nutritional Supplement |
Multivitamin, Iron, B12, Calcium for life |
Multivitamin and Calcium for life. |
Multi vitamin, Iron, Calcium For life |
The same as VBG |
[1] Balsiger BM, Poggio JL, Mai J, Kelly KA, Sarr MG, Ten and more
years after vertical banded gastroplasty as primary operation for
morbid obesity, Gastrointestinal Surgery 2000
Nov-Dec;4(6):598-605.
[2] McLean LD, Rhode BM, Sampalis J,
Forse KA Results of the surgical treatment of obesity. Am J
Surgery 1993;165:155 - 59.
[3] Scopinaro N; Adami GF; Marinari GM; Gianetta E; Traverso E;
Friedman D; Camerini G; Baschieri G; Simonelli A, Biliopancreatic
diversion, World J Surgery 1998 Sep;22(9):936-46.
[4] Hess DS; Hess DW, Biliopancreatic diversion with a duodenal
switch, Obesity Surgery 1998 Jun;8(3):267-82.
[5] Baltasar A; Bou R; Bengochea M; Arlandis F; Escriva C; Mir J;
Martinez R; Perez N, Duodenal switch: an effective therapy for
morbid obesity--intermediate results, Obesity Surgery 2001
Feb;11(1):54-8.
[6] Marceau P; Hould FS; Simard S; Lebel S; Bourque RA; Potvin M;
Biron S, Biliopancreatic diversion with duodenal switch, World J
Surgery 1998 Sep;22(9):947-54.
[7] Marceau P; Hould FS; Potvin M; Lebel S; Biron S,
Biliopancreatic diversion (duodenal switch procedure), European J
Gastroenterology Hepatology 1999 Feb;11(2):99-103.
[8] Balsiger BM et all, Prospective evaluation of Roux-en-Y
gastric bypass as primary operation for medically complicated
obesity. Mayo Clinic proc. 2000 Jul; 75(7):669-72.
[9] Oh CH, Kim HJ, Oh S, Weight loss following transected gastric
bypass with proximal Roux-en-Y, Obesity Surgery 1997 Apr;7(2):142.
[10] Reinhold Rb, Late results of gastric bypass surgery for
morbid obesity, J Am College Nutrition 1994 Aug;13(4):326-31.
[11] Avinoah E et all, [Long-term weight changes after Roux-en-Y
gastric bypass for morbid obesity]. Harefuah 1993 Feb 15;
124(4):185-7,248.
[12] Brolin RE et all, Lipid Risk profile and weight stability
after gastric restrictive operations for morbid obesity, J
Gastrointestinal Surgery 2000 Sep-Oct;4(5):464-9.
[13] Mitchell JE, Lancaster KL, Burgard MA, Howell M, Krahn DD,
Crosby RD, Wonderlich SA, Gonsell BA, Long –term Follow up of
patients’ Status after Gastric Bypass, Obesity Surgery, August
2001,11(4) 464-468.
[14] Sanyal AJ, Sugerman HJ, Kellum JM, Engle KM, Wolfe L.,Stomal
complications of gastric bypass: incidence and outcome of therapy,
Am J Gastroenterology 1992 Sep;87(9):1165-9.
[15] Mallory GN, Macgregor AM, Rand CS, The Influence of Dumping
on Weight Loss After Gastric Restrictive Surgery for Morbid
Obesity. Obesity Surgery 1996 Dec;6(6):474-478.
[16] Avinoah E, Ovanat A, Charuzi I., Nutritional status seven
years after Roux-en-Y gastric bypass surgery. Surgery 1992 Feb;
111(2):137-42
[17] U.S. Food and Drug Administration, FDA Talk Paper T01-26,
June 5, 2001
[18] NIH, Working Group on Bariatric Surgery, Executive Summary,
May 8-9, 2002
[19] Doherty C, Maher JW, Heitshusen DS., “Long term data indicate
a progressive loss in efficacy of adjustable silicone gastric
banding for the surgical treatment of morbid obesity”, Surgery,
2002, Oct.;132(4):724-8
