The surgical method known as switch or duodenal switch is a surgical operation that combines both sleeve gastrectomy and gastric bypass characteristics.
The process is performed in two steps. First, a sleeve gastrectomy is performed in which approximately 80% of the stomach is removed and the rest is formed into a thin tube.
As a result, the stomach with a volume of 1.5-2 L takes the form of a thin and long tube with a volume of about 120 ml. This part of the surgery is an irreversible surgical procedure.
The small intestine (duodenum), which is normally attached to the stomach, is then separated to form a bypass and two separate pathways and a common canal are formed.
The consumed food is normally directed from the tube-shaped stomach after sleeve gastrectomy to the beginning of the small intestine, but is directed to the lower part of the small intestine and from there to the colon.
This sleeve is the short portion of the small intestine that is separated after gastrectomy.
The other path of the longer part of the small intestine is the part where bile and other digestive enzymes mix with food and lead to absorption, the length of which is reduced to 250 cm. As a result, because the stomach volume is too small, the patient gets a sense of satiety by eating less and because the nutrients are absorbed less as the pathways of the small intestine are reduced, the amount of calories left in the body becomes less.
This method, which is generally used in diabetic patients with a high body mass index, can be performed in a single operation, but it can be applied gradually. In the first stage, a different operation can be performed for bypass 6-18 months after sleeve gastrectomy.
With this method, patients can lose 70-100% of their excess weight.
What is Duedonal Switch?
At the exit of the stomach is a muscle system called pylorus. The pylor has the function of a valve which allows the food contained in the stomach to be controlled to pass into the duodenum, ie the duodenum.
The pyloric muscle also prevents ingestion of the digestive fluids from the bile duct and pancreatic duct opening into the duodenum.
In biliopancreatic diversion (BPD) surgery, pyloric muscle is taken along with the last part of the stomach.
Due to the absence of pyloric muscle, dumping syndrome is frequently seen and severe.
In addition, ulcer development in anastomosis is more common in the absence of pyloric muscle.
Duodenal Switch is another type of Biliopancreatic Diversion (BPD) operation where the stomach is reduced to protect the pyloric muscle and the small intestine is connected to the duodenum two cm. after the stomach and pylorus.
These two are called Biliopancreatic Diversion-Duodenal Switch (BPD / DS).
Why choose Duodenal Switch?
Statistically it is the most comprehensive weight loss method in surgical interventions.
Optimal method for diabetes, high blood pressure, high cholesterol and high triglyceride. The most effective solution for high-calorie-fed patients.
Does not cause indigestion because the “pyrolic valve in of the stomach is preserved This method reduces appetite and the feeling of hunger because of the removal of the stomach that produces GHRELIN (starvation hormone).
This method causes more loss of weight compared to clap or Gastric Bypass methods.
The Duodenal Switch procedure (also known as vertical gastrectomy, biliopancreatic deception, DS and BPS-DS) limits the amount of food consumed (vertical gastrectomy reduces the size of the stomach) and reduces the amount of calories entering the body. (duodenal valve) Duodenal Switch surgery causes more weight loss than it directly affects metabolism and is a more effective method for the treatment of diabetes, hypertension and high cholesterol diseases.
Since it is an application that reduces fat absorption, it is a specially developed method for patients who eat fatty foods.
How is Duodenal Switch Surgery performed?
The first stage of the surgery is to remove 85% of the stomach, such as sleeve gastrectomy or tube stomach surgery, and turn the stomach into a thin tube.
This section has the effect of restricting food intake. In the second stage, the intestine is separated by a few cm ahead of the annular muscle layer called the pylor, and a little behind the spill of the bile-pancreatic fluid.
Gastric outlet from the small intestine-large intestine junction with the small intestine at a distance of 250 cm backward mouth.
That is, the length of the bowel, where bile and other digestive enzymes are mixed with food and leads to absorption, is reduced to 250 cm.
This procedure reduces the absorption of calories and fats in foods by a rate that is higher than that of gastric bypass.
Surgical Methods Used in Duodenal Switch Surgery:
1) Robotic Surgery (Robot Assisted Minimally Invasive Surgery):
2) Open Surgery:
Open duodenal switch surgery is performed through a large incision in the abdomen of the patient.
The size of the incision prolongs postoperative recovery time.
The biggest advantage of open surgery is that the surgeon performs the operation by feeling the tissues.
3) Laparoscopic Surgery (Minimally Invasive Surgery):
As in the robotic duodenal switch surgery, the operation is performed through small incisions in the abdomen of the patient. The surgeon at the patient’s head performs the operation with long, flat laparoscopic instruments accompanied by a 2-D image provided by a camera called a laparoscope.