Duodenal Switch

The Biliopancreatic Diversion with Duodenal Switch is also called Vertical Gastrectomy with Duodenal Switch, the Scopinaro procedure, the Duodenal Switch procedure, the DS or BPD-DS. This procedure was developed by Professor Nicola Scopinaro in Italy and has been performed since 1979. It generates weight loss by combining of restrictive and malabsorptive techniques. Restrictive component of the operation allows an individual to eat small portion meals to achieve feeling of being full. The malabsorptive component of the operation limits the amount of food, specifically fat, that is absorbed into the body. The Duodenal Switch procedure is controversial because it creates a great deal of malabsorption, which augments and maintains long-term weight loss. Of the procedures that are currently performed for the treatment of obesity, the Duodenal Switch procedure seems to be the most powerful and effective, but is also associated with most side effects.

In the Duodenal Switch(DS) operation, the surgeon removes approximately 85 percent of the stomach so the remaining stomach takes the shape of a tube or "sleeve". The part of the stomach that is most susceptible to stretching and relaxing is removed reducing stomach's volume. The stomach that remains measures from 4-7 ounces (120-250 cc). The nerves to the stomach and to its outlet valve, pylorus, are kept intact to preserve the functions of the stomach. With DS operation normal gastro-duodenal emptying is maintained; latter avoids or decreases complications of dumping syndrome, gastritis and "marginal ulcers" since the stomach is not connected directly to the small intestine. To create malabsorption, the intestines are divided and rearranged to separate food from the digestive juices. The food limb is attached to the duodenum and receives food from the stomach. This limb is 150 cm long. The digestive juices are now separated from the food and travel through the bypassed small intestine. Both food and digestive juices mix together and travel together for about 100 cm in the common limb. Thus, food and digestive juices are separated for most of the length of the intestines. In the BPD-DS patients, the digestion and obsorption can only take place with in this 100 cm of common channel. Latter prevents patients who have undergone this surgery from absorbing all of the calories that are eaten, specially fats. By comparison, the Roux-en-Y gastric bypass has more restriction and less malabsorption then the Duodenal Switch procedure.

Advantages of the Biliopancreatic Diversion with Duodenal Switch operation:

• This operation results in a high degree of patient satisfaction because patients are able to eat larger meals than with a purely restrictive or standard Roux-en-Y gastric bypass procedure.
• The BPD-DS procedure can produce the greatest excess weight loss because it provides the highest levels of malabsorption.
• In one study of 125 patients, excess weight loss of 74% at one year, 78% at two years, 81% at three years, 84% at four years, and 91% at five years was achieved.
• Long-term maintenance of excess body weight loss can be successful if the patient adapts and adheres to a straightforward dietary, supplement, exercise and behavioral regimen.

The Biliopancreatic Diversion with Duodenal Switch operation requires close lifelong monitoring for protein malnutrition, anemia and bone disease. As with all weight loss operations, lifelong vitamin supplementing is required. It has been generally observed that if eating and vitamin supplement instructions are not rigorously followed, at least 25% of patients will develop problems that require treatment. The DS operation, is a well documented operation that is reserved for individual who is able to appreciate and comply with the absolute necessity of following instructed dietary guidelines, taking daily vitamin supplements and life long post operative care.