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Duodenal Switch
Introduction
This procedure modestly restricts
food intake while radically limiting the absorption
of calories, especially the obesity causing calories
from fat, complex carbohydrates, and starches. Approximately
3/4 of the stomach is removed, but the natural outlet
of the stomach, the pylorus, is left in, allowing
the stomach pouch to function more naturally. As the
stomach pouch stretches out in the first year after
surgery, patients are moderately limited in the amount
of food they can eat, reduced to about 2/3 of what
they could eat before surgery. However, patients are
not limited in the types of food they are able to
eat, tolerating meats and whole vegetables without
difficulty.
The food is rerouted through a radically altered
intestine, limiting the amount of food that is absorbed,
which is what results in weight loss, despite the
patient eating freely. The intestine is essentially
reduced to less than half of its length and the digestive
juices (the biliopancreatic secretions) mix with the
food at only the last 10% of the intestine. This arrangement
means that not only are the total amount of calories
eaten not absorbed, but especially fats, complex carbohydrates,
and starches - the things that contribute to obesity.
Patients undergoing duodenal switch
eat normally and have bowel habit changes characterized
by frequent (2-4 per day) soft stools and a propensity
for gas. Both of which are generally malodorous unless
a stool deodorant (such as Devrom) is taken.
A The stomach is trimmed to a 4-6
ounce volume, preserving its natural inlet and outlet
( the pylorus). Trimming the stomach results in a
temporary restrictive effect on eating for several
months, which then reverts to normal, and decreases
the incidence of ulcer formation as well.
B The small intestine that the stomach normally empties into (the duodenum) is "switched" to the downstream portion of the small intestine (the digestive limb-D). The outflow from the duodenum, carrying the digestive juices and enzymes (but no food) becomes the bilio-pancreatic limb (C) utilizing approximately 60% of the small intestines length.
D The digestive limb takes up approximately 40% of the small bowel length, and most of this length is upstream from where the biliopancreatic limb deposits its juices to allow for the absorption of fats, starches, and complex carbohydrates.
E The common limb, being the portion of intestine where both food and biliopancreatic outflow meet, is made up of the most downstream 100 cm of small intestine and is the only portion where absorption of dietary starches, fats, and complex carbohydrates occurs. The capacity for absorption reaches a maximum within several months after surgery and cannot be over eaten, resulting in long term sustained weight loss..
F The gallbladder and appendix are
removed.
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