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Month: March 2011

“Gas problem”

March 25, 2011 3:15 am

Following the Duodenal Switch operation, patients will have more frequent flatulence. The problem can get worse with specific dietary choices. A very simple way of looking at this would be that, in general, Carbohydrates contribute to gas and the fat contributes to causing loose bowel movements. There is a significant overlap and one has to remember that they often accompany each other.
In the majority of cases, when a patient is having a significant “gas problem,” a close investigation of the diet usually identifies the condition. The most frequent culprit is carbohydrates (breads, pasta, etc.). Special attention should also be given to Gluten in other food products. Carbonation should also be avoided. Other less obvious contributing factors may include artificial sweeteners (Splenda). Milk-Lactose can also cause significant gas. If the dietary sources of the “gas problem” have been eliminated, probiotics should then be considered. There is very little published scientific data on this subject that I am aware of. Wasserberg et.al, from The University of Southern California in 2008, published “Bowel Habits after Gastric Bypass Versus the Duodenal Switch Operation”. They concluded: “…Although duodenal switch is associated with more bowel episodes than gastric bypass, the difference is not statistically significant. Bowel habits are similar in patients who achieve 50% estimated body weight loss with duodenal switch surgery or gastric bypass.”
Ara Keshishian, MD, FACS, FASMBS

“Common bile duct is dilated”

March 10, 2011 8:16 am

 
Common Bile duct is part of the “plumbing” that drains the secretion of the liver (bile) into small bowel (duodenum).  The size of the common bile duct, if dilated, may suggest a blockage downstream. This is a specific finding that is looked for when a patient gets an ultrasound for a suspected liver or Gallbladder disease. When a patient has their gallbladder removed, the common bile duct dilates over some time. Dilated common bile after a cholecystectomy is of no significance by itself and should only be considered important if there are other findings, such as pancreatitis or elevated liver function tests. It is, however, important to remember that for any patient who has had the Duodenal switch operation, or the Gastric bypass procedure, the altered anatomy precludes the option of ERCP as a diagnostic or Therapeutic study.
Ara, Keshishian, MD, FACS, FASMBS