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Long Term Studies

January 14, 2012 6:26 am

To follow are the long term studies on the safety and efficacy of the Duodenal Switch procedure for the morbidly obese. Perioperative complications in a consecutive series of 1000 duodenal switches. Marceau et al. Nov 2011 PubMed Abstract BACKGROUND: In the past 10 years, most bariatric surgeries have seen an important reduction in the early complication rate, partly associated with the development of the laparoscopic approach. Our objective was to assess the current early complication rate associated with biliopancreatic diversion with duodenal switch (BPD-DS) since the introduction of a laparoscopic approach in our institution, a university-affiliated tertiary care center. METHODS: A consecutive series of 1000 patients who had undergone BPD-DS from November 2006 to January 2010 was surveyed. The primary endpoint was the mortality rate. The secondary endpoints were the major 30-day complication rate and hospital stay >10 days. The data are reported as a mean ± SD, comparing the laparoscopic (n = 228) and open (n = 772) groups. RESULTS: The mean age of the patients was 43 ± 10 years (40 ± 10 years in the laparoscopy group versus 44 ± 10 years in the open group, P < .01). The preoperative body mass index was 51 ± 8 kg/m(2) (47 ± 7 laparoscopy versus 52 ± 8 kg/m(2) open, P < .01). The conversion rate in the laparoscopy group was 2.6%. There was 1 postoperative death (.1%) from a pulmonary embolism in the laparoscopy group. The mean hospital stay was shorter after laparoscopic surgery (6 ± 6 d versus 7 ± 9 d, P = .01), and a hospital stay >10 days was more frequent in the open group (4.4% versus 7%, P = .04). Major complications occurred in 7% of the patients, with no significant differences between the 2 groups (7% versus 7.4%, P = .1). No differences were found in the overall leak or intra-abdominal abscess rate (3.5% versus 4%, P = .1); however, gastric leaks were more frequent after open surgery (0% versus 2%, P = .02). During a mean 2-year follow-up, 1 additional death occurred from myocardial infarction, 2 years after open BPD-DS. CONCLUSION: The early and late mortality rate of BPD-DS is low and comparable to that of other bariatric surgeries. Duodenal Switch: Long Term Results (15 Years) Marceau et al. Nov 2007 PubMed Abstract Full Article BACKGROUND: This report summarizes our 15-year experience with duodenal switch (DS) as a primary procedure on 1,423 patients from 1992 to 2005. METHODS: Within the last 2 years, follow-up of these patients, including clinical biochemistry evaluation by us or by their local physician is 97%. RESULTS: Survival rate was 92% after DS. The risk of death (Excess Hazard Ratio (EHR)) was 1.2, almost that of the general population. After a mean of 7.3 years (range 2-15), 92% of patients with an initial BMI < or = 50 kg/m2 obtained a BMI < 35 and 83% of those with an initial BMI > 50 obtained a BMI < 40. Diabetes was cured (i.e. medication was discontinued) in 92% and medication decreased in the others. The use of the CPAP apparatus was discontinued in 90%, medication for asthma was decreased in 88%, and the prevalence of a cardiac risk index > 5 was decreased by 86%. Patients’ satisfaction in regard to weight loss was graded 3.6 on a basis of 5, and 95% of patients were satisfied with the overall results. Operative mortality was 1% which is comparable with gastric bypass surgery. The need for revision for malnutrition was rare (0.7%) and total reversal was exceptional (0.2%). Failure to lose > 25% of initial excess weight was 1.3%. Revision for failure to lose sufficient weight was needed in only 1.5%. Severe anemia, deficiency in vitamins or bone damage were exceptional, easily treatable, preventable and no permanent damage was documented. CONCLUSION: In the long-term, DS was very efficient in terms of cure rate for morbid obesity and its comorbidities. In terms of risk/benefit, DS was very sucessful with an appropriate system of follow-up. The Biliopancreatic Diversion with the Duodenal Switch: Results Beyond 10 Years. Hess et al. Mar 2005 PubMed Abstract The BPD/DS, if properly performed, has the best long-term weight loss of any bariatric operation. It is easy to reverse or revise, has the least marginal ulcers, cures the highest percentage of co-morbidities, has the least failures, and permits normal although smaller meals. It is our opinion that the BPD/DS should be considered as the gold standard bariatric operation. The Duodenal Switch Operation for the Treatment of Morbid Obesity: A 10 Year Experience Anthone et al. Apr 2003 Full Article OBJECTIVE: To determine the safety and efficacy of the duodenal switch procedure as surgical treatment. BACKGROUND: The longitudinal gastrectomy and duodenal switch procedure as performed for morbid obesity involves a 75% subtotal greater curvature gastrectomy and long limb suprapapillary Roux-en-Y duodenoenterostomy. This results in a restricted caloric intake and diversion of bile and pancreatic secretions to induce fat malabsorption. Broad acceptance of this procedure has been impeded because of concerns that the malabsorptive component may produce serious nutritional complications. METHODS: Review of data collected prospectively from all patients who underwent duodenal switch as the primary surgical treatment for morbid obesity at a single institution during the ten year period beginning September 1992. Operative morbidity and mortality, weight loss, volume of food intake, and bowel function were recorded. Sequential measurements of serum albumin, hemoglobin, and calcium levels were obtained to assess metabolic function and nutrient absorption. RESULTS: Duodenal switch was performed as the primary operation in 701 (81%) of a total 863 patients undergoing bariatric surgery during the period of study. The average BMI was 52.8 (range 34-95). Perioperative mortality was 1.4% and morbidity (including leaks, wound dehiscence, splenectomy, and postoperative hemorrhage) occurred in 21 patients (2.9%). Weight loss averaged 127 pounds at one year, 131 at three years and 118at five or more years (% EBWL of 69%, 73%, and 66%, respectively). The mean number of bowel movements was less than three per day. Patients reported and maintained a mean restriction of 63% of their preoperative intake (approximately 1600 calories), with no specific food intolerance, at 3 or more years follow-up. At three years, serum albumin remained at normal levels in 98% of patients, hemoglobin in 52%, and calcium in 71%. No patients reported dumping and marginal ulcers were not seen. CONCLUSION: The longitudinal gastrectomy with duodenal switch is a safe and effective primary procedure for the treatment of morbid obesity. It has the advantage of allowing acceptable alimentation with a minimum of side effects while producing and maintaining significant weight loss. These results are achieved without developing significant dietary restrictions or clinical metabolic or nutritional complications.

Duodenal Switch in Canada

January 08, 2012 1:27 pm

Duodenal Switch in Canada currently includes information for Ontario residents. Information for other provinces and territories on qualifying and having the Duodenal Switch weight loss surgery procedure will be added when available. If you would like to help us complete this section on Duodenal Switch in Canadaand can provide information on having surgery in your province or territory please use the Contact Us button on the left.

Provincial Links

Ontario Information and guidelines on applying for Duodenal Switch surgery through OHIP to be performed out of country.

Duodenal Switch Related Products in Canada

Duodenal Switch Related Products in Canada Duodenal Switch patients have unique vitamin supplement requirements and you will have to make sure you are getting the right products to meet your needs. We have compiled a list of Canadian online stores that carry DS friendly products to help reduce your shipping costs from the US.

Duodenal Switch Related Products in Canada

January 08, 2012 12:27 pm

Having trouble finding Duodenal Switch related products in Canada? We need dry vitamins to stay healthy but they can be hard to find here. Below are some online stores we have discovered where you can purchase the items DSers want or need.

Dry Vitamins

We need Dry versions of the fat soluble vitamins A, D, E & K. Not all surgeons request you take E or K unless your blood work indicates you are developing a deficiency. So be sure to talk to your surgeon and follow his/her vitamin requirements. For more information on Dry vitamins see our section on Vitamin and Mineral Supplement Basics. If you are vitamin D deficient your surgeon may write you a prescription for 50,000 i.u. or more daily. You will need to talk to the pharmacist as often these prescription vitamin D pills are packed in oil and we will only absorb 20%. We NEED dry D to effectively absorb it. You can purchase the 50,000 i.u. of dry D from Vitalady. This is an American source so there will be higher shipping charges.

Protein Powder

You can request protein powder samples from Fortius Pharmedica. Send them an email and let them know you are a bariatric patient and would like to try some samples of their products. To purchase these products you can order from iWinDirect.

Low Carb or Sugar Free Food

Low Carb Grocery carries Dreamfields Pasta

When is revision of adjustable gastric banding (AGB) to another adjustable gastric banding (Lap-Band® Realize®) indicated?

January 07, 2012 9:19 pm

Band to band revision is never a good idea, in my opinion. Please let me explain. There are many reasons why an adjustable gastric banding (AGB) revision may be needed, which include but not limited to complications of the surgery, inadequate weight loss or both. These complications are a lot more common than publicized. (i)

Over time the incidence of band failure, as defined to EBWL (Excess body weight loss) <25% or band removal increases from 13.2% at 18 months (the best mark) to 36.9% at 7 years(ii).The source that this date comes from has lowered the EBWL to 25% and although it’s been lowered, the success rate is still not impressive.

If the patient has had complications such as slippage, erosion, ulceration or perforation and the adjustable gastric banding needs to be removed, the procedure should then be revised to an alternative such as a Sleeve Gastrectomy or the Duodenal Switch operation. Revising to either of the two procedures, in my opinion, serve as better alternatives than to revise to a Gastric Bypass.

If the patient has developed physiologic and functional complication of the adjustable gastric banding, such as reflux, difficulty with swallowing or esophageal dysfunction, then removing and replacing the band will not solve the underlying problem. I would argue that the band itself would likely be the cause of the complication(s).

If the patient has an infection of the injection port side, then the port will needs to be removed and replaced in a subsequent operation.

The only time that I can possibly think that a revision of a band to band is an option is if the band was one an earlier model placed many years ago. You may question why this would be important. The value behind this is that it will not only determine what type of band was used for placement but also were it has been placed.

So the only question of importance would be: when was the adjustable gastric banding placed? This question is only significant if the AGB was placed at a time prior to the recommendation of a “pars flaccida” dissection. The first technique recommended for adjustable gastric banding placement was the “perigastric” technique. This meant that the band was placed sitting right on the stomach. In order to perform this, all the tissue around the stomach specifically on the medial aspect was dissected and the band was wrapped around the tissue of the stomach itself. This provided a tighter grip of the stomach. However, it became evident that this also resulted also in a high erosion rate because there was no tissue protecting the stomach from the foreign body wrapped around it. A second problem with this technique was that the top part of the stomach, again on the medial aspect, had a near straight extension line to the distal esophagus and thus resulted in a higher slippage rate. Additionally, the design of the band itself evolved during the same time frame, as the techniques were refined. So, if a patient has complications that a surgeon can directly contribute to the older “model” or the early technique of the placements of the AGB, one can argue revising and AGB to AGB.

I would like to raise the following question that all patients need to ask themselves; If some of the overwhelming reasons for choosing the AGB was its perceived “least invasive” nature, and the “low complication rate” as it is advertised so much, then wouldn’t the need for a revision itself prove both of those fact to be incorrect. The data demonstrates that the complications of the AGB are much more prevalent than initially thought, or reported.

It is my opinion that the AGB should not be the default procedure of choice and that there should be very good indications as to why a patient cannot have any of the other procedures.

(i) Long-Term Results of a Prospective Study of Laparoscopic Adjustable Gastric Banding for Morbid Obesity – Y. Nieuwenhove et.al. Obesity Surgery-21 (5), 2011, 582-587

(ii)A 10-year Experience with Laparoscopic Gastric Banding for Morbid Obesity: High Long-Term Complication and Failure Rates – M. Suter et.al. Obesity Surgery, 16, 2006, 829-835

Sleeve Gastrectomy post operative diet

January 03, 2012 11:15 pm

A relatively common question asked post operatively regards the pace at which the post operative diet should be advanced. In our practice, patients are given a simple list describing 3 broad categories. They are outlined in the work book.
Each patient should advance his or her diet over a 1-4 weeks in the post operative timeframe. The most important point to remember is that each one of us responds differently to the food at a certain point following surgery. The safest method to advance the diet would be to pay attention to what your body is telling you. If a patient is tolerating Bariatric 1 and Bariatric 2 diet, then they should be able to advance to a soft diet in one or two weeks. Alternatively, if the patient is having difficulty getting their required water on a daily basis, then advancing to a soft diet may be an incorrect move at that point.The basic order of food is water, protein, and everything else.

References

January 03, 2012 1:31 pm

To follow is a list of clinical data references for www.dssurgery.com.

[1] Hess DS, Hess DW, Oakley RS. The Biliopancreatic Diversion with the Duodenal Switch: Results Beyond 10 Years, Obesity Surgery 2005 Mar;15(3):408-16. PubMed abstract

[2] Marceau P, Biron S, Hould FS, Lebel S, Marceau S, Lescelleur O, Biertho L, Simard S. Duodenal Switch: Long-Term Results, Obesity Surgery 2007 Nov;17(11):1421-30. PubMed abstract

[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. PubMed abstract

[4] Hess DS, Hess DW. Biliopancreatic diversion with a duodenal switch, Obesity Surgery 1998 Jun;8(3):267-82. PubMed abstract

[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. PubMed abstract

[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. PubMed abstract

[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. PubMed abstract

[8] MacLean LD, Rhode BM, Nohr CW. Late outcome of isolated gastric bypass, Ann Surg., 2000 Apr;231(4):524-8. PubMed abstract

[9] Anthone G. The duodenal switch operation for morbid obesity, Surg Clin North Am. 2005 Aug;85(4):819-33. PubMed abstract

[10] Balsiger BM, Kennedy FP, Abu-Lebdeh HS, Collazo-Clavell M, Jensen MD, O’Brien T, Hensrud DD, Dinneen SF, Thompson GB, Que FG, Williams DE, Clark MM, Grant JE, Frick MS, Mueller RA, Mai JL, Sarr MG. Prospective evaluation of Roux-en-Y gastric bypass as primary operation for medically complicated obesity. Mayo Clinic proc. 2000 Jul;75(7):669-72. PubMed abstract

[11] Oh CH, Kim HJ, Oh S. Weight loss following transected gastric bypass with proximal Roux-en-Y, Obesity Surgery 1997 Apr;7(2):142. PubMed abstract

[12] Reinhold RB. Late results of gastric bypass surgery for morbid obesity, J Am College Nutrition 1994 Aug;13(4):326-31. PubMed abstract

[13] Avinoah E, Ben-Yehuda A, Ovnat A, Pilpel D, Charuzi I. Long-term weight changes after Roux-en-Y gastric bypass for morbid obesity, Harefuah 1993 Feb 15;124(4):185-7,248. PubMed abstract

[14] ” Gastric Reduction Duodenal Switch (GRDS) (LGRDS -DS) “. Retrieved on 2008-08-31.

[15]

[16] Palomar R, Fernandez-Fresnedo G, Dominguez-Diez A, López-Deogracias M, Olmedo F, Martón de Francisco AL, Sanz de Castro S, Casado Martón F, Gómez-Fleitas M, Arias M, Fernández-Escalante C. Effects of weight loss after biliopancreatic diversion on metabolism and cardiovascular profile, Obes Surg. 2005 Jun-Jul;15(6):794-8. PubMed abstract

[17] Nelson WK, Houghton SG, Milliner DS, Lieske JC, Sarr MG. Enteric hyperoxaluria, nephrolithiasis, and oxalate nephropathy: potentially serious and unappreciated complications of Roux-en-Y gastric bypass, Surg Obes Relat Dis. 2005 Sep-Oct;1(5):481-5. PubMed abstract

[18] Nelson WK, Fatima J, Houghton SG, Thompson GB, Kendrick ML, Mai JL, Kennel KA, Sarr MG. The malabsorptive very, very long limb Roux-en-Y gastric bypass for super obesity: results in 257 patients, Surgery. 2006 Oct;140(4):517-23. PubMed abstract

[19] Wasserberg N, Hamoui N, Petrone P, Crookes PF, Kaufman HS. Bowel Habits after Gastric Bypass Versus the Duodenal Switch Operation, Obes Surg. 2008 Aug 28. [Epub ahead of print] PubMed abstract

[20] ” What You need to Know About Biliopancreatic Diversion (BPD/DS) ” Retrieved on 2008-08-31.

[21] Hamoui N, Anthone GJ, Kaufman HS, Crookes PF. Maintenance of weight loss in patients with body mass index >60 kg/m2: importance of length of small bowel bypassed, Surg Obes Relat Dis. 2008 May-Jun;4(3):404-7. PubMed abstract

[22] McConnell DB, O’Rourke RW, Deveney CW. Common channel length predicts outcomes of biliopancreatic diversion alone and with the duodenal switch surgery, Am J Surg. 2005 May;189(5):536-40. PubMed abstract

[23] Chapman AE, Kiroff G, Game P, Foster B, O’Brien P, Ham J, Maddern GJ. Laparoscopic adjustable gastric banding in the treatment of obesity–a systematic literature review. Surgery. 2004;135:326-351. PubMed abstract

[24] Schauer PR, Ikramuddin S. Laparoscopic surgery for morbid obesity. Surg Clin North Am. 2001;81:1145-1179. PubMed abstract

[25] Dávila-Cervantes A, Borunda D, Domónguez-Cherit G, Gamino R, Vargas-Vorackova F, González-Barranco J, Herrera MF. Open versus laparoscopic vertical banded gastroplasty:a randomized controlled double blind trial. Obes Surg. 2002;12:812-818. PubMed abstract

[26] Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000;232:515-529. PubMed abstract

[27] Fried M, Peskova M. Gastric banding: advantages and complications; a 5-year and 10-year follow-up. Obes Surg. 1995;5:372-374. PubMed abstract

[28] Fried M, Peskova M. Gastric banding in the treatment of morbid obesity. Hepatogastroenterology. 1997;44:582-587. PubMed abstract

[29] Gorecki P, Wise L, Brolin RE. Champion JK. Complications of combined gastric restrictive and malabsorptive procedures: part 1. Curr Surg. 2003;60:138-144. PubMed abstract

[30] Higa KD, Ho T, Boone KB. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg. 2003;13:350-354. PubMed abstract

[31] Higa KD, Boone KB, Ho T. Complications of the laparoscopic Roux-en Y gastric bypass: 1,040 patients–what have we learned? Obes Surg. 2000;10:509-513. PubMed abstract

[32] Puzziferri N, Austrheim-Smith IT, Wolfe BM, Wilson SE, Nguyen NT. Three-year follow-up of a prospective randomized trial comparing laparoscopic versus open gastric bypass. Ann Surg. 2006;243:181-188. PubMed abstract

[33] Nguyen NT, Silver M, Robinson M, Needleman B, Hartley G, Cooney R, Catalano R, Dostal J, Sama D, Blankenship J, Burg K, Stemmer E, Wilson SE. Result of a national audit of bariatric surgery performed at academic centers: a 2004 University Health System Consortium Benchmarking Project. Arch Surg. 2006;141:445-449. PubMed abstract

[34] Nguyen NT, Goldman C, Rosenquist CJ, Arango A, Cole CJ, Lee SJ, Wolfe BM, Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs [with discussion]. Ann Surg. 2001;234:279-291. PubMed abstract

[35] Kim WW, Gagner M, Kini S, Inabnet WB, Quinn T, Herron D, Pomp A. Laparoscopic vs. open biliopancreatic diversion with duodenal switch: a comparative study, J Gastrointest Surg. 2003 May-Jun;7(4):552-7. PubMed abstract

[36] Martínez Castro R, Baltasar A, Vidal V, Sánchez Cuenca J, Lledó JL. [Gastric emptying in patients with morbid obesity treated with a duodenal switch] [Article in Spanish] Rev Esp Enferm Dig. 1997 May;89(5):413-4. PubMed abstract

[37] ” Soy “. Retrieved on 2008-09-17.

[38] Position of the American Dietetic Association and Dietitians of Canada: Vegetarian diets. JADA, 2003; 103(6) 748-765. PubMed Abstract

[39] Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids (macronutrients). (2005) Food and Nutrition Board (FNB), National Academies Press. This publication can be accessed from The National Academies Press.

[41] ” Dietary Guidelines for Duodenal Switch Patients “. Retrieved on 2008-09-17.

[42] ” Discharge Instructions for Duodenal Switch Surgery Patients “. Retrieved on 2008-09-17.

[43] ” Nutrition Guidelines Duodenal Switch Surgery “. Retrieved on 2008-09-17.

[44] Cranney C, Horsely T, O’Donnell S, Weiler H, Ooi D, Atkinson S, et al. Effectiveness and safety of vitamin D. Evidence Report/Technology Assessment No. 158 prepared by the University of Ottawa Evidence-based Practice Center under Contract No. 290-02.0021. AHRQ Publication No. 07-E013. Rockville, MD: Agency for Healthcare Research and Quality, 2007. PubMed abstract

[45] Armas LAG, Hollis BW, Heaney RP. Vitamin D2 is much less effective than vitamin D3 in humans. J Clin Endocrinol Metab 2004;89:5387-91. PubMed abstract

[46] Houghton LA, Vieth R. The case against ergocalciferol (vitamin D2) as a vitamin supplement. Am J Clin Nutr. 2006;84:694-7. PubMed abstract

[47] Heaney RP, Saville PD, Recker RR. Calcium absorption as a function of calcium intake. J Lab Clin Med. 1975;85:881-90. PubMed abstract

[48] Heaney RP, Recker RR, Hinders SM. Variability of calcium absorption. Am J Clin Nutr. 1988;47:262-64. PubMed abstract

[49] Barrett-Connor E, Chang JC, Edelstein SL. Coffee-associated osteoporosis offset by daily milk consumption. JAMA. 1994;271:280-83. PubMed abstract

[50] Massey LK, Whiting SJ. Caffeine, urinary calcium, calcium metabolism, and bone. J Nutr. 1993;123:1611-14. PubMed abstract

[51] ” AACE/TOS/ASMBS Guidelines For Clinical Practice for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient “. Retrieved on 2008-12-06.

[52] Goode LR, Brolin RE, Chowdhury HA, Shapses SA. Bone and gastric bypass surgery: effects of dietary calcium and vitamin D. Obes Res. 2004;12:40-47. PubMed abstract

[53] Miller AD, Smith KM. Medication and nutrient administration considerations after bariatric surgery. Am J HealthSyst Pharm. 2006;63:1852-1857. PubMed abstract

[54] Levenson DI, Bockman RS. A review of calcium preparations [published correction appears in Nutr Rev. 1994;52:364]. Nutr Rev. 1994;52:221-232. PubMed abstract

[55] Slater GH, Ren CJ, Siegel N, Williams T, Barr D, Wolfe B, Dolan K, Fielding GA. Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg. 2004;8:48-55. PubMed abstract

[56] Shiffman ML, Sugerman HJ, Kellum JH, Brewer WH, Moore EW. Gallstones in patients with morbid obesity: relationship to body weight, weight loss and gallbladder bile cholesterol solubility. Int J Obes Relat Metab Disord. 1993;17:153-158. PubMed abstract

[57] Sugerman HJ, Brewer WH, Shiffman ML, et al. A multicenter, placebo-controlled, randomized, doubleblind, prospective trial of prophylactic ursodiol for the prevention of gallstone formation following gastric bypass-induced rapid weight loss [with discussion]. Am J Surg. 1995;169:91-97. PubMed abstract

[58] Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta-analysis, JAMA. 2004 Oct 13;292(14):1724-37. PubMed abstract

[59] ” Roux en Y Gastric Bypass (RNY) is a restrictive and malabsorptive procedure. “. Retrieved on 2008-10-25.

[60] Sugerman HJ, Starkey JV, Birkenhauer R. A randomized prospective trial of gastric bypass versus vertical banded gastroplasty for morbid obesity and their effects on sweets versus non-sweets eaters. Ann Surg. 1987;205: 613-624. PubMed Abstract

[61] Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339-350. PubMed abstract

[62] Hsu LK, Mulliken B, McDonagh B, et al. Binge eating disorder in extreme obesity. Int J Obes Relat Metab Disord. 2002;26:1398-1403. PubMed abstract

[63] Monteforte MJ, Turkelson CM. Bariatric surgery for morbid obesity. Obes Surg. 2000;10:391-401. PubMed abstract

[64] Mallory GN, MacGregor AM, Rand CS. The influence of dumping on weight loss after gastric restrictive surgery for morbid obesity. Obes Surg. 1996;6:474-478. PubMed abstract

[65] ” Bariatric Nutrition: Suggestions for the Surgical Weight Loss Patient “. Retrieved on 2008-12-06.

[66] ” Nutrition Perspective: Comparison of Nutritional Therapy for Roux-en-Y Gastric Bypass and Biliopancreatic Diversion with Duodenal Switch “. Retrieved on 2008-12-06.

[67] ” Zinc “. Retrieved on 2008-12-06.

[68] Gagner M, Rogula T, Strain G, Emerson R, Biertho L, Pomp A. Decreased lipid malabsorption in both gastric bypass and biliopancreatic diversion with duodenal switch. Surgery for Obesity and Related Diseases. 2005;1(3):240-241. PII: S1550-7289(05)00173-5

[69] Rabkin RA. The duodenal switch as an increasing and highly effective operation for morbid obesity. Obes Surg. 2004 Jun-Jul;14(6):861-5. PubMed abstract

[70] Prachand VN, Davee RT, Alverdy JC. Duodenal switch provides superior weight loss in the super-obese (BMI > or =50 kg/m2) compared with gastric bypass. Ann Surg. 2006 Oct;244(4):611-9. PubMed abstract

[71] Georgeann N. Mallory, RD; Alex M.C. Macgregor, MD, FACS; Colleen S.W. Rand, PhD*. The Influence of Dumping on Weight Loss After Gastric Restrictive Surgery for Morbid Obesity. Obes Surg. 1996 Dec;6(6)474-478 PubMed abstract

[72] Sánchez-Pernaute A, Rodríguez R, Rubio MA, Pérez-Aguirre E, Crespo SC, Valderrama OC, Talavera P, Méndez R, Díez-Valladares L, Torres A. Gastric tube volume after duodenal switch and its correlation to short-term weight loss.
Obes Surg. 2007 Sep;17(9):1178-82. PubMed abstract

[73] Symons, T. Brock, Melinda Sheffield-Moore, Robert R. Wolfe, and Douglas Paddon-Jones. Moderating the portion size of a protein-rich meal improves anabolic efficiency in young and elderly. 2009 Sep; 109(9): 1582-1586.

Duodenal Switch Support

January 03, 2012 12:32 pm

Below you will find links to the best places to go for additional Duodenal Switch support. You are strongly encouraged to do as much research as you can on this superior weight loss surgery. At these web sites you can connect with other people who are researching Duodenal Switch surgery, are waiting to have their surgery or you can ask questions of those who have already had the procedure done. Forums

https://bariatricfacts.org/forums/
https://www.dssurgery.com/
Various private and open Facebook groups such as the Duodenal Switch Patients group: https://www.facebook.com/groups/114884365199737/
https://www.weightlosssurgery.proboards.com/
https://www.bariatricpal.com/forum/1018-duodenal-switch-surgery-forum-new/
www.obesityhelp.com/forums/DS

Message Groups

Yahoo Duodenal Switch Group

Weight Loss Surgery Support Groups Please check with your local surgeons and bariatric practices to find support groups you can attend in real life.

Bowel Function After Duodenal Switch

January 03, 2012 11:34 am

The main questions pre-op patients usually have about Duodenal Switch (D.S.) revolve around bowel function. These are the questions our expert surgeons will address: Do DS patients have chronic diarrhea? NO Do DS patients spend all day on the toilet? NO Do DS patients have control over their bowels? YES Do DS patients have to wear diapers for the rest of their lives!? NO These are probably the most outrageous pieces of misinformation that is being promoted by those who do not offer D.S. as an alternative to their patients, and patients who wish to justify their reasons for choosing alternative procedures. There will always be patients on either end of the spectrum; some will have a lot more bowel movements than the average post-op patient and some will have far fewer or be constipated. These extreme issues are very rare and are dealt with by the surgeon or other medical specialists. Almost all cases lose frequent bowel function that can be traced back to a patients’ dietary intake. One of the most common contributing factors is excessive fat intake. There is the misconception that since D.S. limits fat absorption, then excessive amounts of fat can be tolerated and some also suggest that it is needed. Both of these may be incorrect; not only does this contribute to excessive loose bowel movements, but it also contributes to the associated loss of nutrients and minerals, such as potassium, vitamin D and serious hydration issues. This is just not the case for the majority of patients. Most D.S. post-op patients have 2-3 bowel movements per day. What the experts say… Baltasar et al., “Gastric emptying in patients with morbid obesity treated with a duodenal switch”, May 1997. [36]

81.3% of Duodenal Switch patients experience normal gastric emptying.

Gary Anthone, MD, “The duodenal switch operation for morbid obesity”, Aug 2005. [9]

The average number of bowel movements per day for 43 pre-op patients was 1.9, 421 patients six months post-op was 2.7, 316 patients twelve months post-op was 2.6 and 113 patients > thirty six months post-op was 2.8.

Wasserberg et al., “Bowel habits after gastric bypass versus the duodenal switch operation.”, Dec 2008. [19]

Although duodenal switch is associated with more bowel episodes than other weight loss procedures, 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.

Marceau et al., “Duodenal Switch: Long-Term Results”, Nov 2007, p 1428. [2]

There are negative side effects with DS that is worth mentioning. The unpleasant odor of stool and is always exacerbated by patients’ dietary choices. Artificial sweeteners, carbonated drinks, carbohydrate intake (simple and complex) can all cause or worsen the flatulence after the DS.

How do different medication that treat constipation work?

December 26, 2011 9:27 pm

Constipation is a prevalent problem in the adult U.S. population. This is not, however, an issue for most duodenal switch patients. Constipation is defined as having less than three bowel movements per week, and is considered severe if there is less than one bowel movement per week. The benchmark for normal bowel function is considered to be one bowel movement a day. Most of the time, the cause of constipation is considered idiopathic (no underlying origin identified). In these cases, the treatment is symptomatic.

The treatment options for constipation are outlined in the table below:

Treatment option	Pros	Cons
Lubricants (Mineral Oil)	Facilitated bowel movements Promotes soft bulk	Limits fat soluble vitamin absorption Interaction with Birth control pill and Coumadin
Emollients (Colace, Docusate)	Penetrates stool Effective for painful anal fissure	May cause increased gas and bloating
Hyperosmolar Laxatives (Miralax)	Promotes water retention in stool	May cause increased gas and bloating
Saline Laxatives (Fleet, MOM, Mag. Citrate)	Rapid acting	May cause electrolyte imbalances
Stimulants (Dulcolax, Senekot, Ex-Lax)	Increased water in stool	Prolonged use can cause dependence of the GI track
Herbs (Green Tea)	Natural in origin	Prolonged use can cause dependence
Bulking agents	Absorbs water, softens, and bulks the stool	May cause increased gas and bloating

Increased rates of Alcoholism is seen in Gastric bypass patients

December 26, 2011 9:26 pm

This study comes from Dr. Östlund at the Department of Molecular Medicine and Surgery of the Stockholm. He studied over 12,000 patients that had either a Gastric bypass or gastric restrictive procedure, and looked at their follow up data for an average of 8.9 years. There were more than 122,000 data points matched for a number of variables, including age, gender, and type of procedure. “…Patients undergoing gastric bypass were 2.3 times more likely than those receiving banding procedures to get inpatient treatment for alcohol related diagnosis.” The significance of this study, as pointed out by the authors, is that the data is very reliable because the majority of patients could be followed up over a very long period of time.