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Bowel Length in Duodenal Switch

Posted On : November 09, 2015

Malnutrition is one of the most feared complication of the duodenal switch operation. It may present years after surgery. What is common is a mix of nutritional deficiencies which include fat soluble vitamins, and protein calorie malnutrition. These all point to possible excessive shortening of the common channel. In my practice we have seen patients that have had lengthening of their common channel to improve their metabolic picture. What is very obvious to us, is that we see disproportionately higher number of cases coming to us for revision from practices where the common and alimentary lengths are done as a “standard” numbers with no specific adjustments made for the patient, their anatomy and situation. I have said for years, that the length of the bowel that is measured to be become the common and the alimentary limb should be a percentage of the total length of small bowel, rather than a pre-determined measurement. Here is a visual description of how this works.

If a common channel and the alimentary limb is measured to be a percent of the total length then the chance of protein calorie malnutrition is minimized since this will take into account the bowels absorptive capacity which is being reduced. This decrease in the absorption is done as a fraction of the total length.

Raines et al. published  a study in 2014, that showed how small bowel length is related more closely to a patient’s height and not weight.  And yet, some surgeons totally based the length of the common channel and the alimentary limb arbitrarily based on the patient pre operative BMI and nothing else. Could this be the cause of why I see some patients coming to us for revision of their duodenal switch for malnutrition?

2 responses to “Bowel Length in Duodenal Switch”

  1. I had the DS in 2003 with a 75cm CC. Never had any deficiencies or problems. Never had great weight loss either. I still diet constantly to stay just moderately fat. From what I’ve seen over time, the CC is a best guess scenario.

    The shortest one I know of, 40cm, a female in Australia. She did meet her goal and has no problems. The longest, 250cm in the US, also met her goal.

    • Hello, There are two points to be made. One is the subjective term of the “goal weight” and the second one is what is being discussed in this blog the bowel lengths. We should all take note that the two examples that you have given, CC of 40 and 250 , do not represent the same bowel. I would suspect that the patient that has 40cm common channel is a shorter person with more absorption per unit of length of bowel, vs the patient that has 250 cm common channel. The length of bowel between patients can not be compared as an absolute value. The better measure of comparison would be to know what the total length of the bowel was in those two patients, and then calculate their % common channel (measured common channel/total length)
      Thank you

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