Category: Duodenal Switch
Nearly 16 years Post DS
January 29, 2015 3:24 am
2015 Back on Track or A New Start after Weight Loss SurgeryExclusive Member Content
January 08, 2015 8:37 pm
Hernia Repair And Weight loss surgery
December 22, 2014 3:35 pm
Patients having weight loss surgery (WLS) either primary or revision are sometimes also diagnosed with having a hernia. Whether a hernia can be repaired concurrently with WLS or not, depends on the type of the hernia and also type of weight loss surgery.
The 2 most common hernias encountered in weight loss surgical patient’s are 1.Ventral (incisional), or 2. Hiatal hernias. Ventral hernia refers to defects or weaknesses of the abdominal wall. If this involves a previous midline incision then an incisional hernia is diagnosed. These hernias may present with any or all of the following findings; protrusions or bulging of the anterior abdominal wall tissue through the abdominal muscle cavity, abdominal pain, and nausea and/or vomiting.
Hiatal hernias are located inside the abdominal cavity at the junction of the esophagus and the stomach at the level of the diaphragm. This condition is where the upper portion of the stomach this is usually located in the abdominal cavity has migrated through the esophageal hiatus into the chest cavity. These hernia’s usually present with reflux, episodes of nausea and are quite frequently seen in patients with experienced complications of the LAP-BAND.
The surgical treatment of these hernias are very different:
Ventral hernia repairs may require mesh placement. There are different mesh products that are available. Some are made with non absorbable material and other are absorbable- biologic material that last long enough to allow incorporation by the patients own tissue. In general, when a mesh is used, the incidence of hernia recurrence goes down significantly. However, there is an increase in complications associated with the use of mesh. These may include infection of the mesh, indications of synthetic material, and serum and rejection indications of non synthetic material. To add another layer of complexity, when the hernia is encountered at the time of weight loss surgery, especially when the GI track has to be opened ( in the case of duodenal switch, revision from a failed gastric bypass with a duodenal switch) then it is recommended that no mesh be placed because of the high incidence of mesh infection or the associated complications. In extreme cases where the abdominal wall cannot be closed, biologic meshes may be used with the understanding that a repeat hernia repair may be required at a later date.
In my practice, Hiatal hernias are always repaired at the time of the weight loss surgical procedures. Depending on the type of the weight loss surgery the patient has had previously, the type of the hernia repair, and whether or not a mesh needs to be utilized, and the amount of stomach and fundus remains for the repair, will dictate how the Hiatal hernia is repaired.
Additional information regarding hernias in a newsletter.
Holiday Survival Tips by: Marylin Calzadilla, Psy.D.
November 17, 2014 8:23 pm
REFLECT
SUPPORT, SUPPORT, SUPPORT
ALLOWANCES
KEEP ACTIVE
CREATE
PLAN ACTIVITES
Marylin Calzadilla, Psy.D
Shared Success Story: Krystal U. Had a LapBand to Duodenal Switch Revsion
November 13, 2014 6:23 pm
Another amazing and emotional success story by Krystal Unruh. Krystal we celebrate you and your successful LapBand to Duodenal Switch revision. Thank you for sharing with us all.
Shared Success Story: Patricia Y. Had a LapBand to Duodenal Switch revision
November 04, 2014 3:16 am
Patricia’s success story is truly inspiring and emotional. Please take a moment to celebrate her success by watching video about her journey and revision from LapBand to Duodenal Switch. Thank you Patricia for sharing you journey with us.
Laboratory Blood Specimen Collection Change
October 30, 2014 5:20 pm

No one likes surprises at the lab when you are about to get your blood drawn. The picture above is of the older vacutainers blood specimen tubes and a new type of tube that is being introduced. There is currently a change over of blood specimen tubes in laboratories across the country. Locally we are seeing the use of SARSTEDT tubes/syringes. This change over is for several reasons. First and foremost is to reduce blood bourne pathogen exposure due to needle sticks and tube breakage. However, these blood specimen tubes offer some additional benefits, especially to people who frequently have lab draws. One of which is the ability to use aspiration of the specimen to decrease the incidence of hemolysis. Hemolysis skews laboratory studies and damages the red blood cells in the collected specimen causing the need for repeated testing. Aspiration is also easier on fragile veins due to the decrease pressure versus vacuum. The SARSTEDT tubes are versatile in that they can also be used as a vacuum tube if needed.
Dental Issues after Weight Loss Surgery
October 13, 2014 10:53 pm
Please click the link to view the webinar on Dental Issues after Weight Loss Surgery. A special thank you to Armen Mardirossian, DDS, MS Diplomate for his contributions to this article.
Update for Feb. 2017 Dental Resources here.
This is a review of data regarding weight loss surgery and dental health. I am not a Dentist so please follow up with your Dental Health Care Providers if you are having any issues. Always keep your health care providers informed of your overall health status.
Controversies of Duodenal Switch -Staged or Single Stage
September 27, 2014 5:29 pm
There is almost no science supporting the two staged duodenal switch. The “theory” advocated was that one can try a less invasive procedure and then if it does not work, proceed with the more complex operation. This was also advocated as a risk reduction tool for patient to have the sleeve component done as a planned first stage to reduce the operative and the anesthesia risk of the full duodenal switch operation. The “DS” surgeons soon recognized that the weight loss after sleeve is limited and not long lasting.
Laparoscopic Sleeve Gastrectomy has received a great deal of attention in the last few years. Most of this attention is contributed to the almost universal failure and high complication rate of the adjustable gastric banding (AGB) procedures. Since some practices and surgeons promised a low risk, minimally invasive procedure with the AGB procedures, they had to find an alternative as the complications and the failure of the AGB procedures mounted. This is when the Sleeve Gastrectomy started gaining more acceptance by surgeons who previously had performed AGB. Sleeve Gastrectomy is becoming one of the most commonly performed weight loss surgical procedure in several areas in the country and world.
It is worth mentioning, that Sleeve Gastrectomy is nothing new to the surgeons who perform Duodenal Switch procedures. Duodenal Switch has been performed as a single stage procedure since it’s inception.In fact every classical Duodenal Switch procedure is a Sleeve Gastrectomy with two small bowel anastomosis, first described by Dr. Hess in 1988. Duodenal Switch surgeons were also first to offer Sleeve Gastrectomy as the first stage of a two staged procedure.
BiliopancreaticDiversion-Duodenal Swtich: Independent Contributions of Sleeve Resection andDuodenal Exclusion, Marceu P, Biron S, Marceau S, et al. Conclusion: SG and DS independently contribute to beneficial metabolic outcomes after BPD-DS. Long-term weight loss and correction of metabolic abnormalities were better after DS favoring its use as first stage in BPD-DS; one-stage BPD-DS outcomes were superior to two-staged.
Other than some extreme cases, there is no indication to offer the sleeve as a staging operation since in vast majority of the cases the patient will require to have an alternative procedure done when the weight loss stops, and in some cases weight gain is experienced.
The reasons one should avoid a staged procedure is the evidence in the research data does not support that staging a procedure benefits the patient. There is also consideration for two general anesthesia exposures. Anesthesia time is based on surgical experience, technique and past patient surgical history. The argument that a patient should have the Sleeve Gastrectomy, to improve the risk for Duodenal Switch has almost no support in the peer-reviewed literature. One should also consider that a patient having had a Sleeve Gastrectomy may not qualify for the second stage Duodenal Switch procedure due to lower BMI or the insurance benefits mandating only one weight loss procedure in a lifetime.
There may be patients who may benefit from the Sleeve Gastrectomy long term, but in my opinion to offer Sleeve Gastrectomy as a planned first phase of the the duodenal switch is not indicated in majority of the cases.
Telogen Effluvium: Hair Loss After WLS (Weight Loss Surgery)
September 14, 2014 12:56 pm
Telogen Effluvium is the premature pushing of the hair root into a resting state and can be chronic or acute. It is usually brought on by a shock to your body such as high fevers, childbirth, severe infections, severe chronic illness, severe psychological stress, major surgery or illnesses, over or under active thyroid gland, crash diets with inadequate protein, and a variety of medications. Most hair loss from medications, is this type of hair loss, and the related medications include retinoids, beta blockers, calcium channel blockers, antidepressants, and NSAIDS (including ibuprofen). Supplements that can also cause or increase telogen effluvium are higher doses of iron and Vitamin A.
The hair begins to fall out in differing amounts and can start weeks to months after the initial shock to the body or medication initiation. The hair loss can continue up to 6 weeks and typically slows at 8 weeks after the start of the hair loss.
Weight loss surgical patients experience this due to the stress of surgery and the low protein state directly after surgery. Although there is no specific treatment for Telogen Effluvium, there are steps that can be taken to potentially slow the hair loss and help support the new hair growth.
The most important steps to take are to maintain your protein supplementation at a minimum of 80-100 grams of protein daily and hydration (at least 64 ounces daily) after weight loss surgery.
Protein, particularly L-lysine, are the building blocks of hair and nails, without adequate protein your body will forgo making hair and nails to maintain critical muscle mass. Also hydration is important to flush the body of toxins, due to fat breakdown in the liver during the rapid weight loss phase, that will prevent further new hair growth.
Vitamin B6 and B12 deficits can also contribute to hair loss. Multivitamin supplementation is essential to maintaining the required levels of these vitamins. The recommended multivitamin supplementation is two multivitamins daily that are equivalent to Centrum brand multivitamin.
Some people add Zinc supplements to increase hair production. However, if you are adding Zinc it is advised to also add a Copper supplement as they compete with each other for absorption. Copper is important for red blood cell production and a copper deficiency can exacerbate iron deficiency anemia. Inactivity can also decrease zinc levels, therefore exercise/activity will naturally maintain zinc levels.
Biotin is also a B vitamin that can be helpful in new hair growth.
Folicure is a supplement tablet that contains many vitamins and minerals that some people find helpful for hair re-growth. They also manufacture a shampoo that can be used.
There are many shampoos and topical treatments that people use and report satisfaction in their results. However, it is important to note that a topical treatment may make your hair appear thicker but the hair regrowth will only be supported by internal nutritional maintenance. Minoxidil is a liquid vasodilator medication applied to the scalp that is the exception to this rule and can help with hair regrowth. However, Minoxidil will not work to it’s optimal level in the absence of adequate nutritional status.
We always go back to our basics after weight loss surgery of hydration, protein and exercise to maintain health of body and hair.





