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Gastric emptying time after Duodenal Switch and Sleeve Gastrectomy.

January 18, 2012 2:10 am

The gastric emptying is shorter after Duodenal Switch than after Sleeve Gastrectomy. This has been studied by having volunteers consume a known amount of measured food that contained trace amounts of medical nuclear markers. Using special imaging cameras, the amount of radiation collected in the stomach was measured over time. In the case of the Duodenal Switch patients, the emptying half time was 28 +/- 16 minutes, with the normal non-operated patient be at 91 +/- 20 minutes(i). The Gastric emptying after sleeve gastrectomy has been reported to be 38 +/- 19(ii) minutes and 57 +/-19(iii) minutes in two different studies.

(i) J. Hedberg et al., Gatric Emptying and Postprandial PYY resposnce after Biliopancreatic Diversion with Duodenal Switch. Obesity Surgery, (2001) 21:609-615.

(ii) Braghetto et al., Scintigraphic evaluation of gastric emptying in obese patients submitted to sleeve gastrectomy compared to normal subjects. Obesity Surgery, (2009); 19:1515-21

(iii) Bernstine et al. Gastric emptying is not affected by sleeve gastrectomy, without removal of the gastric antrum. Obesity Surgery, 2009;19:293-8.

Vitamin and Mineral Deficiencies

January 14, 2012 12:20 pm

Articles highlighting vitamin and mineral deficiencies after Duodenal Switch surgery. Neurologic dysfunction and pancytopenia secondary to acquired copper deficiency following duodenal switch: case report and review of the literature. Btaiche et al. Oct 2011 PubMed Abstract ABSTRACT: The duodenal switch (DS) procedure is a type of restrictive-malabsorptive bariatric surgery that is typically reserved for severe morbidly obese people (body mass index >50 kg/m(2)) with obesity-related comorbidities, when diet, lifestyle changes, and pharmacologic therapy fail to achieve adequate weight loss. Patients who undergo the DS procedure are at risk for malabsorption, malnutrition, and nutrient deficiencies. Copper deficiency is a commonly reported long-term complication of Roux-en-Y gastric bypass (RYGB) surgery. However, data are limited on copper deficiency-associated complications and their treatment in DS patients. This article presents a case of a patient who developed hypocupremia with associated pancytopenia, myeloneuropathy, and leukoencephalopathy following DS and reviews the literature related to the pathophysiology of copper deficiency and copper replacement in bariatric surgery patients. When severe diarrhea was present, intravenous elemental copper 4 mg (as cupric chloride)/d in addition to daily oral copper gluconate was necessary to correct the hypocupremia and improve the hematologic indices and neurologic symptoms of copper deficiency. When diarrhea subsided, oral elemental copper 4 mg (as copper gluconate) 3 times daily maintained normal serum copper concentrations and avoided the relapse of severe neurologic dysfunction. Regular monitoring of serum copper and ceruloplasmin concentrations is recommended following DS surgery to detect any copper deficiency before irreversible neurologic damage occurs. Long-term copper supplementation is likely necessary to maintain normal copper status in DS patients. Nutritional deficiencies in bariatric surgery patients: prevention, diagnosis and treatment. Schweiger et al. Nov 2010 PubMed Abstract ABSTRACT: The number of people suffering from surgery and obesity in the western world is constantly growing. In 1997 the World Health Organization (WHO) defined obesity as a plague and one of greatest public health hazards of our time. The National Institution of Health (NIH) declared that surgery is the only long-term solution for obesity. Today there are four different types of bariatric surgery. Each variation has different implications on the nutritional status of bariatric surgery patients. Bariatric surgery candidates are at risk of developing vitamin and mineral nutritional deficiencies in the post-operative stage, due to vomiting, decrease in food intake, food intolerance, diminution of gastric secretions and bypass of absorption area. It is easier and more efficient to treat nutritional deficiencies in the preoperative stage. Therefore, preoperative detection and correction are crucial. Blood tests before surgery to detect and treat nutritional deficiencies are crucial. In the postoperative period, blood tests should be conducted every 3 months in the first year after operation, every six months in the second year and annually thereafter. Multivitamin is recommended to prevent nutritional deficiencies in all bariatric surgery patients. Furthermore, iron, calcium, Vitamin D and B12 are additionally recommended for Roux-en-Y Gastric Bypass patients. Patients with Biliopancreatic diversion and Duodenal Switch should also take fat soluble vitamins. Zinc Deficiency: A Frequent and Underestimated Complication After Bariatric Surgery. Sallé et al. Aug 2010 PubMed Abstract BACKGROUND: Although zinc deficiency is common after bariatric surgery, its incidence is underestimated. The objective was to monitor zinc and nutritional status before and 6, 12 and 24 months (M6, M12 and M24) after gastric bypass (Roux-en-Y gastric bypass), sleeve gastrectomy and biliopancreatic diversion with duodenal switch (DS) in patients receiving systematised nutritional care. METHODS: Data for 324 morbidly obese patients (mean body mass index 46.2 +/- 7.3 kg/m(2)) were reviewed retrospectively. The follow-up period was 6 months for 272 patients, 12 months for 175, and 24 months for 70. Anthropometric, dietary and serum albumin, prealbumin, zinc, iron and transferrin saturation measures were determined at each timepoint. RESULTS: Nine percent of patients had zinc deficiency pre-operatively. Zinc deficiency was present in 42.5% of the population at M12 and then remained stable. Zinc deficiency was significantly more frequent after DS, with a prevalence of 91.7% at M12. Between M0 and M6, variation in plasma prealbumin, surgery type and zinc supplementation explained 27.2% of the variance in plasma zinc concentration. Surgery type explained 22.1% of this variance between M0 and M24. Mean supplemental zinc intake was low (22 mg/day). The percentage of patients taking zinc supplementation at M6, M12 and M24 was 8.9%, 20.6% and 29%, respectively. CONCLUSIONS: Reduced protein intake, impaired zinc absorption and worsening compensatory mechanisms contribute to zinc deficiency. The mechanisms involved differ according to the type of surgery and time since surgery. Zinc supplementation is necessary early after bariatric surgery, but this requirement is often underestimated or is inadequate. Vitamin status after bariatric surgery: a randomized study of gastric bypass and duodenal switch. Aasheim et al. Jul 2009 PubMed Abstract BACKGROUND: Bariatric surgery is widely performed to induce weight loss. OBJECTIVE: The objective was to examine changes in vitamin status after 2 bariatric surgical techniques. DESIGN: A randomized controlled trial was conducted in 2 Scandinavian hospitals. The subjects were 60 superobese patients [body mass index (BMI; in kg/m(2)): 50-60]. The surgical interventions were either laparoscopic Roux-en-Y gastric bypass or laparoscopic biliopancreatic diversion with duodenal switch. All patients received multivitamins, iron, calcium, and vitamin D supplements. Gastric bypass patients also received a vitamin B-12 substitute. The patients were examined before surgery and 6 wk, 6 mo, and 1 y after surgery. RESULTS: Of 60 surgically treated patients, 59 completed the follow-up. After surgery, duodenal switch patients had lower mean vitamin A and 25-hydroxyvitamin D concentrations and a steeper decline in thiamine concentrations than did the gastric bypass patients. Other vitamins (riboflavin, vitamin B-6, vitamin C, and vitamin E adjusted for serum lipids) did not change differently in the surgical groups, and concentrations were either stable or increased. Furthermore, duodenal switch patients had lower hemoglobin and total cholesterol concentrations and a lower BMI (mean reduction: 41% compared with 30%) than did gastric bypass patients 1 y after surgery. Additional dietary supplement use was more frequent among duodenal switch patients (55%) than among gastric bypass patients (26%). CONCLUSIONS: Compared with gastric bypass, duodenal switch may be associated with a greater risk of vitamin A and D deficiencies in the first year after surgery and of thiamine deficiency in the initial months after surgery. Patients who undergo these 2 surgical interventions may require different monitoring and supplementation regimens in the first year after surgery. This trial was registered at ClinicalTrials.gov as NCT00327912.

Type 2 Diabetes Cure

January 14, 2012 9:22 am

Studies on Duodenal Switch as a type 2 diabetes cure. Improvement of type 2 diabetes mellitus in obese and non-obese patients after the duodenal switch operation. Frenken et al. Mar 2011 PubMed Abstract Full PMC Article ABSTRACT: Introduction. Type 2 diabetes mellitus (T2DM) is one of the most important obesity-related comorbidities. This study was undertaken to characterise the effect of the biliopancreatic diversion with duodenal switch (BPD-DS) in morbidly obese and nonmorbidly obese diabetic patients. Methods. Outcome of 74 obese diabetic patients after BPD-DS and 16 non-obese diabetic patients after BPD or gastric bypass surgery was evaluated. Insulin usage, HbA(1c)-levels, and index of HOMA-IR (homeostasis model assessment of insulin resistence) were measured. Results. A substantial fraction of patients is free of insulin and shows an improved insulin sensitivity early after the operation, another fraction gets free of insulin in a 12-month period after the operation and a small fraction of long-term insulin users will not get free of insulin but nevertheless shows an improved metabolic status (less insulin needed, normal HbA(1c)-levels). Conclusion. BPD-DS leads to an improvement of T2DM in obese and non-obese patients. Nevertheless, more data is needed to clarify indications and mechanisms of action and to adjust our operation techniques to the needs of non-obese diabetic patients. Metabolic intestinal bypass surgery for type 2 diabetes in patients with a BMI <35 kg/m2: comparative analysis of 16 patients undergoing either BPD, BPD-DS, or RYGB. Frenken et al. Mar 2011 PubMed Abstract BACKGROUND: Metabolic surgery for type 2 diabetes mellitus in patients with low body mass index (BMI) is a novel concept. Early studies show the surgery to be safe and effective but are inconclusive regarding the most effective procedure. METHODS: Metabolic intestinal bypass surgery was performed in n = 16 patients with type 2 diabetes and a BMI < 35 kg/m(2) (mean age 56 years, range 36-68; 8 females; mean BMI 32 kg /m(2), range 26-34.5). Biliopancreatic diversion with duodenal switch (BPD-DS), biliopancreatic diversion according to Scopinaro (BPD), and Roux-en-Y gastric bypass (RYGB) were performed in 7, 5, and 4 diabetic patients, respectively. Mean preoperative duration of medical antidiabetic therapy was 16 years (range 4-40). Thirteen patients used insulin on average for 6 years (range 1-12), the mean insulin requirement was 92 IU per day (range 30-140). The analysis was accomplished retrospectively from data prospectively collected in our data base. RESULTS: At discharge from hospital, only 3 of the 13 patients who used insulin preoperatively required small amounts of insulin (mean 21 IU per day, range 15-30) to keep fasting and postprandial plasma glucose levels below 200 mg/dl. After 1 year, none of the patients used insulin or oral antidiabetic drugs. The HbA1c level decreased for the total patient population from 8.6% (range 5.8-12.1) preoperatively to 6.0% (range 4.3-7.8), 5.7% (range 4.1-7.6), and 5.6% (range 4.1-7.8) after 3, 6, and 12 months, respectively. The HbA1c levels at 1 year were significantly lower after BPD-DS and BPD than after RYGB (5.2%, range 4.1-6.4 versus 6.7%, range 5.8-7.8, p < 0.01, DHbA1c 1.4%, 95% confidence interval 0.5-2.4). CONCLUSION: Metabolic intestinal bypass surgery for type 2 diabetes in low BMI patients is effective, with HbA1c levels at 1 year after the operation being significantly lower after BPD-DS or BPD than after RYGB. Biliopancreatic diversion with duodenal switch in patients with type 2 diabetes mellitus: is the chance of complete remission dependent on therapy and duration of insulin treatment? Cho et al. Mar 2011 PubMed Abstract BACKGROUND: Rapid resolution of type 2 diabetes mellitus (T2DM) is a common feature after intestinal bypass surgery bypassing the duodenum and parts of the jejunum. However, the parameters determining the individual chance of remission are imprecisely defined. METHODS: Biliopancreatic diversion with duodenal switch and sleeve gastrectomy (BPD-DS) was performed in n = 86 patients with T2DM (mean age 50 years, range 26-68, 51 females; BMI 47 kg/m(2), range 26-71). The patients were retrospectively divided into 4 groups according to the treatment modality and the duration of insulin treatment preoperatively: n = 18 patients were treated with oral antidiabetic drugs only (group 1); n = 32, n = 24, and n = 12 patients were treated with insulin for less than 5 years, for 5-10 years, and for more than 10 years (groups 2, 3, and 4), respectively. RESULTS: At discharge from hospital, all patients of groups 1 and 2 were free of insulin usage, 30% and 75% of the patients of groups 3 and 4 used up to 48 units of insulin per day (mean 24, n = 16). After 1 year, only 4 patients of group 4 permanently required small amounts of insulin (mean 17 units per day) to keep blood glucose below 200 mg/dl. These 4 patients had been using insulin preoperatively for 13, 15, 22, and 25 years. In 3 of these 4 patients, fasting C-peptide was measured and found to be low (<1.2 ng/ml). The rate of complete remission of diabetes for the whole study population was 91%. CONCLUSION: BPD-DS reliably causes rapid and complete remission of T2DM in all patients on oral antidiabetic drugs and in patients with insulin treatment for less than 5 years. In patients with insulin treatment longer than 5 or 10 years, complete remission rates decline to 88 and 66%, respectively. A low C-peptide preoperatively might be a specific adverse prognostic parameter for the chance of diabetes remission. Bileopancreatic Diversion with Duodenal Switch Lowers Both Early and Late Phases of Glucose, Insulin and Proinsulin Responses After Meal. Johansson et al. Mar 2010 PubMed Abstract BACKGROUND: Hyperproinsulinemia is associated with obesity and type 2 diabetes. We explored the after-meal dynamics of proinsulin and insulin and postprandial effects on glucose and lipids in patients treated with bileopancreatic diversion with duodenal switch (BPD-DS) surgery compared with normal-weight controls [body mass index (BMI)+/-SD, 23.2 +/- 2.4 kg/m(2)]. METHODS: Ten previously morbidly obese (BMI+/-SD, 53.5 +/- 3.8 kg/m(2)) patients free from diabetes who had undergone BPD-DS (BMI+/-SD, 29.0 +/- 5.2 kg/m(2)) 2 years earlier were recruited. A standardised meal (2400 kJ) was ingested, and glucose, proinsulin, insulin, free fatty acids and triglycerides (TGs) were determined during 180 min. Follow-up characteristics yearly on glucose, lipids, creatinine and uric acid over 3 years after BPD-DS are presented. RESULTS: Fasting glucose and insulin were lower, 0.4 mmol/L and 4.6 pmol/L, respectively, in the BPD-DS group despite higher BMI. Fasting proinsulin was similar in both groups. Postprandial area under the curve (AUC) for glucose, proinsulin and insulin did not differ between the two groups (p = 0.106-734). Postprandial changes in glucose, proinsulin and insulin were essentially similar but absolute concentrations of proinsulin and insulin were lower in the later phases in the BPD-DS group (p = 0.052-0.001). Postprandial AUC for TGs was lower in the BPD-DS group (p = 0.005). Postprandial changes in TGs were lowered in the intermediate phase (p = 0.07-0.08) and in the late phase (0.002). Follow-up data showed markedly lowered creatinine and uric acid after BPD-DS. CONCLUSIONS: BPD-DS surgery induces a large weight loss and lowers, close to normal, postprandial responses of glucose, proinsulin and insulin but with marked lowering of TGs. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Buchwald et al. Mar 2009 PubMed Abstract Register to access the full article from The American Journal of Medicine BACKGROUND: The prevalence of obesity-induced type 2 diabetes mellitus is increasing worldwide. The objective of this review and meta-analysis is to determine the impact of bariatric surgery on type 2 diabetes in association with the procedure performed and the weight reduction achieved. METHODS: The review includes all articles published in English from January 1, 1990, to April 30, 2006. RESULTS: The dataset includes 621 studies with 888 treatment arms and 135,246 patients; 103 treatment arms with 3188 patients reported on resolution of diabetes, that is, the resolution of the clinical and laboratory manifestations of type 2 diabetes. Nineteen studies with 43 treatment arms and 11,175 patients reported both weight loss and diabetes resolution separately for the 4070 diabetic patients in these studies. At baseline, the mean age was 40.2 years, body mass index was 47.9 kg/m2, 80% were female, and 10.5% had previous bariatric procedures. Meta-analysis of weight loss overall was 38.5 kg or 55.9% excess body weight loss. Overall, 78.1% of diabetic patients had complete resolution, and diabetes was improved or resolved in 86.6% of patients. Weight loss and diabetes resolution were greatest for patients undergoing biliopancreatic diversion/duodenal switch, followed by gastric bypass, and least for banding procedures. Insulin levels declined significantly postoperatively, as did hemoglobin A1c and fasting glucose values. Weight and diabetes parameters showed little difference at less than 2 years and at 2 years or more. CONCLUSION: The clinical and laboratory manifestations of type 2 diabetes are resolved or improved in the greater majority of patients after bariatric surgery; these responses are more pronounced in procedures associated with a greater percentage of excess body weight loss and is maintained for 2 years or more. Is Type 2 Diabetes an Operable Intestinal Disease? A Provocative Yet Reasonable Hypothesis Rubino Feb 2008 PubMed Abstract Full article can be found at Diabetes Care Type 2 diabetes, which accounts for 90-95% of all cases of diabetes, is a growing epidemic that places a severe burden on health care systems, especially in developing countries. Because of both the scale of the problem and the current epidemic growth of diabetes, it is a priority to find new approaches to better understand and treat this disease. Gastrointestinal surgery may provide new opportunities in the fight against diabetes. Conventional gastrointestinal operations for morbid obesity have been shown to dramatically improve type 2 diabetes, resulting in normal blood glucose and glycosylated hemoglobin levels, with discontinuation of all diabetes-related medications. Return to euglycemia and normal insulin levels are observed within days after surgery, suggesting that weight loss alone cannot entirely explain why surgery improves diabetes. Recent experimental studies point toward the rearrangement of gastrointestinal anatomy as a primary mediator of the surgical control of diabetes, suggesting a role of the small bowel in the pathophysiology of the disease. This article presents available evidence in support of the hypothesis that type 2 diabetes may be an operable disease characterized by a component of intestinal dysfunction. Duodenal switch without gastric resection: results and observations after 6 years. Cossu et al. Nov-Dec 2004 PubMed Abstract BACKGROUND: The results on metabolic effects of the classical biliopancreatic diversion (BPD) have led us to investigate the operation without gastric resection, thus preserving stomach and pylorus, in patients who are not seriously obese but suffer from hypercholesterolemia, often associated with type 2 diabetes and hypertriglyceridemia. METHODS: Between 1996 and 1999, we performed the duodenal switch (DS) without gastric resection on 24 mildly obese patients. Mean preoperative BMI was 36.2 kg/m(2). 17 patients (70.8%) suffered from type 1 diabetes, 4 (16.6%) had impaired glucose tolerance, while the remainder had fasting hyperglycemia. In 20 patients (83.3%), hypercholesterolemia and alterations in lipid profile were present. Another 20 patients were taking drugs for arterial hypertension. The pluri-metabolic syndrome was present in 41.6% of patients. RESULTS: Mean follow-up was 4 years. BMI reduction and weight loss were not large. 2 patients who had severe longstanding diabetes type 2 needed a second operation of the classical BPD because of failure in improving diabetes. Another 2 patients were changed to classical BPD because of a relapsing chronic duodeno-ileal ulcer. The incidence of ileal ulcer was 29.1%. Regarding hypercholesterolemia, hypertrigliceridemia, and type 2 diabetes when there is a good pancreatic “reservoir”, the operation seems effective in the long-term. Protein absorption is better than that obtained with the classical BPD. CONCLUSIONS: Our long-term results suggest that in carefully selected patients suffering from serious hypercholesterolemia or type 2 diabetes with insulin reserves still at an acceptable level, and with BMI 30-40, DS without gastric resection can be proposed as a surgical treatment for metabolic diseases but not for obesity.

Nutritional Deficiencies

January 14, 2012 8:23 am

Clinical data that discusses nutritional deficiencies in post-op Duodenal Switch patients. Metabolic changes after morbid obesity surgery using the duodenal switch technique. Long term follow-up. Vázquez et al. Dec 2011 PubMed Abstract INTRODUCTION: The duodenal switch (DS) technique is considered to be complex surgery with a series of metabolic complications due to its malabsorptive character. For these reasons, it has not been extensively used by bariatric surgeons. Despite this, we consider it to be a suitable technique for the grossly obese. PATIENTS AND METHODS: A retrospective study was performed on 110 patients with morbid obesity operated on using the DS technique and who were followed up for a minimum period of four years after surgery. We evaluated the weight loss, the outcomes of the comorbidities, and the metabolic complications. RESULTS: The loss of excess weight was greater than 50% in 75% of the patients after 12 months follow up. The comorbidities suffered by 68 patients (75.5%) were completely resolved. The most frequent metabolic complications were iron (Fe) deficiency and an increased parathyroid hormone (PTH). CONCLUSION: DS is a safe and effective technique for the treatment of morbid obesity, with good weight loss results, a high percentage of remission of the comorbidities, a similar morbidity and mortality to other techniques, and with correctable nutritional changes, and thus acceptable. Obesity surgery results depending on technique performed: long-term outcome. Gracia et al. April 2009 PubMed Abstract BACKGROUND: Many techniques have excellent results at 2 years of follow-up but some matters regarding their long-term efficacy have arisen. This is why bariatric surgery results must be analyzed in long-term follow-up. The aim of this study was to extend the analysis over 5 years, evaluating weight loss, morbidity, and mortality of the surgical procedures performed. METHODS: This was a retrospective cohort study of the different procedures for morbid obesity practiced in our Department of Surgery for morbid obesity. The results have been analyzed in terms of weight loss, morbidity improvement, and postoperative morbidity (Bariatric Analysis And Reporting Outcome System). RESULTS: One hundred twenty-five patients were operated on open vertical banded gastroplasty (VBG), 150 patients of open biliopancreatic diversion (BPD) of Scopinaro, 100 patients of open modified BPD (common limb 75 cm; alimentary limb 225 cm), and 115 patients of laparoscopic Roux-en-Y gastric bypass (LRYGBP). Mean follow-up was: VBG 12 years, BPD 7 years, and LRYGBP 4 years. An excellent initial weight loss was observed at the end of the second year of follow-up in all techniques, but from this time an important regain of weight was observed in VBG group and a discrete weight regain in LRYGBP group. Only BPD groups kept excellent weight results so far in time. Mortality was: VBG 1.6%, BPD 1.2%, and LRYGBP 0%. Early postoperative complications were: VBG 25%, BPD 20.4%, and LRYGBP 20%. Late postoperative morbidity was: protein malnutrition 11% in Scopinaro BPD, 3% in Modified BPD group, and no cases reported either in VBG group or LRYGBP group; iron deficiency 20% VBG, 62% Scopinaro BPD, 40% modified BPD, and 30.5% LRYGBP. A 14.5% of VBG group required revision surgery to gastric bypass or to BPD due to 100% weight regain or vomiting. A 3.2% of Scopinaro BPD with severe protein malnutrition required revision surgery to lengthen common limb to 100 cm. A 0.8% of LRYGBP required revision surgery to distal LRYGBP (common limb 75 cm) due to 100% weight regain. CONCLUSIONS: The most complex bariatric procedures increase the effectiveness but unfortunately they also increase morbidity and mortality. LRYGBP is safe and effective for the treatment of morbid obesity. Modified BPD (75-225 cm) can be considered for the treatment of superobesity (body mass index > 50 kg/m(2)), and restrictive procedures such as VBG should only be performed in well-selected patients due to high rates of failure in long-term follow-up. Roux-en-Y gastric bypass versus a variant of biliopancreatic diversion in a non-superobese population: prospective comparison of the efficacy and the incidence of metabolic deficiencies. Skroubis et al. April 2006 PubMed Abstract BACKGROUND: In the non-superobese population, an agreement has not been made as to the optimal bariatric operation. The present study reports the results of a prospective comparison of Roux-en-Y gastric bypass (RYGBP) and a variant of biliopancreatic diversion (BPD) in a non-superobese population. METHODS: From a cohort of 130 patients with BMI 35 to 50 kg/m(2), 65 patients were randomly selected to undergo RYGBP and 65 to undergo BPD. All patients underwent complete follow-up evaluation at 1, 3, 6, and 12 months postoperatively and every year thereafter. RESULTS: Patients in both groups have completed their second postoperative year. Mean % excess weight loss (%EWL) was significantly better after BPD at all time periods (12 months, P=0.0001 and 24 months, P=0.0003), and the %EWL was >50% in all BPD patients compared to 88.7% in the RYGBP patients at 2-year follow-up. No statistically significant differences were observed between the 2 groups in early and late non-metabolic complications. Hypoalbuminemia occurred in only 1 patient (1.5%) after RYGBP and in 6 patients after BPD (9.2%). Only 1 patient from each group was hospitalized and received total parenteral nutrition. Glucose intolerance, hypercholesterolemia, hypertriglyceridemia and sleep apnea completely resolved in all patients in both groups, although mean total cholesterol level was significantly lower in BPD patients at the second year follow-up (t-test, P<0.0001). Diabetes completely resolved in all BPD patients and in 7 of the 10 diabetic RYGBP patients. CONCLUSION: Both RYGBP and BPD were safe and effective procedures when offered to non-superobese patients. Weight loss after BPD was consistently better than that after RYGBP, as was the resolution of diabetes and hypercholesterolemia. Because the nutritional deficiencies that occurred following this type of BPD were not severe and were not significantly different between the 2 operations, both may be offered to non-superobese patients, keeping in mind the severity and type of preoperative co-morbidities as well as the desired weight loss. Nutritional Markers following Duodenal Switch for Morbid Obesity Rabkin et al. Jan 2004 PubMed Abstract Full Article BACKGROUND: Laparoscopic duodenal switch with gastric reduction (LapDS) is a minimally invasive hybrid operation combining moderate intake restriction with moderate malabsorption for treatment of morbid obesity. In LapDS, both the quantity of food ingested and the efficiency of digestion are reduced. METHODS: A cohort of 589 sequential LapDS patients had laboratory studies drawn annually. Serum markers for calcium, iron and protein metabolism and for hepatic function were analyzed using SAS statistical software. RESULTS: There were 95 men and 494 women. Mean age was 44 years, mean BMI 50 kg/m(2) and mean preoperative weight 142 kg. Although mean hemoglobin decreased below reference and mean parathyroid hormone (PTH) increased above reference, similar to abnormal values reported after Roux-en-y gastric bypass, both hemoglobin and calcium in LapDS readily returned to within the reference range following supplementation with iron and calcium respectively. Mean iron, corrected calcium, alkaline phosphatase, albumin, total protein, aspartate aminotransferase (AST), alanine transaminase (ALT), and bilirubin remained within the normal range. CONCLUSION: LapDS is not associated with broad nutritional deficiencies. Annual laboratory studies, which are required following any type of bariatric operation, appear to be sufficient to identify unfavorable trends. In selected patients, additional iron and calcium supplementation are effective when indicated. Comparison of nutritional deficiencies after Roux-en-Y gastric bypass and after biliopancreatic diversion with Roux-en-Y gastric bypass. Skroubis et al. Aug 2002 PubMed Abstract BACKGROUND: Patients undergoing either Roux-en-Y gastric bypass (RYGBP) or biliopancreatic diversion (BPD) with RYGBP are at risk of developing metabolic sequelae secondary to malabsorption. We compared the differences in nutritional complications between these two bariatric operations. METHODS: A retrospective analysis of a prospective database was done. From June 1994 to December 2001, 243 morbidly obese patients underwent various bariatric procedures at our institution. Of these patients, 79 (BMI 45.6 +/- SD = 4.9) who underwent RYGBP (gastric pouch 15 +/- 5 ml, biliopancreatic limb 60-80 cm, alimentary limb 80-100 cm and common limb the remainder of the small intestine), and 95 super obese (BMI 57.2 +/- 6.1) who underwent a BPD (gastric pouch 15 +/- 5 ml, biliopancreatic limb 150-200 cm, common limb 100 cm and alimentary limb the remainder of the small intestine), were selected and studied for the incidence of micronutrient deficiencies and level of serum albumin at yearly intervals postoperatively. A variety of nutritional parameters including Hb, Fe, ferritin, folic acid, vitamin B12 and serum albumin were measured preoperatively and compared postoperatively at 1, 3, 6, 12, 18 and 24 months, and yearly thereafter. RESULTS: Nutritional parameters were compared preoperatively and at similar periods postoperatively. No statistically significant (P < 0.05) difference in the occurrence of deficiency was observed between the groups for any of the nutritional parameters studied, except for ferritin, which showed a significant difference at the 2-year follow-up (37.7% low ferritin levels after RYGBP vs. 15.2% after BPD, P = 0.0294). All of these deficiencies were mild, without clinical symptomatology and were easily corrected with additional supplementation of the deficient micronutrient, with no need for hospitalization. Regarding serum albumin, there was only one patient with a level below 3 g/dl in the RYGBP group and two in the BPD group. These three patients were hospitalized and received total parenteral nutrition for 3 weeks, without further complications. CONCLUSION: There was no significant difference in the incidence of deficiency of the nutritional parameters studied, except for ferritin, following RYGBP vs. BPD with RYGBP. The most common deficiencies encountered were of iron and vitamin B12. The incidence of hypoalbuminemia was negligible in both groups, with mean values above 4 g/dl.

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

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.