Duodenal Switch in Turkey
The operation method known as switch or duodenal switch is a surgical operation that combines both sleeve gastrectomy and gastric bypass qualities. The process is carried out in two steps. First, a sleeve gastrectomy is performed in which approximately 80% of the stomach is removed and the rest is made into a thin tube. As a result, the stomach with a volume of 1.5-2 L takes the form of a thin and long tube with a volume of approximately 120 ml. This part of the surgery is now an irreversible surgical procedure.
Then the small intestine (duodenum), which normally connects to the stomach, is separated to create a bypass, and two separate paths and a common canal are created. The food consumed is normally directed to the lower part of the small intestine from the stomach, which remains in the form of a tube after sleeve gastrectomy, and then goes to the colon.
This is the short part of the small intestine separated after sleeve gastrectomy. The other way consisting of the longer part of the small intestine is the part where bile and other digestive enzymes mix with food and cause absorption, the length of which is reduced to 250 cm. As a result, as the stomach volume remains very small, the patient eats less and reaches a feeling of satiety, and since the pathways of the foods in the small intestine are shortened, the amount of calories remaining from the food is less.
This method, which is generally applied to diabetic patients with high body mass index, can be performed in a single operation, but it can also be applied gradually. 6-18 months after sleeve gastrectomy is applied in the first stage, a different operation can be applied for bypass. With this method, patients can lose their excess weight by 70-100%.
What is Duodenal Switch?
Duodenal Switch is used as a comprehensive weight loss method among surgical procedures. It has been observed that it is seen as the most effective solution in patients with high calorie diet, and it is also very effective in conditions such as diabetes, high blood pressure and cholesterol.
Sleeve gastrectomy (sleeve gastrectomy) is performed in this surgery. During the procedure, the small intestine, which is cut by protecting the stomach outlet, is connected to the end of the stomach outlet. The common canal is adjusted between 75 cm and 10 cm, reducing some of the side effects seen in biliopancreatic diversion. In addition, since the pyrolic lid of the stomach is preserved, the patient does not have indigestion.
In the duodenal switch procedure, when the part of the stomach producing ghrel (hunger hormone) is removed during the procedure, the patient’s feeling of hunger decreases and the amount of food consumed can be limited accordingly. Thus, it becomes easier for the patient to lose weight due to the decrease in the amount of calories taken after the procedure. Since this application, which is aimed at reducing fat absorption, is specific to patients consuming fatty foods, it is observed that it is effective in such patients.
However, duodenal switch patients have to take a special diet and vitamin – mineral support for life.
What is Malabsorption ?
Intestinal malabsorption, which occurs due to the inadequate functioning of the digestive system. The cause of this ailment may be due to another disease. Absorption restriction occurs when problems occur in the small intestines where absorption occurs. The main cause of malabsorption, which manifests itself with symptoms such as diarrhea, is a different disease. Absorption restriction, which usually occurs after celiac disease, can be determined by changes in stool.
Changes in the color and fat content of the stools indicate absorption restrictions. Gas problem and bloating also occur as a result. Absorption disorder, which also causes vitamin and mineral deficiency in the body, can be treated.
What are the side effects of duodenal switch?
- Lifelong vitamin and mineral support intake
- Protein deficiency
- Formation of intraabdominal abscess
- Intestinal obstruction
- Transient kidney disease
To whom is duodenal switch surgery applied?
It is an operation performed in patients in whom the stomach volume is not seriously reduced but the small intestines need intervention. It is the most effective obesity surgery for patients with a body mass index of 50 and above, called super obesity. Since it is a surgical operation performed by shortening the intestines rather than on the stomach, the possibility of the patient gaining weight again after the operation is almost negligible.
Therefore, it is not necessary to adhere to any diet program after surgery. It is especially recommended to consume foods with high fat content. Since the absorption of fat is restricted by surgery, it is necessary to increase the absorption of vital vitamins from fat by consuming a lot of fatty foods. Super obesity patients who lose weight thanks to duodenal switch surgery without changing their lifestyle can stop their lifelong weight gain.
Surgical Methods Used in Duodenal Switch Surgery:
Robotic duodenal switch surgery is performed through several small incisions in the patient’s abdomen. The surgeon performs the surgery from the surgeon console, which is a few steps away from the patient throughout the surgery. At the same time, another surgeon at the head of the patient helps the surgeon at the console by including the necessary materials or instruments during the operation.
The special camera of the robot provides the surgeon on the console with a real 3D view of the patient’s interior, which can be magnified up to 16 times, and the image is transmitted to the operating room and guides the surgeon and nurse at the bedside. The console instantly transmits all the surgeon’s movements into the patient in a more precise and sharper way, eliminating hand tremors.
The small incisions in robotic duodenal switch surgeries enable the patient to return to his daily life more quickly.
Open duodenal switch surgery is performed through a large incision in the patient’s abdomen. The size of the incision prolongs the recovery period after the operation. The biggest advantage of open surgery is that the surgeon performs the operation by feeling the tissues.