Why I prefer the Duodenal Switch

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Hi Everyone,

Enclosed is a short essay. I will also upload this to " Hull's

Folder " in the files section.

Hull

Why I prefer the Duodenal Switch procedure

The " gold standard " gastric bypass procedure, known as the Roux-en-Y

proximal gastric bypass (RNY), has a number of significant problems.

I am concerned about the long-term efficacy of this procedure, as it

has a reported failure rate of about one in four after 10 years. By

comparison, the biliopancreatic diversion with duodenal switch (DS)

has proven to be successful in over 95% of the patients.

I am also concerned about the many side effects of the RNY procedure.

The RNY procedure, by design, defunctionalizes the pyloric valve.

Without a pyloric valve to regulate the rate of food movement into

the small intestine, a well-known phenomenon known " dumping syndrome "

occurs, and this can cause an individual to feel sick or even faint.

The RNY procedure also restricts the stoma to a mere 1-1.5 oz, making

it impossible to ingest food and beverages together in one meal.

This extremely restrictive procedures social embarrassment, as many

cultures consider it insulting if you only eat a tiny portion of the

food that is served to you. Normal satiety is lost with this

procedure, as the stoma is located at the top of the stomach.

Unintended consequences of the RNY procedure include persistent

vomiting, plugging of the stoma, and meat intolerance. The plugging

of the stoma is reported by patients to be very uncomfortable. It

should be noted that other restrictive procedures (such a vertical

banded gastrectomy) suffer these same problems.

The Duodenal Switch procedure preserves normal pyloric and gastric

functioning. While some moderate gastric restriction is involved,

normal satiety and regulation of the rate of movement of food into

the small intestine are preserved. Because the procedure depends on

a combination of restriction and malabsorption, patients can consume

near normal level of foods except for the first several months after

the procedure. In addition, problems such as vomiting are much less

frequent, and meat intolerance and stomach " plugging " have not been

reported. The combination of moderate malabsorption and moderate

restriction has made this surgery the most successful weight-loss

treatment available.

While concerns have been raised regarding potential nutrition

problems from the malabsorptive portion of the surgery, long-term

studies have shown that using the proper balance of malabsorption and

restriction along with proper supplementation leads to excellent long-

term health with no clinical difficulties.

Long-term side effects of the DS do include frequent malodorous

stools that are softer than normal. Some patients exhibit lactose

intolerance, manageable by use of lactose-free milk products and use

of enzyme supplements that aid in the digestion of lactose. I

consider this a preferable outcome to the vomiting, extreme food

restriction, and dumping that follow the RNY. I believe that the DS

leads to a much better quality of life than any of the predominantly

gastric restrictive procedures.