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The Duodenal Switch (also known as Bilio-Pancreatic Diversion with Duodenal Switch or the DS) procedure is a weight loss surgery that alters the gastrointestinal tract with two approaches: a restrictive aspect and a malabsorptive aspect. Image File history File links Question_book-3. ... The International Classification of Health Interventions (ICHI) is a system of classifying procedure codes being developed by the World Health Organization. ... ICD-9-CM Volume 3 is a system of Procedural codes. ... Procedure codes are numbers or alphanumeric codes used to identify specific health interventions taken by medical professionals. ... Bariatrics is the branch of medicine that deals with the causes, prevention, and treatment of obesity. ... Gut redirects here. ... Please wikify (format) this article or section as suggested in the Guide to layout and the Manual of Style. ...

The restrictive portion of the surgery reduces the stomach along the greater curvature so that the volume is approximately one third to one fifth of the original capacity. The malabsorptive portion of the surgery reroutes a lengthy portion of the small intestine, creating two separate pathways and one common pathway. The shorter of the two pathways, the digestive loop, takes food from the stomach to the large intestine. The much longer pathway, the bilio-pancreatic loop, carries bile from the liver to the common path. The common path, or common channel, is a stretch of small intestine usually 75-150 centimeters long in which the contents of the digestive path mix with the bile from the bilio-pancreatic loop before emptying into the large intestine. The objective of this arrangement is to reduce the amount of time the body has to capture calories from food in the small intestine and to selectively limit the absorption of fat. “Surgeon” redirects here. ... In anatomy, the stomach is a bean-shaped hollow muscular organ of the gastrointestinal tract involved in the second phase of digestion, following mastication. ... In biology the small intestine is the part of the gastrointestinal tract (gut) between the stomach and the large intestine and includes the duodenum, jejunum, and ileum. ... Digestion is the process whereby a biological entity processes a substance, in order to chemically convert the substance into nutrients. ... The liver is the largest internal organ in the human body, and is an organ present in vertebrates and some other animals. ... Bile (or gall) is a bitter, yellow or green alkaline fluid secreted by hepatocytes from the liver of most vertebrates. ... The large intestine, an organ which is now more commonly referred to by its Greek name, the colon, is the last part of the digestive system: the final stage of the alimentary canal in vertebrate animals. ... A calorie refers to a unit of energy. ... For other uses, see FAT. Fats consist of a wide group of compounds that are generally soluble in organic solvents and largely insoluble in water. ...

Comparison to other surgeries

Advantages

The primary advantage of the Duodenal Switch (DS) surgery is that its combination of moderate intake restriction with substantial calorie malabsorption results in a very high percentage of excess weight loss for obese individuals, with a very low risk of significant weight regain.^[2] Obesity is an excess storage of fat and can affect any mammal, such as the mouse on the left. ...

Because the pyloric valve between the stomach and small intestine is preserved, people who have undergone the DS do not experience the dumping syndrome common with people who've undergone the Roux-en-Y gastric bypass surgery (RNY). From Greek pylorus; pyl- = gate, -orus = guard. ... The dumping syndrome, or rapid gastric emptying, happens when the lower end of the small intestine fills too quickly with undigested food from the stomach. ... Gastric bypass surgery, or Roux-en-Y gastric bypass surgery, is a procedure almost exclusively used in surgical weight-loss applications to correct morbid obesity. ...

The malabsorptive component of the DS/BPD is fully reversible as no small instestine is actually removed, only re-routed.

The chance of developing anastamotic stricture (common with the RNY) is extremely low.^{[citation needed]}

Much of the production of the hunger hormone, Ghrelin, is removed with the greater curvature of the stomach. Ghrelin is a hormone produced by P/D1 cells lining the acer of the human stomach that stimulate appetite. ...

Diet following the DS is more normal and better tolerated than with other surgeries.

Those who undergo the DS often find that comorbidities such as high blood pressure^{[citation needed]}, diabetes mellitus type 2^{[citation needed]}, and arthritis^{[citation needed]} are significantly relieved in a short time after the surgery. In medicine and in psychiatry, comorbidity refers to: The presence of one or more disorders (or diseases) in addition to a primary disease or disorder. ... Arterial hypertension, or high blood pressure is a medical condition where the blood pressure is chronically elevated. ... Diabetes mellitus type 2 or Type 2 Diabetes (formerly called non-insulin-dependent diabetes (NIDDM), obesity-related diabetes, or adult-onset diabetes) is a metabolic disorder that is primarily characterized by insulin resistance, relative insulin deficiency, and hyperglycemia. ... Arthritis (from Greek arthro-, joint + -itis, inflammation; plural: arthritides) is a group of conditions where there is damage caused to the joints of the body. ...

Type 2 Diabetes is "cured" - or put into remission - in the large majority of patients having the DS.^[3]These benefits occur long before great losses in weight are seen.

Some surgeons do the "switch" or intestinal surgery on non-obese patients for the benefits of curing the diabetes.^{[citation needed]}

Some surgeons are so confident in the benefits of the DS that they will accept super-morbidly obese patients^{[citation needed]}, who are often turned down for other weight loss surgeries; however, anyone who qualifies with a body mass index (BMI) of 40 or a BMI of 35 with comorbidities qualifies for the more successful DS surgery. Look up body mass index in Wiktionary, the free dictionary. ...

Disadvantages

The malabsorptive element of the DS requires that those who undergo the procedure take vitamin and mineral supplements above and beyond that of the normal population, as do patients having the RNY surgery. Commonly prescribed supplements include a daily prenatal vitamin and extra calcium citrate. Retinol (one vitamer of Vitamin A) A vitamin is an organic compound required as a nutrient in tiny amounts by an organism. ... For other uses, see Mineral (disambiguation). ... Prenatal means before birth (is widely used in biology). ... Calcium citrate is the calcium salt of citric acid. ...

Because gallstones are a common complication of rapid weight loss following any type of weight loss surgery, some surgeons may remove the gall bladder as a preventative measure during the DS or the RNY. Others prefer to prescribe medication to reduce the risk of post-operative gallstones. In medicine, gallstones are crystalline bodies formed within the body by accretion or concretion of normal or abnormal bile components. ...

Far fewer surgeons perform the DS compared to other weight loss surgeries because it is a more difficult one to learn compared to RNY and Lap Band procedures.

RNY and DS patients require life long and extensive blood tests to check for deficiencies in life critical vitamins and minerals. Without proper follow up tests and lifetime supplementation RNY and DS patients can quickly become ill and die. This follow-up care is non-optional and must continue for as long as the patient lives.

The restrictive portion of the DS/BPS is not technically reversible, since part of the stomach is removed and discarded. However, the stomach in all DS patients does expand over time and while it will never reach the same size as the natural stomach, some reversal by stretching always occurs.

Risks

All surgical procedures involve a degree of risk however this must be balanced against the significant risks associated with severe obesity. Some of the risks or complications that can attach to a bypass are:

Almost one-third of stomach bypass patients suffer from nutritional deficits due to non-oberservance of medical guidelines on the type and amount of food supplements to be taken after the operation.

Soon after the bypass operation patients may suffer from the following: staple failure causing leaks, infection, deep thrombo-phlebitis, ulcers and stomal stenosis. This article is about Deep-vein thrombosis. ... An ulcer (from Latin ulcus) is an open sore of the skin, eyes or mucous membrane, often caused by an initial abrasion and generally maintained by an inflammation and/or an infection. ... A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure. ...

Latterly other problems can arise that may necessitate corrective surgical procedures. The mortality and morbidity rates of these secondary operations are higher than those of the initial surgery.

Qualifications

The National Institutes of Health state that if you meet the following guidelines^[4], weight loss surgery may be an appropriate measure for permanent weight loss: National Institutes of Health Building 50 at NIH Clinical Center - Building 10 The National Institutes of Health (NIH) is an agency of the United States Ministry of Health and Human Services and is the primary agency of the United States government responsible for biomedical and health-related research. ...

• BMI of 40 or over
• BMI of 35 or over with obesity-related illnesses such as:
  • Diabetes mellitus type 2
  • Coronary heart disease
  • Sleep apnea
  • Osteoarthritis
• An understanding of the operation and lifestyle changes necessary following the surgery.

Look up body mass index in Wiktionary, the free dictionary. ... Diabetes mellitus type 2 or Type 2 Diabetes (formerly called non-insulin-dependent diabetes (NIDDM), obesity-related diabetes, or adult-onset diabetes) is a metabolic disorder that is primarily characterized by insulin resistance, relative insulin deficiency, and hyperglycemia. ... Coronary heart disease (CHD), also called coronary artery disease (CAD), ischaemic heart disease, atherosclerotic heart disease, is the end result of the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium (the muscle of the heart) with oxygen and nutrients. ... Sleep apnea is a sleep disorder characterized by pauses in breathing during sleep. ... Osteoarthritis (OA, also known as degenerative arthritis, degenerative joint disease), is a condition in which low-grade inflammation results in pain in the joints, caused by abnormal wearing of the cartilage that covers and acts as a cushion inside joints and destruction or decrease of synovial fluid that lubricates those...

References

1. ^ Coding for Obesity. Retrieved on 2007-10-14.
2. ^ Prachand VN, Davee RT, Alverdy JC (2006). "Duodenal switch provides superior weight loss in the super-obese (BMI > or =50 kg/m2) compared with gastric bypass". Ann. Surg. 244 (4): 611-9. doi:10.1097/01.sla.0000239086.30518.2a. PMID 16998370. 
3. ^ MD Consult. Comparison of rates of resolution of diabetes mellitus after gastric banding, gastric bypass, and biliopancreatic diversion.
4. ^ Weight-control Information Network, National Institutes of Health. Gastrointestinal Surgery for Severe Obesity

Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 287th day of the year (288th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ...

External links

• Duodenal Switch Illustration