Duodenal Switch

Duodenal Switch is a combination of restrictive and malabsorption surgery.  The restrictive part of the Duodenal Switch procedure is achieved via partial gastrectomy (removal of part of the stomach), which reduces the size of the stomach. The malabsorptive component of the duodenal switch procedure is achieved by rearranging the small intestine so as to separate the flow of food from the flow of bile and pancreatic juices.  Reducing the amount of bile and pancreatic juices the food comes in contact with reduces the amount of food that is digested and decreases absorption of some calories and nutrients.

• Patients are able to consume larger meals when compared to more restrictive procedures.
• Stomach function remains intact with normal stomach emptying, and thus "Dumping Syndrome" seldom occurs.
• Better maintenance of weight loss when compared to less malabsorptive procedures.
• The portion of the stomach producing hunger-stimulating hormones is removed.
• Rapid weight loss.

• Excessive weight loss
• Diarrhea
• Anemia
• Bowel obstruction
• Dumping syndrome
• Leakage
• Infection
• Vitamin and mineral deficiencies
• Abdominal hernia
• Combined operations are more likely to lead to complications than purely restrictive operations
• The restrictive portion of the procedure (sleeve gastrectomy) is not reversible.

Roux-en Y

Roux-en Y is a combination of restrictive and malabsorptive surgery, with more of the focus on restriction. The surgeon creates a small stomach pouch and then constructs a “bypass” for food. The bypass allows food to skip parts of the small intestine. Because food bypasses a portion of the small intestine, the body cannot absorb as many calories or nutrients. Like other weight loss procedures, there are advantages and disadvantages to Roux-en Y which include, but are not limited to:

Advantages

• 83.7% of all type-2 diabetes cases are resolved, with resolution often occurring within days of the surgery.
• 96.9% of hyperlipidemia (high cholesterol levels in the blood) cases are resolved.
• 75.4% of hypertension cases are resolved, with 87.1 % being resolved or improved.
• Two-thirds of excess weight is lost.
• The average excess weight loss after a gastric bypass procedure is generally higher than with a purely restrictive procedure.
• Back pain, sleep apnea, high blood pressure, type-2 diabetes, depression and quality of life are improved or resolved.

Risks and Disadvantages

• Poor absorption of iron can cause low total body iron and a greater chance of iron-deficiency anemia. Patients who experience chronic blood loss should be aware of the risk of iron-deficiency anemia.
• Women, already at risk for osteoporosis, should be aware of the possibility of decreased absorption of calcium.
• Metabolic bone disease can occur in some patients, resulting in bone pain, loss of height, humped back, and fractures of the ribs and hipbones.
• Low levels of B12 can lead to chronic anemia.
• The bypassed section of intestine cannot be seen through conventional X-ray or endoscopy if there is bleeding, ulcers or malignancy.