Bret Hollander

Lap Band, Gastric Bypass, Liquid Protein, South Beach Diet – what is the best bariatric weight-loss solution that will keep the weight off permanently, even if you have an insatiable appetite, and live by the mantra of “I live to eat”!

All weight loss surgeries work by making the stomach smaller (restrictive procedures) and/or creating changes in the digestive tract which do not permit the body to absorb all of the fats in the food you eat (called malabsorptive procedures).The Duodenal Switch (DS) is a combination restrictive and malabsorptive surgery. The stomach is made smaller and the intestines are rerouted so that you can’t absorb all the food you eat. Because of this malabsorption it’s essential that you monitor your vitamin levels and take your prescribed vitamins for the rest of your life. It’s also the malabsorption that can cause diarrhea if you eat too much fat. The undigested fat in your colon can cause gas problems, but they usually improve in the first 6 months after surgery.

The DS is similar to the Roux en-Y Gastric Bypass (RNY) with respect to the intestinal bypass (malabsorptive) portion of the procedure. The lower part of this surgery is basically the same as a distal RNY. RNY’s are done either proximal (with a shorter length of the intestines bypassed) or distal (with more of the intestines bypassed). Studies have shown that people who have distal bypasses have greater success at losing large amounts of weight and keeping it off.

The RNY and DS are very different with respect to what is done at the top end of the surgery — the portion involving the stomach (the restrictive aspect of the surgery). The RNY doctors do a variety of things to make the stomach smaller — most create “pouches” or transect (divide) the stomach. They then reroute the intestines by connecting them directly to the new stomach pouch, bypassing the duodenum. In the RNY/pouch procedures, the pyloric valve (which regulates the emptying of stomach contents into the duodenum) is bypassed and therefore doesn’t function after surgery.

In the DS procedure, the surgeon creates a smaller stomach by removing about 75% of the stomach (which is called a partial gastrectomy). The top part of the gastric bypass is connected below the duodenum which keeps the upper part of the digestive process the same as before surgery (except that your stomach is smaller). Your pyloric valve continues to regulate the emptying of the stomach contents into the duodenum and all of the hormones and secretions that occur in the duodenum continue after surgery.

In RNY/pouch procedures, the duodenum and pyloric valve are bypassed and the intestines are connected to the newly created stomach pouch. Dumping happens when the stomach contents (unregulated by the pyloric valve which has been bypassed) dump directly from the new stomach pouch into the intestine. Eating sugars can cause dumping for many RNY/pouch patients. For this reason, they must be very careful of sugars. Some feel that this type of surgery with the dumping syndrome is the best option for people who eat a lot of sweets, since the dumping acts as a deterrent to eating sweets.

Since our pyloric valve and duodenum are left functioning as before, we DS patients don’t have dumping syndrome, nor a risk of staple line problems, clogging of the anastamosis, ulcers at the stoma, etc. (remember, we don’t have pouches or stomas). So, we don’t have the problems with “stretching” the pouch or getting something stuck in the stoma — because what we have is our real stomach, connected the same way it was before surgery to the duodenum.

Good luck in sorting all of this out!! Of course, I’m biased but I believe the Duodenal Switch is the best surgery for morbid obesity.