Laparoscopic Duodenal Switch

Duodenal Switch
What is a laparoscopic duodenal switch?
It is an operation to reduce the size of the stomach and then create a new stomach pouch and bypass. This means that food does not need to go through the stomach. It is achieved by grafting (attaching) a piece of intestine onto the pouch so that food passes through the pouch and down the bypass. Part of the intestine is left in place to take digestive juices and bile to the large bowel. These are needed in the bowel to break down waste products (food not needed by the body).
Why might I need a laparoscopic duodenal switch?
It is performed for helping very overweight patients achieve substantial and permanent weight loss. This is because it restricts both the amount that someone can eat, but also it reduces the amount of calories absorbed from food that is eaten.
What does laparoscopic mean?
The operation is carried out laparoscopically, which is also known as keyhole surgery. This means that the surgeon makes five small incisions (cuts) in the abdomen (belly) to get to the stomach. The surgeon may decide to convert to an open procedure (the conventional way of carrying out this operation through a longer incision) if they think it would be safer.
What does the operation involve?
The operation takes approximately three hours. For some patients, the surgery can be technically difficult depending on body-build or previous surgery. In these circumstances the operation can take longer.
Before the operation
You will come into hospital (sometimes called your admission) on the day of surgery.
You will wear anti-embolism socks (like very tight stockings) to prevent blood clots forming in your legs.
The anaesthetist will see you before or on the morning of surgery.
After the operation
You will be in the High Dependency Unit for one night.
You will probably have:
1. Oxygen and a tube in your nose (NG tube)
2. A drip in your neck (central line)
3. An epidural or morphine machine to control your pain
4. A wound drain to remove excess blood and fluid (2 days)
5. A catheter to drain your bladder (for one day).
6. If there are no leaks, you will be allowed to sip water and as soon as your intestines are working, you will be able to start increasing your fluid intake and then start a liquid diet.
You may need laxatives to help you regularly open your bowels.
The physiotherapist will help you to exercise and to get out of bed.
You will probably be ready to go home three days after the operation.
You may have dissolvable stitches (that disappear naturally after a while)
We will arrange regular appointments for follow up tests and scans.
At home
You will feel tired for about one months but can generally go back to work after two to three weeks.
Take gentle exercise.
No heavy lifting, such as children, luggage. You will need to arrange some assistance if lifting is part of your everyday life.
Do not drive until you are able to depress the brake pedal hard enough to perform an emergency stop.
Keep the wound clean by taking a shower rather than a bath.
Watch for signs of wound infection such as:
1. pain
2. redness
3. swelling
4. discharge (oozing)
Are there any risks from the surgery itself?
This is a common and safe procedure, but every procedure has some risks associated with it. These are related to the anaesthetic and the surgery itself:
Bleeding may occur during the operation. If this happens, you might need a blood transfusion which will be done at the same time as the operation.
Damage to internal organs: this can happen as a result of placing instruments in the abdomen. This is rare (1 in 1000) but higher in patients who have previously had surgery to the abdomen. If an injury does happen, open surgery may be needed which involves a much bigger cut.
Leaks from staple line: This may require fasting (not eating or drinking), antibiotics and intravenous fluids in order for the perforation to heal. In some cases you may require additional surgery.
A blood clot may occur in the legs or in the lungs which means you will require medication to keep your blood thin for several weeks or months.
Hernia can occur as a result of the incisions into the abdomen but it is less likely with laparoscopic surgery as the incisions are quite small.
Infection: can occur in the wounds, lungs and urine, in fact anywhere because of the nature of the surgery and the tubes into and out of your body post-operatively.
Heart Attack: This can be as a result of the physical stress of surgery or pre-existing heart problems
Overall the figure published in medical journals for all these risks together ranges from 5% to 20%. Therefore we believe 15% is a reasonable figure to have in mind. In most patients these complications will be mild, but in a small proportion may lead to an emergency re-operation, a period in intensive care and / or extended hospital stay.
Death: the risk of death at the time of operation is very small but the complications just about 0.5%
Long Term Consequences of Duodenal Switch
Under emergency circumstances it may be possible to restore most of the changes that we will make to the digestive tract. However, for practical purposes this operation is not completely reversible.
For your safety you must remain under medical follow-up for the rest of your life, with several visits to the doctor / hospital in the first year and at least an annual visit thereafter.
We view this as a partnership between you and us. It is very important that you understand you will be taking the major share of the responsibility, by coming to the appointments that we send you.
The long term biochemical consequences (how it affects the blood) of this operation are regarded internationally as much less serious than with other kinds of bypass. However, other effects include:
1. cases of kidney stones and kidney failure
2. low bone density
3. other serious problems.
The operation will make you permanently dependent on vitamin and mineral supplements taken by mouth, including iron and zinc.
It is quite possible you will require regular injected supplements of Vitamin B12, Vitamin D and Vitamin A, to remain healthy.
We normally advise our patients to have blood-tests at regular intervals to check whether these injections are needed.
Malabsorption (when the body does not break down food normally) of food as a result of the surgery can cause:
1. diarrhea (up to 6 bowel movements a day)
2. and smelly wind (flatulence).
These symptoms can lessen 6 months after surgery.
Are there any benefits from the surgery?
This surgery is a proven method of weight loss.
When combined with a supervised diet, increased activity and behaviour modification, it can lead to long-term weight loss and the associated health benefits.
Weight loss is more than with non-surgical programmes alone and can be more than other gastric bypass surgery.
Average excess weight loss is 60 to 70% (for example, if a patient is 10 stone over weight then we would expect him/her to lose on average 6 to 7 stone).
Balancing Risks
We feel it is important for patients to have a clear view of the commitments and risks attaching to this surgery. However, these have to be balanced against the longer term risks of remaining severely overweight.
We advise that you discuss these issues carefully with appropriate family members or friends.
Because the two sets of risks occur on a different timescale, it may be difficult to weigh one against the other.
Therefore please ask whatever questions you wish.
Any questions?
If you have any questions or worries, please contact the Obesity Service for advise on 020 71008083
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