Duodenal Switch vs. Stomach Stapling

Duodenal Switch

A Lighter Me does not recommend the duodenal switch procedure. A gastric sleeve operation is more affordable and often has less complications.

Overview

Duodenal switch surgery combines a sleeve gastrectomy and an intestinal bypass. During this procedure, approximately 60 to 70 percent of the stomach is removed; this results in the stomach forming into the shape of a tube. After that, two thirds or more of the intestine is bypassed, which leaves only a few feet inside the intestine where digestive enzymes and food can meet; this causes malabsorption. After surgery, the body will be unable to absorb a majority of the calories and nutrients that are eaten, so very high weight loss often occurs. This procedure got its name because the duodenum, the first part of the intestine, is divided and attached to the lower section of the small intestine. The pylorus, the outlet muscle that controls the emptying of the stomach, is preserved during this surgery; this often results in dumping syndrome. This surgery has been shown to result in the most reliable and longest lasting results of all weight loss procedures.

Patient Eligibility

Good candidates for this surgery have a body mass index (BMI) greater than 40. Individuals with lower BMIs may still be eligible for this procedure if they have weight-related medical problems.

Average Weight Loss Results

Most patients lose between 60 and 80 percent of their excess body weight over a 2-year period. Ten years after surgery, most patients have shown to still have a total weight loss of approximately 70 percent.

Recovery Time

The average recovery time is between 3 and 4 weeks.

Common Side Effects

After duodenal switch surgery, patients often experience decreased absorption, which causes more frequent and looser bowel movements and increased flatulence. Patients should also be closely monitored for vitamin, mineral, and protein deficiencies, due to the decrease in the absorption of nutrients.

Cost

Most insurance companies will not cover this surgery, and it can cost as much as $20,000.

References:

http://www.columbiasurgery.org/conditions-and-treatments/duodenal-switch-bpd-ds

Stomach Stapling (Vertical Banded Gastrectomy)

A Lighter Me does not recommend the stomach stapling procedure. A gastric sleeve operation is more affordable and often has less complications.

Overview

Vertical banded gastrectomy is one of the oldest forms of surgery for weight loss. It is used to limit the amount of food that can be eaten. It does not alter any part of the digestive process, and none of the stomach is removed. During this procedure, the upper part of the stomach near the esophagus is stapled vertically. This creates a small pouch. The rest of the stomach is then banded, leaving a small opening at the bottom of the small pouch, which opens into the larger portion of the stomach. A mesh or plastic tissue is placed around the small opening to prevent stretching. This process is known as a restrictive surgery because it limits the amount of food that can be consumed at one time, which causes patients to feel fuller faster. After surgery, most meals must be limited to approximately one ounce. This surgery does not typically cause malnutrition or dumping syndrome. The entire procedure typically lasts between 3 and 4 hours. Vertical banded gastrectomy surgery is reversible, but the procedure to do so is quite complex.

Patient Eligibility

In general, candidates for this procedure will either have a BMI over 40 or a BMI between 35 and 40 plus weight-related health problems. Women who are 80 pounds over their goal weight and men who are 100 pounds over their goal weight are also good candidates for this surgery.

Average Weight Loss Results

On average, most patients are able to lose approximately 50 to 60 percent of their excess body weight after one year. Weight gain can happen easily if the patient does not adhere to consuming very small portions of food and drinks.

Recovery Time

If the surgery is performed laparoscopically, the patient will need to remain in the hospital for 2 or 3 days. If it is performed in an open surgery, then the hospital stay is longer, usually 4 or 5 days. Patients will initially need to follow a liquid diet and gradually move onto thicker liquids and soft foods. After about one month, most patients are able to eat solid foods and return to normal activities.

Common Side Effects

Patients may experience side effects such as reflux, stomal stenosis, incisional hernia, staple-line disruption, intolerance to the band, gastric leak, bleeding, fistulas, pulmonary embolus, and peritonitis. More commonly, side effects such as vomiting can occur if a strict diet is not followed, if food is not chewed properly, or if food is eaten too quickly.

Cost

The average cost of this procedure is $20,000 to $25,000. Insurance may cover a portion of the cost.\

References:
https://obesitynewstoday.com/vertical-banded-gastroplasty/
https://www.hopkinsmedicine.org/healthlibrary/test_procedures/gastroenterology/gastric_stapling_restrictive_surgery_procedure_92,p07989