Duodenal Switch

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Duodenal Switch


diversione - 1


duodenal switch - 1

 

The Biliopancreatic Diversion with Duodenal Switch – abbreviated as BPD/DS – is a procedure with two components. First, a smaller, tubular stomach pouch is created by removing a portion of the stomach, very similar to the sleeve gastrectomy, determining a volume of 200-300cc preserving the pylorus and duodenum. Next, a large portion of the small intestine is bypassed.
The duodenum, or the first portion of the small intestine, is divided just past the outlet of the stomach. A segment of the distal small intestine (250 cm from the ileocecal valve) is then brought up and connected to the outlet of the newly created stomach, so that when the patient eats, the food goes through a newly created tubular stomach pouch and empties directly into the last segment of the small intestine (alimentary limb). The segment of small bowel excluded from the food transit (biliopancreatic limb) is then connected to the alimentary loop 50-100 cm from the ileocecal valve, creating the common channel.

 

Similar to the other surgeries described above, the BPD/DS initially helps to reduce the amount of food that is consumed; however, over time this effect lessens and patients are able to eventually consume near “normal” amounts of food. Unlike the other procedures, there is a significant amount of small bowel that is bypassed by the food stream.
Additionally, the food does not mix with the bile and pancreatic enzymes until very far down the small intestine. This results in a significant decrease in the absorption of calories and nutrients (particularly protein and fat) as well as nutrients and vitamins dependent on fat for absorption (fat soluble vitamins and nutrients). It is necessary to follow the indications in order to reduce the occurrence of smelly flatus and diarrhea, generally controlled by diet.

 

After this procedure it is mandatory the compliance to lifelong nutrient supplementation, which are not absorbed with food.

 

– Multivitamins and iron daily.
– calcium 1200-1500 mg pro/die + vit. D Vitamin D should be taken with your calcium supplement. If you prefer, you can take a combination calcium-vitamin D supplement to avoid taking multiple pills, so long as it contains the proper dosages.

 

Iron:
– if the saturation is ‹ 10% and ferritin ‹ 10 ng /ml or if saturation ‹ 7% it is not considered the ferritin
supplement with ferrous sulfate 325 + 250 of vitamin C each day

 

Folic acid:
If insufficient levels: first supplement vit.B12 and then assume 1 mg of folic acid each day for 3 months

 

VitaminB12:
– if neurological symptoms are present (or if levels < 100 μg/dl ) vit.B12 1000 μg/week I.M. for 4 weeks – if levels 100-150 pg /dl vit. B12 1000 μg I.M. per month and recontrol after 3-4 months – if levels 150-250 pg /dl vit.B12 1000 μg per os or sublingual or spray and recontrol after 3-4 months