Super Obesity Surgery

A less popular form of weight loss surgery appears to be better than the standard type currently done in most centers. For so-called “super obese” patients, it could mean a better result. It’s called the biliopancreatic diverserion with duodenal switch. Like the older surgery, called the roux-en-y bypass (roo-en-y) gastric bypass surgery, it cuts the stomach and diverts the intestine. But this does it differently, resulting in a greater amount of excess body weight that is lost. You wouldn’t know it now, but Emilio Vingna piano, at 5 foot 8 inches tall, used to weigh 380 pounds. “Very difficult sleeping, very difficult time breathing, very difficult time functioning on every and any level just because you are carting around excess weight. I didn’t think I would reach 50 years old uh because of uh the amount of strain on your heart and respiratory system as a whole,” says Emilio. But he’s lost 200 pounds, thanks to this lesser known surgery more commonly called the duodenal switch—a procedure intended for super obese patients. Obesity is 30 and over.

A super-obese person is classified as having a body mass index of at least 50. In the duodenal switch, roughly one half of the stomach is permanently removed. The stomach is then connected to the last 8 feet of small intestine. The remainder of the small intestine is connected from the end of the small bowel to merge and form a common channel where food mixes with digestive enzymes.

Dr. Mitchell Roslyn, Chief of Bariatric Surgery at Lenox Hill Hospital, says “A gastric bypass is predominantly an “eat less” operation that has some malabsorption. The duodenal switch is both a strong “eat less” operation as well as a strong malabsorption operation. And by malabsorption, I mean more food is passed and less calories are absorbed.”

Now, new research shows a greater weight loss with the duodenal switch: 173.5 lb versus 118.0 lb with gastric bypass at 36 months after surgery. But there are downsides to the procedure: The duodenal switch is a substantially "bigger" operation than the gastric bypass. It’s technically more complex, it permanently removes a portion of the stomach, making it irreversible, and there are significant nutritional risks.

“We really reserve our duodenal switches for people who have real strong weight problems and also have a fairly high degree of education both in life and about the operation so they understand the importance of supplements and follow up.. And even that’s not perfect,” says Dr. Roslyn. The duodenal switch has, in every way, given Emilio a new life. “I can bend over and tie my shoelaces relatively easily, I can walk up many flights of stairs without becoming breathless, I can go play baseball with my son. You know everything has been changed dramatically,” says Emilio.

One in 400 U.S. adults classify as super-obese—again a BMI greater than 50. Problems like diabetes, high blood pressure and high cholesterol were more frequently improved with the duodenal switch than with gastric bypass. In the study one of 198 duodenal switch patients and none of the gastric bypass patients experiencing 30-day mortality. The one 90-day mortality in the duodenal switch group (0.5%) was presumed to be due to a pulmonary embolism three days after being discharged on postoperative day three.

However, it is necessary to take a number of nutritional supplements after the operation than after gastric bypass. These include: • Multivitamins (usually twice per day) • Iron supplements (usually twice per day) • Calcium (usually twice per day) • DAKE’s (fat-soluble vitamins) usually 3 times per day Additionally, there are some very significant side effects that accompany this procedure, including: • Frequent soft bowel movements (up to 4-6 per day) • Frequent passing of foul-smelling gas • Change in body odor • Gas pains and bloating • Hair loss • Intolerance of certain foods (varies from person to person)