Laparoscopic Duodenal Switch

These operations combines removal or exclusion of 2/3rds of the stomach along with a long intestinal bypass which significantly reduces the absorption of fat. The capacity to eat is greater than with the other operations, and the eventual weight loss is the best of all the operations but if fatty foods are overeaten e.g. a hamburger and fries then diarrhoea and foul flatus will result.

Bilio Pancreatic Diversion BPD

This operation combines removal or exclusion of 2/3rds of the stomach along with a long intestinal bypass which significantly reduces the absorption of fat. The capacity to eat is greater than with the other operations, and the eventual weight loss is the best of all the operations but if fatty foods are overeaten e.g. a hamburger and fries then diarrhoea and foul flatus will result.

Advantages:

• Greater stomach capacity (200-250 mls) therefore can eat a small main meal instead of an entrée portion
• Best weight loss of all techniques 70-90% EWL over 2yrs
• Weight loss is well maintained
• Adjustable and partially reversible, but only by further surgery
• A very good option for revision if other techniques have failed

Disadvantages:

• Open operation (usually), therefore greater operative risks e.g infection, Bowel leak, Clots to legs and lungs wound infection and hernia, chest infection. Risk of Death 1:200
• Malabsorbtion to some minerals vitamins and Protein. Patients must commit to taking lifelong supplements of the fat soluble vitamins (A D E K) Calcium and sometimes Iron
• Risk of deficiency state e.g. Iron deficiency anaemia or osteoporosis if supplements not taken
• Take longer to recover (6-8 weeks off work)
• Increased stool frequency 2-4/day
• Flatulance if fatty foods eaten

Residual stomach capacity 200mls and Estimated weight loss is 70-90%EWL at 2 years.