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- Hi there, I'm Dr. John Tann
with Metabolic and Bariatric Specialists.
Just wanted to talk to you about the duodenal switch.
There's a lot of questions about what a duodenal switch is
and there's been a lot of history around different types
of bypasses and switches and biliopancreatic and you'll hear
all these words when you look up stuff online.
What I want you to focus on is what we're doing now
and it's really important and it's one of the best surgeries
that we've looked up and found and discovered
for severe obesity and severe diabetes.
It's even more effective with diabetes than
the gastric bypass, which is already extremely effective.
But when we look at people that have a BMI of 60 and 70
and 80, 90, 100, there's more severe disease there
and we're seeing more of that
as obesity and metabolic disease progresses.
And so with a duodenal switch
it's a little bit of a combination
between the gastric bypass and the gastric sleeve.
We're getting elements from both which is what allows us
to make it a better, more effective surgery
for severe disease.
So when we look at a gastric bypass and gastric sleeve
and duodenal switch we're talking about 60% and 70%
and this is gonna be 80% excess body weight on average.
And so it's a little bit more in terms
of the amount of weight loss that you're going to get.
So when we're doing the duodenal switch
you're gonna get partial sleeve.
So it's not gonna be the same really tight sleeve
that we saw before with a gastric sleeve.
This is gonna be part of a switch sleeve 'cause I want you
to have a little bit more room to intake food.
But I still want to capitalize on removing those hormones
and that gut-signaling that your stomach does.
And then we counted down from the top before
with a gastric bypass.
Here we're counting back from the end.
So where the small bowel goes into the colon
at the terminal ilium,
we go find that section,
and we count backwards around 300 centimeters
and we bring that up and we're gonna hook that in.
But before we do that,
the reason that the duodenal switch is a trickier procedure
is because of the dissection
that we have to do around the duodenum.
After the stomach ends, which is about right here,
we need to dissect down the duodenum about 3 centimeters,
which is not very far,
and make sure that we don't hurt any
of the pancreatic drainage, any of the liver drainage,
and get a good portion to go across with our stapler load.
And so that's gonna be about right here
'cause I want to have the natural stomach valve
still left in place.
And then that's where we're gonna hook up
the ileum to the duodenum.
So that's gonna be an ileo-duodenostomy,
which is the fancy word where we connect those.
So this is what that looks like.
So we bring up this loop
and this is gonna be a loop
that the anastomosis is right here
on that duodenum right there at the end of the stomach.
And this is gonna be 300 centimeters
which means we have about 300 centimeters on this side.
So now the food comes down
and goes into this stomach and digestion starts here.
Well, where the enzymes coming from?
Remember, imagine if you will, that area that we saw,
those pancreatic, and the liver enzyme is draining out.
And those are gonna come down.
They're gonna go through this all this 300
and then they're gonna come all the way up here
and that's where they're gonna interact with the food.
And then that's where digestion continues
for the rest of the way out after that.
So a little bit less digestion
and a little bit of that stomach change.
And that's what makes this a little bit more effective.
And this is gonna be about that 90% more effective
at curing really severe diabetes.
And this is gonna be an option even for people
that have a bypass that still have persistent disease
and have a gastric sleeve and still have persistent disease.
We can change them from those to a duodenal switch.
We do a lot of duodenal switches
and that's really important when you're looking at this type
of procedure because you need extra special care
and extra special multidisciplinary teams taking care of you
when you have more severe disease.
So that is the duodenal switch.
If you have more questions about this, please let me know.
Otherwise, we'll look forward to talking to you
in later episodes.
Thank you.
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