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The duodenal switch (DS) procedure, also known as biliopancreatic diversion with duodenal switch (BPD-DS) or gastric reduction duodenal switch (GRDS), is a weight loss surgery procedure that is composed of a restrictive and a malabsorptive aspect.

The restrictive portion of the surgery involves removing approximately 70% of the stomach along the greater curvature.

The malabsorptive portion of the surgery reroutes a lengthy portion of the small intestine, creating two separate pathways and one common channel. The shorter of the two pathways, the digestive loop, takes food from the stomach to the common channel. The much longer pathway, the biliopancreatic loop, carries bile from the liver to the common channel.

The common channel is the portion of small intestine, usually 75-150 centimeters long, in which the contents of the digestive path mix with the bile from the biliopancreatic loop before emptying into the large intestine. The objective of this arrangement is to reduce the amount of time the body has to capture calories from food in the small intestine and to selectively limit the absorption of fat. As a result, following surgery, these patients only absorb approximately 20% of the fat they intake.

Advantages
The primary advantage of duodenal switch (DS) surgery is that its combination of moderate intake restriction with substantial calorie malabsorption results in a higher percentage of excess weight loss versus a purely restrictive gastric bypass for all individuals In a Systemic Meta Analysis of the weight loss surgical procedures Buckwald et.al . Type 2 diabetics have had a 98% "cure" (i.e. became euglycemic) almost immediately following surgery which is due to the metabolic effect from the intestine switch. The results are so favorable that some surgeons in Europe are performing the "switch" or intestinal surgery on non-obese patients for the benefits of curing the diabetes.Novel operations are geared toward the treatment of diabetes and not necessarily to induce weight loss. Among the most prominent of these operations are the duodenal-jejunal bypass and ileal transposition where duodenal switch is a part of the operation.

The following observations were reported on the resolution of obesity related comorbidities following the duodenal switch: type 2 diabetes 99%, hyperlipidemia 99%, sleep apnea 92%, and hypertension 83%.

Because the pyloric valve between the stomach and small intestine is preserved, people who have undergone the DS do not experience the dumping syndrome common with people who've undergone the Roux-en-Y gastric bypass surgery (RNY). Much of the production of the hunger hormone, ghrelin, is removed with the greater curvature of the stomach.

The summarized data can be found on a poster- comparative poster

Diet following the DS is more normal and better tolerated than with other surgeries.

The malabsorptive component of the DS is fully reversible as no small intestine is actually removed, only re-routed.

Disadvanteges

The malabsorptive element of the DS requires that those who undergo the procedure take vitamin and mineral supplements above and beyond that of the normal population, as do patients having the RNY surgery. Commonly prescribed supplements include a daily multivitamin, calcium citrate, and the fat-soluble vitamins A, D, E and K.

Because gallstones are a common complication of rapid weight loss following any type of weight loss surgery, some surgeons may remove the gall bladder as a preventative measure during the DS or the RNY. Others prefer to prescribe medication to reduce the risk of post-operative gallstones.

Like RNY patients, DS patients require lifelong and extensive blood tests to check for deficiencies in life critical vitamins and minerals. Without proper follow up tests and lifetime supplementation RNY and DS patients can become ill. This follow-up care is non-optional and must continue for as long as the patient lives.

DS patients also have a higher occurrence of smelly flatus and diarrhea, although both can usually be mitigated through diet, including avoiding simple carbohydrates.

The restrictive portion of the DS is not reversible, since part of the stomach is removed. However, the stomach in all DS patients does expand over time, and while it will never reach the same size as the natural stomach in most patients, some stretching does occur.

Risks

All surgical procedures involve a degree of risk however this must be balanced against the significant risks associated with severe obesity.

Some of the surgical risks or complications for this procedure are: perforation involving small bowel, duodenum, or stomach causing a leak, infection, abscess, deep vein thrombosis (blood clot), and pulmonary emboli (blood clot traveling to the lungs).

Longer term risks include the possibility of vitamin and mineral deficiency, hernia and bowel obstruction. There is little information as to the longer-term risks (greater than 15 year), as this procedure was very rarely performed prior to the year 2000.

Malnutrition is an uncommon and preventable risk after duodenal switch.

For more information or to schedule a Duodenal Switch please send us an email

State of the Art technology and procedures done in State of the Art facilities!  Our Doctors only use the finest  hospitals in Puerto Vallarta, ones that are state of the art, with clean, sterile, and the very best equipment available.  The operating rooms are designed specifically for bariatric surgery and the doctors make sure that they have met all of their requirements.

When you are in Puerto Vallarta and your doctor is providing you service during your medical tourism vacation, if there is an emergency you may contact the doctor, 24 hours a day via telephone or email.  Someone will be available to assist you!

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Please feel free to contact us with any questions, concerns, that you may have regarding our services. If you would like to contact us via e-mail, please forward your information to info@drjoya.com and one of our friendly staff members will contact you directly or via email within 24 hours.  We can provide you with a risk free price quote based on the information you provide.  You may also call us toll free at 866.509.0571 or 817.405.2778
At DRJOYA.com we are all well trained, and bilingual, speaking both English and Spanish.  We have been working in the Medical Tourism industry for more than 15 years.  By selecting to have your surgery with us, you not only get the best doctors in Puerto Vallarta to assist you during your surgery, you also get top notch care before surgery, where you questions are answered usually in less than 24hours, to post op where we are here for you as well.  If you don't have insurance and are looking to go overseas for weight loss surgery, then let us bring you to beautiful Puerto Vallarta.  Our staff will get you the answers to your questions and assist you with getting all of your travel preparation needs in order.  Our staff will also assist you with any other specific needs you may have.  

All of the Doctors and staff that work with our doctors speak English and are University trained.  The Hospitals are also accredited and are located  in the heart of Puerto Vallarta and accessible from every hotel.  The hotel and hospitals are about 10 minutes from the airport. 
We are completely committed to delivering quality medical care to prospective patients.  With our doctors you not only get the best doctors in Mexico for your surgery, but you also get doctors who specialize in the Gastric Bypass, Gastric Sleeve surgery, Gastric Bypass Revision surgeries, Duodenal Switch Surgeries and doctors who have helped patients worldwide lose millions of pounds a year, and all of these treatments can be done at savings over what they cost in the US. The  hospitals in Puerto Vallarta have been approved by and work with most major American Insurance companies.

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