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Loop Duodenal Switch (SADI-S = Sleeve Gastrectomy + Single Anastomosis Duodeno-Ileal bypass) is a modification of the duodenal switch procedure (BPD-DS) that combines both sleeve gastrectomy (sleeve gastrectomy) and gastric bypass surgeries.

As a first step, sleeve gastrectomy (tube stomach) is performed to reduce the volume of the stomach, and then the stomach, which remains plantain-shaped, is anastomosized (mouthed) to the lower part of the small intestine, which is divided into bananas.

Thus, the volume of the stomach is restricted, and the duodenum and the upper part of the small intestine are bypassed. With the newly formed and shortened gastrointestinal tract, the feeling of hunger decreases, and this procedure leads to eating less and subsequently to weight loss.

What is Loop Duodenal Switch?

Obesity surgery, also known as metabolic surgery or bariatric surgery, can be used to make surgical changes in the stomach and small intestines of patients who have obesity problems and meet certain conditions, and to enable the patient to lose weight by limiting the amount of food consumed and reducing the absorption of food.

The coexistence of diabetes, hypertension and high cholesterol-lipid problems in patients is called metabolic syndrome. Obesity surgery is also called metabolic surgery because it eliminates these health problems.

 

Obesity surgery procedures; It can be restrictive (restricting food intake – shrinking the stomach), malabsorptive (disrupting and preventing food absorption – changes in the small intestine) and mixed (having both properties).

 

Duodenal switch surgery, also called loop duodenal switch, is frequently performed to treat obesity problems. Loop duodenal switch surgery is a two-stage surgical procedure combining sleeve gastrectomy and gastric bypass methods.

 

After loop duodenal switch surgery, which has been performed for a long time, patients can lose weight in a short time and get rid of existing health problems such as diabetes and hypertension. Loop duodenal switch surgery, which is frequently preferred as it is a comprehensive weight loss method, can provide effective results in patients who follow a high-calorie nutrition program. At the same time, it can provide benefits for health problems such as cholesterol, diabetes and hypertension.

 

Although approximately 70% of the stomach area is lost within the scope of loop duodenal switch surgery and the patient’s stomach capacity is reduced, there is no negative impact on the normal functions of the stomach. The stomach loses a certain part of its capacity, but continues to function as before. During loop duodenal switch surgery, which is preferred by people who want to lose a large amount of weight, the fundus region of the stomach is removed. In this way, the person can be cured of diabetes.

 

Although it can be said that loop duodenal switch surgery is basically similar to the biliopancreatic diversion method, a larger stomach section is left in this method. Instead of the lower part of the stomach, the left outer part is removed, which is similar to gastric sleeve surgery. Another difference from sleeve gastrectomy performed alone is that a much larger sleeve gastrectomy procedure is performed.

 

Within the scope of the surgery, the function of the muscle structure located in the lower part of the stomach and regulating the entry of consumed food into the intestines continues. The duodenum is separated from the stomach, approximately 2 cm below where the muscle ends, and is closed to the entrance of food. Although the small intestine is marked, unlike biliopancreatic diversion surgery, the last 100 cm is marked instead of the last 50 cm. Since this part, also called the common channel, is kept longer, absorption problems are less common than in biliopancreatic diversion surgery.

 

The connection to the stomach is made from the last 250 cm section, and the connection of the other end is connected to the 100 cm section where bile and pancreatic enzymes are desired to be brought together with the food. The risk of feeding problems is lower than the biliopancreatic diversion method, and the common channel, which is approximately 50 cm in the biliopancreatic diversion method, is approximately 100 cm in duodenal switch surgery. Since the connection between the stomach and small intestine is not made directly to the stomach, but to the protected 2 cm of duodenum, the risk of developing a stomach ulcer is extremely low.

How is Loop Duodenal Switch Surgery Performed?

Loop duodenal switch surgery is performed under general anesthesia and in two different steps. The first stage of the surgery is similar to the first stage of sleeve gastrectomy surgery, in which a large part of the stomach is removed. In the first stage of the surgery, the stomach is turned into a thin tube to restrict the patient’s food intake. In the next stage, the intestine located a few cm ahead of the Pylor region, which is a muscle layer at the exit of the stomach, is cut and separated from the stomach. The cut intestine is combined with the small intestine and the length of the intestine is shortened. Thus, the patient absorbs less fat and absorbs less fat from the food he consumes.

 

In duodenal switch surgery, different methods can be preferred for each patient, depending on the current situation and the surgeon’s preferences. If open surgery, which is the first of these methods, is preferred, the surgery is performed by making a large incision. The large incision may cause some aesthetic concerns after the surgery. Although doctors generally prefer duodenal switch surgery to be performed laparoscopically, that is, closed, open surgery may be performed if a problem occurs during the operation.

 

Laparoscopic duodenal switch surgery, which is performed with a closed surgery technique, is performed by making minimal incisions in the abdominal area. To perform the surgery, the doctor gets help from 2D and 3D images.

 

In addition to open and closed surgical techniques, robotic surgery may also be preferred in patients undergoing duodenal switch surgery. Within the scope of duodenal switch surgery with robotic surgery, entry is made from the patient’s abdomen. This surgery must be performed by a team that is expert and experienced in this field. Because while the surgery is being performed, the process must be monitored with the help of a robotic surgery camera, which allows the image to be magnified in 3D up to 16 times.

After Loop Duodenal Switch Surgery

After duodenal switch surgery, patients are usually kept under observation in the hospital for 1 to 2 days. It is important for the patient to move and consume fluids during this period. In the first days following the surgery, it is important for patients to walk slowly and regularly use the medications recommended by the doctor.

 

Care should be taken to comply with the post-operative diet. Liquid foods should be preferred for the first few weeks, then pureed foods and soft foods should be consumed. Since nutrient absorption will decrease, vitamin and mineral deficiencies may occur. For this reason, the patient should not skip taking nutritional supplements.

 

Physical activity is very important to support weight loss and regulate body functions after duodenal switch surgery. However, heavy exercises should be avoided in the early period. Instead, walking, light exercises and physical activities recommended by the doctor should be preferred. Routine doctor visits should not be interrupted to control the post-operative recovery and weight loss process.

 

After duodenal switch surgery, patients may experience rapid weight loss. In this process, it may be possible for the digestive system to heal and adapt to new changes by applying a special diet list.

Who is Not Suitable for Loop Duodenal Switch Surgery?


Loop duodenal switch surgery, which is an obesity surgery procedure that provides effective results, is not suitable for people with vitamin and mineral deficiencies in their body. Duodenal switch surgery is generally not considered appropriate for people who have chronic diseases, have had surgery in the abdominal area, and have various intestinal diseases.

 

The decision on suitability for duodenal switch surgery is made on a patient-specific basis after evaluations. For this reason, people who have conditions that may prevent surgery should first consult their doctor and wait for the doctor’s decision regarding their suitability for surgery.

Nutrition After Loop Duodenal Switch Surgery


Duodenal switch surgery, one of the most effective obesity surgery procedures, aims to ensure the permanence of the patient’s targeted weight loss. After duodenal switch surgery, which is a surgery that has an absorption-reducing effect, the nutrition process is followed in 5 different steps.

 

Each of these steps, which can be listed as the clear liquid period, rough liquids period, soups period, soft solids period and normal foods period, has different application times. These periods may vary for each patient.

 

Patients begin to follow a strict nutrition program after duodenal switch surgery. Compliance with this plan completely is extremely important for the success of the surgery. Most patients who have duodenal switch surgery lose most of their excess weight within the first 9 months and can continue their daily lives.

What is the Follow-Up After Loop Duodenal Switch Surgery?


The absorption rate of vitamins and minerals after loop duodenal switch surgery will be higher than after biliopancreatic diversion surgery. Accordingly, the need for vitamin and mineral supplements is less. Patients usually stay in the hospital for 4 to 5 days and are then discharged.

 

After loop duodenal switch surgery, patients first start consuming liquid foods. Then gradually switch to pureed foods and solid foods. After duodenal switch surgery, the feeding process is easier since the protected part of the stomach is larger.

 

Loop duodenal switch surgery is generally performed on patients with a body mass index of 40 and above, and it also contributes to the blood sugar control of diabetic patients. It is possible that patients will need lifelong vitamin and mineral supplements after surgery. Especially iron, calcium and B12 rates need to be constantly monitored. If patients are not monitored regularly after surgery, nutritional problems may occur. In some patients, side effects such as diarrhea, protein deficiency, foul-smelling gas and gallstones may occur after duodenal switch surgery.

 

Although the weight loss timeline after duodenal switch surgery may vary from person to person, the fact that there are some general changes cannot be ignored. The fastest weight loss in patients who have duodenal switch surgery is experienced in the first 3 months following the surgery. During this period, patients normally lose approximately 30% of their excess weight. Weight loss occurs more slowly in the next 3 months. 50% to 75% of excess weight can be lost within 1 year after surgery. Weight loss usually peaks 12 to 18 months after surgery and can reach 75% to 85% of excess weight.

 

It can be said that duodenal switch surgery is a serious intervention for a serious condition. Although the surgery involves impressive changes in the way the digestive system works, it brings impressive results. The most important risk of duodenal switch surgery is that nutritional deficiency may develop. If the patient regularly follows the doctor’s recommendations after the surgery and does not skip his routine check-ups, the necessary precautions can be taken to prevent possible negativities. Effective and permanent weight loss thanks to duodenal switch surgery can also eliminate the risks of obesity-related diseases.

 

If due care is not taken regarding the use of lifelong vitamin and mineral supplements after duodenal switch surgery, it is possible to encounter some problems. These include anemia caused by iron and vitamin B12 deficiency, and osteoporosis caused by vitamin D and calcium deficiency. In addition, weakness and extreme fatigue may develop due to energy loss caused by fat and carbohydrates. Although all these situations are among the situations that may develop after surgery; It is possible to minimize the possible risks by following the doctor’s recommendations, using the necessary supplements and not disrupting routine check-ups.

What is the Price of Loop Duodenal Switch Surgery?


The price of loop duodenal switch surgery is determined individually for the patient, depending on the expertise and experience of the surgeon performing the surgery, the price policy of the clinic where the surgery will be performed, how many days the patient will stay in the hospital and many other factors.

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