Duodenal Switch
LapDS reconfigures the intestines so fewer calories are absorbed and reduces the capacity of the stomach so that food intake is restricted resulting in progressive, sustained weight loss. The stomach is reconstructed into a cylindrical tube, allowing more room for food compared to purely restrictive bariatric procedures thus permitting an eating pattern and diet much closer to normal.
Our surgeons developed a method of using the laparoscope to perform this procedure, resulting in smaller incisions, minimal scarring, less discomfort, faster recovery and shorter hospital stay. The Laparoscopic Duodenal Switch achieves an average loss of 50 percent of excess body weight at six months and 90 percent at two years. By combining moderate restriction and moderate malabsorption, the LapDS minimizes complications associated with older bariatric procedures and limits weight regain seen with other procedures.
Risks
Similar for all obesity procedures, there is risk of leak, obstruction, wound infection, hemorrhage, deep vein thrombosis, possible readmission and reoperation. Major complications occur in 6% of patients and minor complications in 10%. We have had no mortality in our laparoscopic series. There have been 3 operative deaths among our patients operated on using a conventional open laparotomy incision. Combined mortality is under 1% in our series.
Vertical Gastrectomy
The Vertical Gastrectomy reduces the gastric capacity to approximately 3 ounces by removing the greater curvature of the stomach. This approach preserves the normal gastric emptying through the pyloric valve and effects excellent initial weight loss with a minimum of side effects and the avoidance of foreign body placement. Dietary patterns will be adjusted to promote long-term durable weight loss.
This procedure is done laparoscopically.
Risks
Although the same risks are present, the chance of a leak is extremely low as there are no anastomoses done. In addition, most post-operative problems are related to the length of surgery, blood loss, fluid shifts, etc. In this procedure, because of its simplicity, the risks of these complications are reduced.
Roux-en-Y Gastric Bypass
This procedure constructs a small pouch at the top of the stomach to limit meal size, generally to one ounce or less. A limb of small intestine is then joined to the pouch to reestablish alimentary continuity with the flow of digestive enzymes. An excess weight loss at 18 months ranging from 45 to 75 percent following this procedure can be expected and is fairly well maintained. This operation is also routinely performed laparoscopically.
Revisional Surgery
Revisional bariatric procedures can be performed when a previous weight loss procedure results in inadequate or excessive weight loss or has led to complications. The malabsorptive component is partially or completely reversible in cases of excessive weight loss following prior malabsorptive procedures.
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