The duodenal switch (DS) is a variation of the biliopancreatic diversion and also works primarily by malabsorption.

The operation can be performed as an open operation through a midline incision from the base of the breastbone, or laparoscopically. Technically it is a complex operation which can take 5–7 hours to complete, and will usually require a post–op hospital stay of 4–6 days.

A large portion of the stomach is removed by dividing it lengthways along the inner curve (called a sleeve gastrectomy) and the pyloric valve at the bottom of the stomach (which regulates how quickly to stomach contents empty into the small intestine) is left intact. This means that although the food holding capacity of the stomach is reduced, its function remains intact.

A short segment of the duodenum at the base of the stomach is left but the remainder cut and the second half of the small intestine bought up and joined to the duodenum (this part of the operation is very similar to a RNY gastric bypass but is slightly lower down in the digestive tract).

Then, as in the BPD operation, the bypassed section of small intestine is then rejoined to carry bile and pancreatic juices to the latter part of the small intestine near where it joins the large intestine (colon).

Digestion and absorption of fat depends on it mixing with bile (from the liver and normally entering the duodenum). As this mixing does not occur until much further on in the intestine after a DS, the body's ability to digest and absorb calories from fat is severely reduced. As a result weight drops, even when eating quite normally.

Of all the operations, DS is associated with the greatest weight loss (after 2 years 80% of patients have achieved normal weight). However, the risks and side effects are also higher with a DS than with other operations.

The risk of death from surgery is the same as a RNY gastric bypass at 1 in 100 operations. However, about 30% of patients experience major problems with offensive wind and diarrhoea, resulting from the undigested fat and the upset to the normal balance of bacteria in the intestines. This can be minimised by following a low fat diet.

As well as preventing the absorption of fat and calories, the DS also hampers absorption of protein and essential minerals and vitamins such as iron, zinc and Vitamins A, D E and K. This can lead to a life threatening condition called protein–calorie malnutrition. Unfortunately, without regular follow up this condition can creep up and overwhelm the patient before anything can be done to correct it.

To avoid this happening, as well as taking vitamin and mineral supplements, DS patients need to take double the normal intake of protein in their diet for the rest of their life. For this reason a good multi–disciplinary team, and a patient committed to complying with diet, supplement instructions and to attending appointments are both vital ingredients to successful outcomes with this surgery.

Resource: http://bospa.org

A Safe and Effective Surgical Weight-Loss Procedure for Highest-Risk Patients:
A relatively new procedure, the Vertical Gastrectomy/Gastroplasty was developed to minimize postoperative complications for our highest-risk patients. It is ideal for older patients (>50 years old) and extremely obese patients (BMI>50), due to excellent weight loss and minimal incidence of complications or postoperative problems.

How the operation works:
1) The surgeon staples the stomach vertically, removing the part of the stomach responsible for storing the majority of food and causing patients to get hungry.

2) The surgeon then removes about 90-95% of the stomach, leaving a small, thin, tube-like stomach with a capacity of about 2 ounces (50-60cc).
This procedure generally takes about 90 minutes to perform. Patients can expect a hospital stay of 1-3 days after this type of weight-loss surgery and the ability to return to work and normal activities very quickly.

Vertical Gastrectomy Works Safely and Quickly:
Large and rapid weight loss and very few complications - even in patients weighing 500 pounds or more - make VG weight-loss surgery a smart choice for many patients. On average, patients lose 1/2 to 1 pound or more per day after this surgery; we have witnessed weight losses of more than 250 pounds in a year.

Because there is no malabsorption or rearrangement of the intestinal tract, vitamin deficiencies or nutritional problems are almost non-existent after this procedure.

Post-Op Dietary Plan for the Vertical Gastrectomy:
Following surgery, it is imperative that VG patients adhere to a strict postoperative diet. Patients are placed on a liquid-based diet for 2 weeks after surgery; 4-6 weeks after the operation, they graduate to a 600-800 calorie/day solid diet. Most patients can consume about 1000-1200 calories per day once their goal weight is achieved (usually 1-2 years after surgery).

Long-Term Results with Vertical Gastrectomy Weight Loss Surgery:
Patients who undergo Vertical Gastrectomy surgery experience a 70-80% loss of excess weight, on average.

Consider VG Weight-Loss Surgery:
Is Vertical Gastrectomy right for you? First, determine your Body Mass Index, then learn more about the specific requirements and benefits of each type of bariatric surgery we offer.

In recent times outside beauty and staying forever young are the newest trend among today’s society. Women are the highest percentage of this trend because women have been conditioned at young age to believe outer beauty is unsurpassed. Plastic or cosmetic surgery in the past has been kept hushed, never knowing did she have her nose worked on? Today plastic surgery is being embraced by the millions and highly looked upon. Some major causes for plastic or cosmetic surgery come from low self-esteem issues, sexual satisfaction and the need to be accepted as beautiful.

The top five surgical cosmetic procedures in 2004 were: liposuction, breast augmentation, eyelid surgery, rhinoplasty, and facelift. The top five non-surgical cosmetic procedures in 2004 were: Botox injection, laser hair removal, chemical peel, microdermabrasion, and hyaluronic acid. Overall, since 1997, there has been a 465 percent increase in the total number of cosmetic procedures. Surgical procedures increased by 118 percent, and non-surgical procedures increased by 764 percent (ASAPS Statistics).

In recent research from Dental and Health Articles, women who have had cosmetic surgery have found greater satisfaction in their daily lifestyles. The study was published in the January-February 2006 issue of Aesthetic Surgery Journal (Dental and Health Articles). “The benefits of cosmetic plastic surgery appear to go beyond enabling patients to feel better about their physical appearance,” commented Mark Jewell, MD, President of ASAPS, which publishes Aesthetic Surgery Journal (Dental and Health Articles). Low self-esteem is major cause for plastic or cosmetic surgery. Many women feel the need for plastic or cosmetic surgery even close friends of mine. It is no secret that a boost in confidence brings out other good qualities in a person. As research has shown the best way for women to raise their self-esteem according to society is an increase of plastic or cosmetic surgery use.

More importantly with more research available now the concept of wanting a better self-image and the need to feel confident is one of the more reoccurring reasons women have plastic or cosmetic surgery. In a recent study, Dr. Sarwer, found that a year after receiving cosmetic surgery, 87 percent of patients reported satisfaction following their surgery, including improvements in their overall body image and the body feature altered. With this in mind the increase in plastic or cosmetic surgery has increased because of the need to feel perfect. Having low self-esteem is from not feeling ideal. Repairing the part of the body needing work by elective surgery is the only cure to feel whole by today’s standards.

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In the late 1960’s and 70’s, Dr. Edward Mason began use of a procedure called Roux-en-Y gastric bypass (RYGB), also a malabsorptive procedure. This has since become the surgery of choice. Over 75 percent of surgeons prefer using this procedure because risks are minimal and can be treated.

During surgery:

A surgical device places parallel lines of staples diagonally across the upper end of the stomach and cuts between the lines, partitioning the stomach into two uneven parts. (Some surgeons only staple and do not cut, leaving the stomach in one piece, but divided by the staple line.) The upper pouch is the only part of the stomach that food will enter after the surgery. This pouch is about the size of a golf ball and can hold 20-30 ml. The amount of food a patient can consume in one meal after this surgery is severely restricted.
The surgeon then chooses a point along the small intestine and cuts it. The end of intestine that is no longer joined to the stomach is brought up and sewn on to a hole in the new pouch, creating an outlet for food and bypassing the first section of the small intestine. The end of intestine that drains from the lower (now unused) portion of the stomach is connected to the part of intestine that now exits the pouch. This allows digestive juices formed in the lower portion of the stomach to mix with the food after it leaves the pouch. The intestinal bypass causes some of the food consumed to be absorbed incompletely.

What’s the difference?

Laparoscopic Roux-en-Y gastric bypass is identical to the traditional gastric bypass except that instead of being performed through an incision extending from the lowest aspect of the breastbone (xiphoid process) to the umbilicus (navel), it is performed through several smaller incisions each measuring about an inch or less in length. A laparoscope connected to a video camera is inserted into the abdominal cavity and the surgical field is visualized on video monitors in the operating room. Long thin surgical instruments are inserted through additional small incisions and the surgeon performs the surgery by watching the video monitor. The operation is performed in a virtually identical manner whether it is done laparoscopically or open.

History of the Lap-Band System:

The Lap-Band was first brought about in the 1980’s by a doctor by the name of Lubomyr Kuzmak. The Bioenterics Company took over the original design and attempted to perfect it. Inamed Company purchased Bioenterics and continued work on the Lap-Band. Finally in 1993 a Dr. Mitiku Belachew placed the first Lap-Band in Belgium. Although may people still travel out of the states to have this procedure done, the FDA approved the Lap-Band system in 2001. Surgeons have now preformed over 120,000 procedures, while gastric bypass is still the most common weight loss surgery, the Lap-Band system is by far the most popular.

How the Lap-Band works and who it is for:

The Lap-Band is a procedure preformed through several small incisions with the aid of a fiber optic camera and other specialized instruments. During the surgery an adjustable band is placed around the top part of the stomach to create a small gastric pouch to avoid cutting the intestines. A portion of the tube connects the band to the adjusting port that is placed under the skin in the abdominal wall allowing easy access for adjustments. The inner lining of the band is a balloon that is filled with saline to narrow the opening of the stomach, limiting the amount of food that is able to pass. Saline is either added or withdrawn through a needle and syringe placed in the port. Both the surgery and adjustments are minimally painful. The best part of the Lap-Band is that it is totally adjustable and reversible. So if for example a patient becomes pregnant the physician would simply drain the band for the duration of the pregnancy and then slowly refill it after the baby is born. Although it is not necessary to remove the band after one reaches the goal weight but it is possible to do so.
Provided patients follow the instruction by choosing the right foods and exercise after the procedure most patients will lose between 50 and 75% of the excess weight. The Lap-Band is said to be much safer than other weight loss surgeries mainly because it is minimally invasive and the weight comes off at a much slower rate than with surgeries such as the gastric bypass.
The Lap-Band is designed for those who have dealt with morbid obesity for a long period of time. One is generally 100 pounds or more over weight, with a minimum age of 16 and a maximum of 65. A require BMI of 30-60 and proven 3 weight loss technique failures. It is not necessary to have a physician referral to have the surgery performed. Once these requirements have been met there is a list of things that must be done before the physician will perform the surgery.

Requirements:
1. You must attend a lecture on the procedure
2. You must have a personal consultation with a counselor
3. You must pay the fees
4. You need a mental health evaluation, a dietician evaluation and a physical evaluation
5. You must attend some pre-operative groups

After the surgery a patient can expect to spend one day in the hospital, then 2-3 days of limited activity. There is first a liquid diet, which then moves in to pureed food, such as yogurts etc. After you can handle those you move to mechanical soft foods and finally back to solid foods. There are some foods you may not be able to have anymore but that depends on the patient. The lap band gives you a feeling of being full and limits food intake. It trains patients to eat slower and in moderation. Patients are also encouraged to engage in physical daily activity and are also encouraged to take vitamins as they may not get all of the nutrition they need with the diet changes. http://http://www.alighterme.com/surgery.html