If you are Type 2 and considering WLS...

Have you heard of the Duodenal Switch (DS)? It has the best chances of curing your diabetes than any other WLS procedure. The DS in the US is a 2-part procedure--vertical sleeve gastrectomy for the stomach, and duodenal switch for the intestines. Here is a study that talks about how the duodenal switch alone (without touching the stomach) can even be successful in curing type 2 diabetes for NON-morbidly obese patients (bold red font added for emphasis):


The DS minus the stomach resection is performed in Europe for cure of diabetes in the NON morbidly obese:

Duodenal Switch without Gastric Resection: Results and Observations after 6 Years Journal Obesity Surgery Publisher Springer New York ISSN 0960-8923 (Print) 1708-0428 (Online) Issue Volume 14, Number 10 / November, 2004 DOI 10.1381/0960892042583851 Pages 1354-1359 Subject Collection Medicine SpringerLink Date Friday, August 24, 2007

Duodenal Switch without Gastric Resection: Results and Observations after 6 Years

Maria Laura Cossu¹, Giuseppe Noya², Gian Carlo Tonolo³, Stefano Profili⁴, Giovanni B Meloni⁵, Matteo Ruggiu⁶, Patrizia Brizzi⁷, Franca Cossu⁸, Luca Pilo⁹ and Pier Luigi Tilocca¹⁰

(1)	Centro di Chirurgia Generale e Della Grande Obesita', Policlinico Universitario, Italy

(2)	Dipartimento di Scienze Chirurgiche, Universita' di Perugia, Italy

(3)	Servizio di Diabetologia, Istituto Clinica Medica, Italy

(4)	Istituto di Scienze Radiologiche, Universita' di Sassari, Italy

(5)	Istituto di Scienze Radiologiche, Universita' di Sassari, Italy

(6)	Servizio di Diabetologia, Istituto Clinica Medica, Italy

(7)	Servizio di Diabetologia, Istituto Clinica Medica, Italy

(8)	Centro di Chirurgia Generale e Della Grande Obesita', Policlinico Universitario, Italy

(9)	Centro di Chirurgia Generale e Della Grande Obesita', Policlinico Universitario, Italy

(10)	Centro di Chirurgia Generale e Della Grande Obesita', Policlinico Universitario, Italy

Published online: 01 November 2004

Background: The results on metabolic effects of the classical biliopancreatic diversion (BPD) have led us to investigate the operation without gastric resection, thus preserving stomach and pylorus, in patients who are not seriously obese but suffer from hypercholesterolemia, often associated with type 2 diabetes and hypertriglyceridemia. Methods: Between 1996 and 1999, we performed the duodenal switch (DS) without gastric resection on 24 mildly obese patients. Mean preoperative BMI was 36.2 kg/m². 17 patients (70.8%) suffered from type 1 diabetes, 4 (16.6%) had impaired glucose tolerance, while the remainder had fasting hyperglycemia. In 20 patients (83.3%), hypercholesterolemia and alterations in lipid profile were present. Another 20 patients were taking drugs for arterial hypertension. The pluri-metabolic syndrome was present in 41.6% of patients. Results: Mean follow-up was 4 years. BMI reduction and weight loss were not large. 2 patients who had severe longstanding diabetes type 2 needed a second operation of the classical BPD because of failure in improving diabetes. Another 2 patients were changed to classical BPD because of a relapsing chronic duodeno-ileal ulcer. The incidence of ileal ulcer was 29.1%. Regarding hypercholesterolemia, hypertrigliceri-demia, and type 2 diabetes when there is a good pancreatic "reservoir", the operation seems effective in the long-term. Protein absorption is better than that obtained with the classical BPD. Conclusions: Our long-term results suggest that in carefully selected patients suffering from serious hypercholesterolemia or type 2 diabetes with insulin reserves still at an acceptable level, and with BMI 30-40, DS without gastric resection can be proposed as a surgical treatment for metabolic diseases but not for obesity.

That's true for the NON morbidly obese.

I am morbidly obese and that's one of the reasons I'm haveing RNY in 25 more sleeps.

My doctor says I ' have about an 80% cure rate, or should I say a good chance of not needing all the meds I'm on now.

Sheri

That is true about the RNY, Sheri - and I wish you ALL the best of luck! You might have misinterpreted the post about the DS, though, as regards doing only the switch portion to help non-morbidly-obese T2 diabetics.

The full DS, whi*****ludes a VSG and a different type of bypass, *for the treatment of morbid obesity* and comorbid conditions like T2 actually does have a better cure/remission rate for T2 diabetes than the RNY in morbidly obese patients.

Neither one is 100% and several factors come into play, including age, genetics, duration and severity of the patient's diabetes, etc.

Note that I chose not to have a DS, I had the VSG (only a smaller stomach, no malabsorption) and I am doing very well with my diabetes and weight loss, so I am not trying to defend "my" surgery here, but only to confirm what the DS poster had to say about the cure/remission rate for DS vs RNY (or the VSG and band).

I wasn't saying anything against any other surgery, just that my doctor thought that in my case the RNY would be best because of my comorbid problems.
He says about 80% chance of ridding myself of diabetes adn HBP, and I thought that was good enough chance for me.
Thanks for taking the time to put me straight.
Sheri

Hi Sheri,

I'm about to have wls.  I have type 2 D, and take insulin also HBP.  Are you happy with your RNY and is your diabetes gone.  I hope you are well and healthy.  I think the RNY is for me.

Thank you
Ralph

I'm not saying the RNY doesn't work for type 2 at all--just that the DS works in even more cases (higher remission/cure rate).

Obesity Related Illnesses that Improved/Resolved Following Weight Loss Surgery:

	Gastric Band	RNY	DS
Diabetes Mellitus	47.9%	83.7%	98.9%
Hyperlipidemia	58.9%	96.9%	99.1%
Hypertension	43.2%	67.5%	83.4%
Sleep Apnea	95%	80.4%	92%

Buchwald, H. Bariatric Surgery, A Systematic Review and Meta-analysis. JAMA, October 13, 2004-Vol 292, No. 14

Hi Sherri,

  I hope you don't mind me asking some questions?Did you have lots of pain after surgery?

I am still tossed about whether or not I should have VSG or RNY? Which one will make my T2 dissapear? I want it to flee!Thank-you in advance. Ruth 

VSG will ONLY help your type 2 diabetes if your diabetes is highly weight-dependent. RNY has a greater chance than the VSG of improving your diabetes or sending it into remission (about 75-83% chance, depending on which study you read).

The DS has up to a 98.9% chance of resolving your diabetes (plus it has a lower chance of regaining your weight in the future).

Since you asked... I had lapriscopic RNY on Nov 5 at 328 pounds (lost 15 pounds pre op) and had HBP was 160/100 most days. After release from hospital I had tylenol (acedeminopin) for a couple days that was it.  No real pain only uncomfortable from incisions and gas.  Walking sure helped that.  I occasionally use acetemonphen (sp?) for discomfort but that is it.  Just spent about half an hour shoveling snow and no pain at all.
No more HBP pills - yeah!! and am only on metformin for the diabets and am down 53 pounds and feeling fantastic.. Doctor says that as the weight comes off so will need for pills.  I also have fibromyalgia and that has been in remission since surgery.

Hope that is what you were looking for.
Sheri

Marceau P, Biron S, Hould FS, Lebel S, Marceau S, Lescelleur O, Biertho L, Simard S.

Department of Surgery, Laval University, Laval Hospital, Québec, Canada. [email protected]

BACKGROUND: This report summarizes our 15-year experience with duodenal switch (DS) as a primary procedure on 1,423 patients from 1992 to 2005. METHODS: Within the last 2 years, follow-up of these patients, including clinical biochemistry evaluation by us or by their local physician is 97%. RESULTS: Survival rate was 92% after DS. The risk of death (Excess Hazard Ratio (EHR)) was 1.2, almost that of the general population. After a mean of 7.3 years (range 2-15), 92% of patients with an initial BMI < or = 50 kg/m2 obtained a BMI < 35 and 83% of those with an initial BMI > 50 obtained a BMI < 40. Diabetes was cured (i.e. medication was discontinued) in 92% and medication decreased in the others. The use of the CPAP apparatus was discontinued in 90%, medication for asthma was decreased in 88%, and the prevalence of a cardiac risk index > 5 was decreased by 86%. Patients' satisfaction in regard to weight loss was graded 3.6 on a basis of 5, and 95% of patients were satisfied with the overall results. Operative mortality was 1% which is comparable with gastric bypass surgery. The need for revision for malnutrition was rare (0.7%) and total reversal was exceptional (0.2%). Failure to lose > 25% of initial excess weight was 1.3%. Revision for failure to lose sufficient weight was needed in only 1.5%. Severe anemia, deficiency in vitamins or bone damage were exceptional, easily treatable, preventable and no permanent damage was documented. CONCLUSION: In the long-term, DS was very efficient in terms of cure rate for morbid obesity and its comorbidities. In terms of risk/benefit, DS was very sucessful with an appropriate system of follow-up.