A question for Dr Keshishian
Dr. Keshishian,
I sure do appreciate your comments and participation on the message boards here on OH, it's wonderful to read your posts.
I have a question about the hybrid operation some surgeons are proposing and doing these days when they say they are revising an old RNY to DS, but are leaving the pouch intact. I don't believe this is a version of the DS but I'm no surgeon so what I think doesn't mean much. The questions I have about this are:
1. What would the correct name of this surgery be or what should it be called?
2. Are there any advantages to this surgery?
3. What are the disadvantages?
4. How would the switch be accomplished? Since the duodenum is already bypassed, how can a switch involving the duodenum be done?
5. Would you be able to use the Hess method to divide the small bowel into alimentary and biliary limbs?
6. Would the common channel be the same as with a full DS?
Thanks so much for your time and efforts here, it is greatly appreciated.
Best regards,
Kerry
I sure do appreciate your comments and participation on the message boards here on OH, it's wonderful to read your posts.
I have a question about the hybrid operation some surgeons are proposing and doing these days when they say they are revising an old RNY to DS, but are leaving the pouch intact. I don't believe this is a version of the DS but I'm no surgeon so what I think doesn't mean much. The questions I have about this are:
1. What would the correct name of this surgery be or what should it be called?
2. Are there any advantages to this surgery?
3. What are the disadvantages?
4. How would the switch be accomplished? Since the duodenum is already bypassed, how can a switch involving the duodenum be done?
5. Would you be able to use the Hess method to divide the small bowel into alimentary and biliary limbs?
6. Would the common channel be the same as with a full DS?
Thanks so much for your time and efforts here, it is greatly appreciated.
Best regards,
Kerry
Hello Kerry,
The duodenal switch operation (DS, GRDS, BPD-DS) has one specific part that makes it the DS (duodenal switch). More specifically what this means is that
1-the pyloric valve stay in the path of the food, and regulates the flow, and
2-The blio-pancreatic secretions are redirected so that they are mixed with the food (that has gone thru the pyloric valve) lower down stream to limit the absorption.
You need to have this two elements to call it duodenal switch. Any thing else is false and misleading.
The specific answers to your question:
1-I would call it distal gastric bypass, because if the pouch is intact, and the pyloric valve is not in the path of the food, then it is a gastric bypass. If the junction of the two small bowel where the food and the bilio-pancreatic is further down stream then it would be distal. These definitions are pretty well set.
2-I am not sure if there are any advantages to the distal gastric bypass.
3-SIgnificant malabsorption, more so that the DS. This is on top of the fact that the patient has much more limited ability to eat and digest food, because of the exclusion of the parts of the stomach and the pyloric valve.
4- A gastric bypass to Duodenal switch is done carefully ! It can be done in the case of the distal gastric bypass as well.
5-Yes in the case of revision to DS.
6- Not to be picky, but I am not sure what you mean by full DS. There is only one DS, and that is the one that includes the two components as described above. Anything else is barely a look alike.
Not too long ago I described some of these points on our website at:
http://www.dssurgery.com/newsletters/dec-5-09.pdf
No problem, and sorry for not getting back to you sooner.
Ara
Ara Keshishian, MD, FACS, FASMBS
[email protected]
www.dssurgery.com
The duodenal switch operation (DS, GRDS, BPD-DS) has one specific part that makes it the DS (duodenal switch). More specifically what this means is that
1-the pyloric valve stay in the path of the food, and regulates the flow, and
2-The blio-pancreatic secretions are redirected so that they are mixed with the food (that has gone thru the pyloric valve) lower down stream to limit the absorption.
You need to have this two elements to call it duodenal switch. Any thing else is false and misleading.
The specific answers to your question:
1-I would call it distal gastric bypass, because if the pouch is intact, and the pyloric valve is not in the path of the food, then it is a gastric bypass. If the junction of the two small bowel where the food and the bilio-pancreatic is further down stream then it would be distal. These definitions are pretty well set.
2-I am not sure if there are any advantages to the distal gastric bypass.
3-SIgnificant malabsorption, more so that the DS. This is on top of the fact that the patient has much more limited ability to eat and digest food, because of the exclusion of the parts of the stomach and the pyloric valve.
4- A gastric bypass to Duodenal switch is done carefully ! It can be done in the case of the distal gastric bypass as well.
5-Yes in the case of revision to DS.
6- Not to be picky, but I am not sure what you mean by full DS. There is only one DS, and that is the one that includes the two components as described above. Anything else is barely a look alike.
Not too long ago I described some of these points on our website at:
http://www.dssurgery.com/newsletters/dec-5-09.pdf
No problem, and sorry for not getting back to you sooner.
Ara
Ara Keshishian, MD, FACS, FASMBS
[email protected]
www.dssurgery.com
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