BODY MASS INDEX
Duodenal Switch is a surgical procedure designed for obesity and weight problems. It reduces stomach size and alters intestines to aid in weight loss and metabolic control.
What is Duodenal Switch?
First performed in 1979 through open surgery, duodenal switch surgery involves the surgeon cutting the stomach. The cutting is done in a sleeve gastrectomy fashion, bypassing part of the duodenum. The surgeon then attaches the stomach to the middle part of the small intestine. Additionally, a second connection is made between the small intestines to alter the flow of bile. This surgical method not only restricts intake but also significantly reduces absorption.
It has a neuroendocrine effect, impacting hormonal outcomes in a meaningful way. “Ghrelin,” known as the hunger hormone, is primarily released from cells in the upper stomach. Under physiological conditions, ghrelin levels rise with hunger and peak just before eating. Ghrelin is suppressed by food intake and drives us to eat; it’s not only from the stomach. Other parts of the digestive system also release ghrelin, affecting the sensation of hunger. Following a sleeve gastrectomy, the basal level of ghrelin leads to a reduced sensation of hunger.
What are the Hormonal Changes and Effects in Diabetes Surgery?
Leptin is another hormone effective in obesity; it is secreted from fat tissue and the intestinal surface. Leptin’s main role is to balance energy by controlling hunger and fat storage. Resistance to leptin develops with obesity, and an increase in fat tissue raises leptin levels. Rapidly transporting food to the last part of the small intestine breaks existing leptin resistance. Fat storage reverses, and fats are utilized for energy production; hence, in cases with bypass surgery, muscle degradation does not occur until fats are depleted.
GLP-1 and GIP hormones are responsible for about 50% of the post-meal release. Additionally, these hormones delay stomach emptying, suppress glucagon release, and increase its sensitivity. Currently, drugs that mimic the effect of the GLP-1 hormone are used in diabetes treatment. The levels of these hormones have been observed to increase in bypass surgeries.
Secreted from the pancreas, this hormone regulates the metabolism of carbohydrates, fats, and proteins. It particularly regulates the absorption of sugar from the blood and its storage in the liver and fat tissue. A decrease in sensitivity leads to obesity and diabetes. Liver sensitivity begins to improve immediately, while fat tissue sensitivity may take weeks to recover. Bypass surgeries have an effect through metabolism, supporting the patient’s weight loss and management.
The duodenal switch surgery is generally not the first option chosen, preferred in patients who gain weight after sleeve gastrectomy or when the body mass index exceeds 50.