Duodenal Switch Surgery/SIPS Procedure
Also known as the Single-Anastamosis Duodenal Switch, this duodenal switch surgery (SIPS) delivers both stomach restriction and decreased absorption. The first part of the surgery is performed by reducing the size of the stomach, which is similar to the sleeve gastrectomy, but larger in volume. The second part is where the duodenum is separated, just below the pyloric valve, from the remaining intestinal tract. 300 cm of the small intestine is measured from the terminal ileum and that loop is connected to the stomach. This longer channel leads to greater absorption of nutrients and vitamins, and less bowel movements compared with the regular Duodenal Switch (DS).
Another important difference between the SIPS and DS is that there is only one opening between the stomach and the small intestine as opposed to two in the classic DS. The creation of the Roux limb is also avoided in this procedure which we anticipate will reduce the risk of bowel obstruction. SIPS is a logical modification of existing operation that seeks to reduce the complications related to roux limbs and reduce diarrhea.
Our Manhattan bariatric surgery team may recommend an open Biliopancreatic Diversion with Duodenal Switch (BPD-DS) instead of a laparoscopic procedure, depending on the patient’s BMI and co-morbidities. Additionally, a larger incision may be necessary if a laparoscopic BPD-DS cannot be completed using small incisions. Although the Biliopancreatic Diversion with Duodenal Switch operation involves removing part of the stomach, it leaves a significant portion of it intact, including the pyloric valve which regulates the passage of stomach contents into the small intestine. The intestines are re-routed to a greater degree than in the link_gastric bypass procedure_link to: C4. An “alimentary limb” is created by dividing the small intestine and attaching one end to the small stomach pouch. This provides a digestive path which completely bypasses most of the small intestine. Digestive juices from the pancreas and stomach travel through the “biliopancreatic limb” and do not mix with ingested food until the two limbs join to form a common limb close to the colon.
Initial weight loss occurs because patients eat less, and long-term weight loss occurs because fat and carbohydrates are not completely absorbed, but sugars are. This procedure provides the most malabsorption of the weight loss procedures.
The Biliopancreatic Diversion with Duodenal Switch operation was popularized in Italy and later modified by surgeons in the US and Canada. Weight loss results are excellent with patients losing up to 82% of their excess weight as far out as 12 years. However, this weight loss is accompanied by a much greater risk of malnutrition, malodorous flatulence, and loose stools.
Benefits of Duodenal Switch Surgery/SIPS Procedure
- The DS-SIPS procedure offers maximal weight loss which can be maintained long-term.
- Patients can eat normally after a while because the capacity of the stomach is greater than a gastric bypass.
- Dumping syndrome does not occur with this surgery.
Risks (Short-Term) of Duodenal Switch Surgery/SIPS Procedure
- Leaks and infection can occur from where the intestines are re-routed or where part of the stomach is removed.
- A narrowing can occur where the duodenum is connected to the intestine.
- A wound infection can occur in the incision which may require further therapy.
- Pancreatitis or inflammation of the pancreas can occur, which can be severe.
Risks (Long-Term) of Duodenal Switch Surgery/SIPS Procedure
- Protein malnutrition occurs 3-10% of the time which may require hospitalization.
- Vitamin, calcium and iron deficiencies can occur.
- A hernia may develop at the incision site that will require further surgery to repair.
- Duodenal Switch Surgery/SIPS procedure is not reversible.