Duodenal Switch in Tijuana Mexico

Not all bariatric surgery is created equal. For patients who hope to lose a substantial amount of weight and present very special conditions, Dr. Liza María Pompa González, our lead surgeon in our clinic of Tijuana, may recommend a duodenal switch. This special type of bariatric surgery combines the restrictive techniques of a gastric sleeve with the malabsorptive benefits of a gastric bypass to obtain the best possible results of weight loss.

If you have a BMI of 60 or above, or if you suffer from weight-related health problems like hypertension, hyperlipidemia or hard to control type 2 diabetes, you may qualify for this procedure. The team at LIMARP® in Tijuana, México , can evaluate your condition and weight-loss goals to determine the best treatment plan for you.

Duodenal Switch Surgery

As a restrictive procedure, a duodenal switch physically restricts the amount of food you can eat by removing 85 percent of the stomach (same as with the gastric sleeve), giving the remaining tissue a narrow tube shape. This reduction in stomach capacity helps patients feel full faster and with smaller portions, a key to significant weight loss.

Another component to this weight loss surgery is changing how the patient digests and absorbs food, an effect known as malabsorption. By rearranging the layout of the small intestine, Dr. Pompa can separate the flow of food from the secretion of digestive juices. This consequently restricts the uptake of fat and sugar-based calories.

The duodenal switch is the most power bariatric surgery since it combines a set of two surgical operations: the gastric sleeve and a biliopancreatic bypass. Also known as a Biliopancreatic Diversion with Duodenal Switch (BPD/DS), it is recognized as the bariatric procedure that delivers the most effective and impressive results when it comes to excess weight loss and the resolution of conditions such as type 2 diabetes, hyperlipidemia, and hypertension.

However, the duodenal switch is the most invasive procedure there is. In comparison with other procedures, a the BPD/DS takes the longest to perform, as the patient could be in the operating room for 3 to 5 hours, and its post-operative stay at the recovery room is also longer, lasting 2 to 3 days. In some circumstances, the surgery may be done at two different stages: first the gastric sleeve, to lose some initial weight; and then the biliopancreatic diversion, to lose the rest. In other cases, a patient might be asked to lose some weight previous to surgery, in order to be prepared for a single stage surgery. This depends on many factors, like the patient’s medical history, his initial weight and his weight-loss goals. A duodenal switch changes the patient’s metabolism, as the intestine absorbs significantly less nutrients and calories than before. Patients who go through this procedure should take proper vitamin and mineral supplementation for the rest of their lives. This is crucial to avoid any malnutrition, anemia or other complications.

The factors described above may be some of the reasons why the BPD/DS is also one of the less solicited procedures. Just to put this into perspective, out of 520,983 bariatric procedures registered worldwide in the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Global Registry of 2019 [1], only 0.5% (a total of 2,554 procedures) were the duodenal switch with gastric sleeve.

Determining Candidacy

Duodenal switch patients must be well studied and classified. Because of generally high BMIs, the procedure may be executed at two separate times, this depends on many factors. Since the BPD/DS combines two different procedures, greater weight loss can be expected compared to what other bariatric procedures provide. In fact, most patients lose at least half their excess weight within a year of their surgery. However, there is consequently a potential for nutrient deficiencies due to malabsorption, making strict and effective supplementation mandatory. As such, this surgery is typically recommended for patients at or above 60 BMI (body mass index) or for patients who suffer from serious and uncontrolled weight-related health problems, such as:

• Type 2 diabetes
• Heart disease
• Hypertension
• Sleep apnea
• Severe hyperlipidemia

Patients that are willing to go through a BPD/DS should be fully aware of its side effects and the changes of dietary and supplementary habits that it entails after the surgery, starting at its recovery period and going forward in the long term after the procedure. They should be committed to follow the post-operative instructions beforehand, as these may be different to what they expect or might imply big changes in their current lifestyle.

Any vitamin deficiency must be identified, assessed and corrected prior to surgery with appropriate supplementation, as this makes prevention and treatment of nutrition deficiencies easier after surgery.

During your first discussion with the doctor and her team, she can evaluate your medical history and weight loss goals to determine whether a duodenal switch is appropriate for you.

Advantages of the Procedure

Duodenal switch patients often enjoy dramatic weight loss while still being able to eat their favorite foods.

However, this convenience should be considered very carefully, as consumption of sugars and starch might lead to less weight loss or weight regain.

The BPD/DS surgery has demonstrated to deliver greater results in weight loss and reduction of BMI during the first year in comparison with the gastric bypass, gastric sleeve, and adjustable gastric band. It also has the greatest odds in resolving type 2 diabetes, hypertension and reflux in comparison with the aforementioned surgeries. This is noteworthy because these outstanding outcomes were observed out of 130,796 patients, where only 1,436 (a 1.09%) received a BPD/DS [3].

Additionally, because of how the stomach is reshaped, there is a lower risk of digestive complications such as ulcers, blockages, or dumping Syndrome compared to other restrictive procedures.

The procedure can also relieve a number of weight-related health issues. Patients may find that their back and joint pain is alleviated, they have improved energy, or their diabetes is more controlled. These improvements in a patient’s health go far in boosting mental health and self-esteem.

Risks

The rates of surgical complications in the duodenal switch resembles those of other bariatric procedures [4]. However, this surgery is consistently associated with more nutritional adverse effects. For instance, in a study with 284 patients that received a BPD/DS, 29.8% developed nutritional problems over the course of 9 years [4].

Duodenal switch patients are often more predisposed to vitamin D deficiency, although this deficiency is usually prevalent in most obese patients before they receive treatment and it tends to persist in most weight loss surgery patients [5]. Deficiencies related to minerals such as iron, copper, zinc, and magnesium can also take place [2].

To avoid vitamin and mineral deficiencies, BPD/DS patients should attend annual follow-up consults for monitoring and screening. Every bariatric patient receives a prescription with the appropriate dosage of vitamins and minerals that he or she should obtain, but annual screenings help prevent any deficiencies by allowing to adjust these dosages when deemed necessary.

Despite the fact that a BPD/DS has a higher complication rate than other bariatric surgeries, it still is considered as a safe and efficient treatment for obesity and other related illnesses, from a clinical standpoint [2], and it also proves efficient where other less invasive methods fail.

Bariatric Surgery in Tijuana, Mexico

At LIMARP we offer different bariatric procedures in an Integral Program destined for patients struggling with obesity. Our clinic is located in Tijuana, Mexico, just minutes away from the International Border with San Diego, U.S.A. Tijuana is the number one city in Mexico when it comes to international medical tourism. People from all over the world visit Tijuana to obtain quality medical services, therapy treatments and even pharmaceuticals at a more affordable price in comparison with the same services in the United States or Canada. At least 2 million people a year visit Tijuana as medical tourists and that number is expected to grow in the upcoming years.

LIMARP is located in the Twin Tower complex, home to the Grand Hotel Tijuana and Plaza Aguacaliente, right in the business district of Tijuana. Our private recovery rooms have stunning panoramic views to the Tijuana’s Country Club golf course.

To make your travelling experience more convenient for our foreign travelers, we offer an all-inclusive package that includes a two-night stay at the luxurious Grand Hotel Tijuana and transportation from the airport to the hotel and back. All of this on top of your medical treatment and intervention with our team of bariatric professionals and our experienced lead surgeon Dr. Liza María Pompa González.

Traveling to Tijuana, Mexico is definitely the most convenient and smart choice for receiving quality care and service, as well as a pleasurable experience, at a really competitive price.

Discuss Your Options with our Bariatric experts in Tijuana

Our practice wants all bariatric patients to enjoy the healthy lives they deserve. To find out if a duodenal switch is right for your health needs, contact our office at Tijuana today online or call us toll-free from the US at (619) 270-8827. We can start planning your journey to a healthier future today.

References

• [1] International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) (2019). 5th IFSO Global Registry Report 2019. Dendrite Clinical Systems. https://www.ifso.com/pdf/5th-ifso-global-registry-report-september-2019.pdf
• [2] Sudan, R. (2020). Biliopancreatic Diversion with Duodenal Switch: Technique and Outcomes. In Ninh T. Nguyen, Stacy A. Brethauer, John M. Morton, Jaime Ponce & Raul J. Rosenthal (eds.), The ASMBS Textbook of Bariatric Surgery (2nd ed, pp. 161-167). Springer.
• [3] Sudan, R.; Maciejewski, M. L.; Wilk, A. R.; Nguyen, N. T.; Ponce, J. & Morton, J. M. (2017). Comparative effectiveness of primary bariatric operations in the United States. Surgery for Obesity Related Diseases, 13(5):826-834. https://pubmed.ncbi.nlm.nih.gov/28236529/
• [4] Stran, G. W.; Torghabeh, M. H.; Gagner, M.; Ebel, F.; Daking, G. F.; Abelson, J. S.; Connolly, D. & Pomp A. (2017). The Impact of Biliopancreatic Diversion with Duodenal Switch (BPD/DS) Over 9 Years. Obesity Surgery, 27: 787-794. https://link.springer.com/article/10.1007/s11695-016-2371-1
• [5] Parrot, J.; Frank, L.; Dilks, R.; Craggs, L.; Isom, K. A.; Gremain, L. (2016). ASMBS Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient – 2016 Update: Micronutrients. Surgery for Obesity and Related Diseases, 13: 272-741. https://asmbs.org/app/uploads/2008/09/PIIS1550728916308826.pdf