Duodenal Exclusion - Bariatric Surgery

THE DUODENAL EXCLUSION (NON-OBESE PEOPLE) — WHAT IS IT?

Duodenal exclusion (duodenal exclusion with a loop duodenojejunostomy) performed by Dr. Jacobo Zafrani at Hospital Clínica Bíblica in San José, Costa Rica, is a pioneering surgical technique for non-obese (overweight, slightly overweight or in the normal category) people with a BMI of under 30 suffering from Type 2 diabetes. (Calculating your BMI is simple. Click here.) This hour-long surgical operation involves removing or bypassing part of the upper small intestine or duodenum, so that food from the stomach goes directly into the lower small intestine — most importantly, removing the duodenum from the nutrient flow.

This surgery is done laparascopically. But unlike the gastric sleeve, the stomach is not touched. Stomach volume is kept intact, maintaining the caloric ingestion so that in many instances, the patient undergoing duodenal exclusion will lose less than 5% of her/his pre-op weight, eliminating potential nutritional zig-zags and drastic dietary changes that may follow other types of bariatric surgery.

Advantages of the duodenal exclusion

The impact of this procedure on overweight, slightly overweight or normal-weight diabetes patients can be dramatic. Some patients find that within a few days of duodenal exclusion, they no longer need diabetes medication; others take just over a month to end dependence. In addition, this health-bringing change usually occurs with no weight loss. One preliminary study of just under 100 overweight (but non-obese) or slightly overweight patients who had undergone duodenal exclusion showed that over a 9-12 month period, almost 80% had a complete remission or great improvement of their Type 2 diabetes, independent of their weight loss or gain over the period examined. Some actually gained weight, but still remained diabetes free.

In another study, Dr. R. Cohen performed the slightly more complicated but related laparoscopic Roux-en-Y duodenal bypass procedure on seven diabetes patients who were not morbidly obese (BMI between 22 and 34). Their hospital stay was 1-2 days. After a year, all the patients had a complete resolution of their diabetes, and there were almost no post-op complications.

Two large-scale trials published in the summer of 2009 in the New England Journal of Medicine have shown that patients who underwent a duodenal exclusion had a 92% reduction in diabetes-associated death.

The duodenal procedure does not require much active follow-up participation on the part of patients. Patients can get back to normal life very quickly, and maintain a virtually normal diet with almost no restrictions on the types of food that they can eat.

Not everyone with a BMI under 30 is eligible for this surgery. The only way you can find out whether you are a candidate is to consult with Dr. Zafrani.

As we remind those contemplating duodenal exclusion, no form of surgery is foolproof, and this procedure is no exception. As with all forms of bariatric surgery, the patient must want and work for success in order for the operation to succeed as a treatment for curing Type 2 diabetes. Dr. Zafrani and your own doctor will work together with you on monitoring and evaluating your post-operative progress on an agreed schedule and regimen.

Duodenal exclusion surgery is the best option for many non-obese people with Type 2 diabetes. If you think you are in this category and are considering bariatric surgery to cure Type 2 diabetes, contact Americana WellcareCR to discuss duodenal exclusion with bariatric specialist Dr. Jacobo Zafrani.

LAPAROSCOPIC SURGERY

Laparoscopic surgery, also referred to as minimally invasive surgery, describes the performance of surgical procedures with the assistance of a video camera and several thin instruments. During the surgical procedure, small incisions of up to half an inch are made and plastic tubes called ports are placed through these incisions. The camera and the instruments are then introduced through the ports which allow access to the inside of the patient.

The camera transmits an image of the organs inside the abdomen onto a television monitor. The surgeon is not able to see directly into the patient without the traditional large incision. The video camera becomes a surgeon's eyes in laparoscopy surgery, since the surgeon uses the image from the video camera positioned inside the patient's body to perform the procedure.

The benefits of minimally invasive or laparoscopic procedures are:

less post-operative discomfort since the incisions are much smaller

quicker recovery times

shorter hospital stays

earlier return to full activities

much smaller scars

there may be less internal scarring when the procedures are performed in a minimally invasive fashion compared to standard open surgery

DUODENAL EXCLUSION AT A GLANCE

Approach: Non-restrictive

Does NOT limit amount of food that can be eaten

Anatomy Changes: Upper small intestine

Bypasses or removes part of the upper small intestine or duodenum

Surgery Method:

Laparoscopic

Operating Time:

Two hours

Hospital Stay:

Usually 1 day

Adjustable:

Reversible:

Medical Implant:

Success Rate:

80-90% succesful in curing Type 2 diabetes in non-obese patients

Surgery Benefits and Advantages:

Does not require a medical device implant into body

Stomach volume is kept intact

Requires virtually no change in diet or eating habits

No food intolerances

No malnutrition risk

Time Off Work:

One week

Post-op recovery Time:

One week

Dietary Guidelines:

Liquid diet first week after operation

Pureed diet second week

Gradual return to regular diet beginning third week

maintain a healthy diet

avoid high fat and high calorie foods that will cause excessive weight gain

Nutritional Supplements:

Not required

Disadvantages:

Not FDA approved

General surgical risks

Not reversible

Requires patient effort (changing diet and eating habits) for initial recovery

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