Duodenal switch surgery was first performed in 1979 with the open surgery method. In this surgical method, the stomach is cut as a sleeve gastrectomy, the duodenals are closed and the stomach is connected to the middle part of the small intestine. In addition, a second connection is made between the small intestines to change the direction of gall flow. This method of surgery is an absorption-reducing and neuroendocrine effective method besides it’s intaking limiting effect.
This surgical method which seems very complex has very effective hormonal results. “Ghrelin” which defined as the appetite hormone, is mainly released from the cells located in the fundus which is the upper part of the stomach. In physiological conditions, the level of ghrelin starts to increase with hunger, peaks just before eating and it is suppressed with food. It is actually the hormone that directs us to food. But it should not be forgotten that it is not only released from the stomach but also from other digestive system organs. After sleeve gastrectomy, the feeling of hunger begins to decrease as the ghrelin reaches the basal level.
Leptin is another hormone which is effective in obesity. It is secreted from adipose tissue and intestinal surface. The main task of leptin hormone is to balance the energy balance; it does this through hunger control and fat storage. With obesity, resistance to leptin develops and the increase in adipose tissue causes the leptin level to increase. Rapid delivery of food to the last part of the small intestine breaks the existing leptin resistance. Fat storage reverses and fats are used for energy production. This is exactly why there is no muscle breakdown in bypassed cases until the fat is exhausted.
GLP-1 and GIP hormones are responsible for an average of 50% of postprandial release. In addition, these hormones delay gastric emptying, suppress glucagon secretion and increase sensitivity. Even today, drugs that show the effect of GLP-1 hormone are used in the treatment of diabetes. It has been observed that the levels of these hormones increase in bypasses.
Insulin is a hormone which is secreted from the pancreas and it is a hormone which regulates carbohydrate, fat and protein metabolism. Particularly, it regulates the absorption of sugar from the blood and it’s storage in the liver and adipose tissue. Decreased sensitivity causes obesity and diabetes. The sensitivity of the liver begins immediately but recovery of the sensitivity of adipose tissue may take weeks. The by-passes which were made affect the metabolism and they support the patient’s losing and controlling weight.
Duodenal switch surgery is generally not preferred as the first option. It is preferred for patients who gain weight after sleeve gastrectomy or for patients whose body mass index exceeds 50.