Weight loss surgery is usually the last option for patients who struggle with other weight loss methods. Biliopancreatic diversion with duodenal switch is among most common bariatric surgeries available in the United States, alongside gastric bypass adjustable gastric banding and sleeve gastrectomy. However, before undergoing biliopancreatic diversion with duodenal switch or any other type of bariatric surgery, there are numerous factors to consider and preparations to be done.
A biliopancreatic diversion alters the normal digestive process, making the stomach smaller and redirecting the course of ingested food. It is particularly recommended for super obese patients, which means having a Body Mass Index (BMI) higher than 50. During the procedure, patients are asleep under general anesthesia and surgeons cut a determined part of the stomach, so that the pylorus valve, which is responsible for food drainage from the stomach, intact. The new pouch created is then attached to the lower part of the small intestine causing malnutrition of nutrients and calories.
What to Consider Prior to Deciding for a Biliopancreatic Diversion With Duodenal Switch
Bariatric surgery is an extreme option and has many implications that need to be considered. Physicians are expected to provide information on all options for their patients, as well as evaluate patients’ overall health, their need for a bariatric surgery, and eligibility criteria. In order to undergo biliopancreatic diversion with duodenal switch, patients need to present copies of their medical records with the results of the evaluation, medical clearance from the primary care physician, as well as psychological clearance. Patients are evaluated on a psychological level since obesity may be related to underlying problems like stress or binge eating, in which case surgery may not be the best option.
Patients are also given or should seek information on the risks associated with the disease, possible results, as well as commitment needed before and after the surgery. In addition to be informed about the efficacy and safety of a biliopancreatic diversion with duodenal switch, patients should not only be aware of but also be fully committed to the lifestyle alterations that the surgery requires. The full treatment with biliopancreatic diversion with duodenal switch does not start or end in the surgery, while commitment and compliance with the physicians’ recommendations for a healthy diet and regular physical activity is crucial to ensure weight loss. Before making any decision, both patients and physicians should consider the patient’s level of commitment toward the treatment.
Lifestyle Alterations Prior to the Biliopancreatic Diversion With Duodenal Switch Surgery
In some cases, patients are asked to lose weight even before the surgery for different reasons. First of all, patients need to follow a treatment plan, including lifestyle alterations that need to start even before the biliopancreatic procedure and has impact in the long-term. Adopting new habits before the surgery may facilitate the changes and increase weight loss after the surgery. In addition, there are insurance companies that require patients to start losing weight before the biliopancreatic diversion to provide financial coverage.
Since patients submitted to a biliopancreatic diversion with duodenal switch are usually super obese, in some cases it is conducted in two phases, being performed as a sleeve gastrectomy weeks before the final surgery. The healthcare team, which includes a dietitian, will define a plan and provide specific guidelines on behavioral alterations during the preparation for the surgery, which can take months or even more than a year. There is no fixed protocol and the recommendations take into consideration patient’s age, weight, and the existence of any co-morbidity.
Overall Preparation After Scheduling the Biliopancreatic Diversion With Duodenal Switch
A patient should only schedule the surgery if fully aware of the implications of undergoing a biliopancreatic diversion with duodenal switch, after being cleared by the medical team and having completed the preparation plan defined by the physicians. It is an important day that needs preparing and may be stressful. Asking physicians any remaining questions about the surgery or treatment plan, and seeking a psychologist or support group can help reduce the stress, while asking a family member or friend to be there at the day can help with the recovery.
Patients will be submitted to additional lab tests and exams before the surgery, in addition to the dietary restrictions, and are requested to quit smoking. Regarding recovery, it is important to remember that following about two days in the hospital, patients will still have weeks ahead without being able to work. Therefore, work and house arrangements should be done before the biliopancreatic diversion with duodenal switch. The night before, patients can’t eat or drink anything since the stomach must be empty to minimize surgical risks.
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