Laparoscopic Sleeve Gastrectomy with Duodenal Jejunal Bypass
Clinically, this bariatric procedure is a modification of biliopancreatic diversion with duodenal switch (BPD-DS) which is the most effective bariatric surgery but at the same time carries highest risk of malabsorption. But SG – LDJB has much less risk of malabsorption when compared to BPD – DS. It also can be considered as a combination of sleeve gastrectomy (SG) and mini-gastric bypass (MGB). In some aspects, SG – LDJB is better than Sleeve Gastrectomy or RYGB (roux-en-y gastric bypass) or MGB since hormonal changes are more and risk of complications are less.
How it works
- With the help of linear cutting staplers, about 70% of stomach is excised quite similar to sleeve gastrectomy.
- First part of small bowel (duodenum) is divided 3 to 4 cm below the stomach. It is then rejoined to the intestine after bypassing 200-250 cm of intestine as in mini gastric bypass.
- After leaving ‘gastric sleeve’ food directly enters ‘common channel’ where it mixes with bile and pancreatic juices and reaches lower small bowel faster. This 250 cm of bowel doesn’t come in contact with the food.
Positives of Loop Duodenal Jejunal Bypass
- This is primarily a malabsorptive procedure and has excellent long term weight loss
- This procedure causes successful resolution of co- morbidities and the success rate is almost similar to gastric bypass.
- No remnant stomach present as seen in gastric or mini gastric bypass, one of the very important advantages in patients who have a history of recurrent gastric ulcers or family history of gastric cancer.
- The lower part of stomach has a small valve which helps in controlled passage of food into the intestines. in this procedure, this valve is preserved thereby reducing the incidence of dumping syndrome usually seen in gastric bypass.
- Partial duodenum is still present which provides important advantage to patients for absorption of important nutrients. It thereby reduces the nutritional deficiency to some extent when compared to gastric or mini gastric bypass.
- Risk of bowel herniation low when compared to gastric bypass
How long the procedure take place?
The procedure is done through laparoscopic or key hole surgery and generally takes an an hour and a half to perform.
How long will be the scars?
The procedure involves making 4 or 5 small cuts ranging from 5 mm to 10 mm long in the abdomen.
How does the patient feel following surgery?
The patient should be able to walk around within hours of surgery. Some patients might experience a little pain or discomfort which is well controlled with soluble painkillers.
How long the patient stay in hospital?
Some patients will feel very comfortable to go home the day after surgery but most will prefer to stay and relax in the hospital and return home after the second night.
How long the patient need off work?
One or two weeks depending upon the nature of your job.If the patient has a sitting job, he can join after one week and the patient who job profile involves stern activity, the patient can join in 2 weeks time.
After how long the patient can exercise?
The morning after surgery we would expect our patient to walk around relatively comfortably. On discharge from hospital we recommend increasing activity levels on a daily basis under the constant guidance of our physiotherapists. More active exercise such as at the gym can be introduced one week after surgery, with a gentle reintroduction to aerobic exercise such as light jogging, cycling or swimming. Any exercise involving heavy lifting can be started after one month.
How soon the patient can introduce solid foods?
Our dedicated bariatric nutritionists will ensure a smooth and pleasant weight loss journey. Depending upon your eating habits and preferences for food, we make a customized diet plan to ensure comfortable recovery. Following surgery, patient is kept on liquid diet for one week. This is followed by pureed diet for one week. During the third week, diet consists of mashed food and in fourth week, a slow introduction of solid food is done where in the patient is able to eat normal food but in small quantities.
What is the long term like eating?
Following LDJB after the initial month when solid food is reintroduced, eating becomes much easier. Within two or three months you will be able to contemplate eating out. Clearly the amount of food will be much less and a starter portion will usually suffice. However patients report that the quality of life, as far as eating is concerned, is back to normal within a few months of surgery.
Why SG – LDJB is better than MGB?
In mini-gastric bypass (MGB), unused or excluded stomach is still present. There is always a little possibility of developing any ulcer or cancer in that remnant stomach in future and its detection by upper GI endoscopy is not possible. In mini gastric bypass, due to complete exclusion of duodenum, risk of calcium and iron deficiency is comparatively high. MGB has a higher incidence of dumping syndrome due to bypass of pylorus, a valve which controls the passage of food into the intestine. In LDJB, all these risk factors are absent and hence appears to be a better procedure when compared to MGB in some aspects.