<![CDATA[For many years duodenal switch has played an important, but a fairly small role in the practice of weight loss surgery. It has consistently delivered the best results for the permanent remission or resolution of type two diabetes, but this procedure has also led to more profound micro nutrient deficiencies, and some of these have been difficult to resolve. In the United States, most surgeons in experienced practices have seen dramatic reductions in the rates of complications or adverse events among patients undergoing weight loss surgery, such that today the risks are lower than the risks of cesarean section, knee arthroplasty, and many other common procedures. This improved safety record has happened as a result of repetition through hundreds and then thousands of procedures, and attention to continuous quality improvement. Most recently, the move toward the gastric sleeve procedure has further reduced complications, especially those involving micro nutrient deficiencies which are milder with the sleeve procedure. So why is the duodenal switch playing a more important role today? The answer is that the techniques have improved and become less invasive with less complications, and there is a high success rate and greater compatibility with someone who has previously had a sleeve gastrectomy. For a patient who has regained weight years after a sleeve gastrectomy, single anastomosis laparoscopic duodenal switch may be the best procedure to induce weight loss success. While more long-term studies are needed, the single anastomosis loop duodenal switch appears to lead to less vitamin deficiencies and still delivers weight loss success, and successful treatment of type two diabetes. Kent C. Sasse, M.D., MPH, FACS, FASCRS, FASMBS Adjunct Assistant Professor, University of Nevada School of Medicine]]>
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