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Dr. Heap Mini-Switch Advantages

In Dr. Heap's Opinion the primary advantages of the Heap Mini-switch over other procedures offered today, are:

  • The mini-switch is safer, as there is one less bowel anastomosis that can leak and cause post-operative complications and it is a surgical procedure that is more easily performed.
  • With the removal of the unnecessary amount of stomach, intestine and the large apron of omental fat (together weighing at times 6 to 14 pounds) the patient’s abdomen is decompressed allowing much easier breathing and less post-operative pain and less tension on the abdominal wall. This reduces the risk of hernia or wound disruption.
  • Recovery is faster. For the first week you take only liquid food while the stomach heals. During the second week you are on soft foods so as not to unduly stress the staple line and to teach you the reduced capacity of your stomach. After two weeks patients can eat what they wish. However, as with all weight loss surgeries, excessive high calorie liquids and continuous nibbling on candy and sweets must be avoided to prevent excessive caloric intake.
  • Gastric and intestinal function is not altered. Only volume and speed of food intake is reduced and the rate of intestinal transit is increased. The physiology of hormone and neuro-peptide secretion by the remaining gut is altered to lead to beneficial changes in appetite control, carbohydrate metabolism and insulin sensitivity. (This is known as the Ileal brake)
  • Initial weight loss is similar to the duodenal switch, 40% excess weight loss in 6 months continuing for a year. Follow-ups at 3 years for 200 patients show the average weight loss is slightly in excess of 100lbs with heavier patients loosing the most. Over the five years I have been performing this surgery, patient weight loss in most cases has been maintained.  10 year data is not yet available, but for a sensible patient that needs a safe tool to help control eating volume and calorie intake, I believe this procedure is adequate for long term maintenance. The stomach should not enlarge significantly as there is not a significant restrictive component that will cause this.  As well, I do not expect the small intestine to grow excessively as there is no severe malabsorptive component in the operation to encourage this response.
  • For future surgeries of an unrelated condition, intestinal configuration appears normal and a surgeon unfamiliar with weight loss surgery will not be confused by an abnormal anatomical arrangement.
  • As the intestine is normal, an lending company in the future cannot deny claims easily on the premise of pre-existing condition.
  • The risk of future bowel complications, which occasionally happen with the Roux-y and the duodenal switch, are eliminated for the most part. Although, as in any surgery, early or late adhesions can occur. This may cause a bowel obstruction and necessitate surgery to relieve the problem. The risk is small.
  • The biggest advantages are patient satisfaction, lack of complaints and problems, minimized follow-up, and no need for expensive adjustment as in the Lap-Band procedure.

I strongly believe the secret to continued weight maintenance is for a patient to be able to eat all foods they want, though in reduced amounts, without problems, to satisfy themselves and to be able to live a healthy life style and partake of a normal social life without concern for vomiting episodes or stool dysfunction. Some patients have temporary or even permanent food intolerances after this surgery, but based on my research papers , I can detect no rhyme or reason for this, as all patients are different. My patients are only required to take two multivitamin tables (chewable if preferred), and an iron supplement daily. I strongly recommend annual blood work.