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A True Destination for Bariatric Patients

Rana Pullatt, M.D.
Dr. Rana Pullatt in the operating room.

MUSC Health is one of the few centers in the Southeast offering a complex surgical weight loss procedure for adults with severe obesity, including patients turned away at other locations because of their weight.

"Biliopancreatic diversion with duodenal switch (BPD/DS) is considered safe and effective and can help patients lose more weight than traditional gastric bypass or the sleeve gastrectomy,” says Rana Pullatt, M.D., director of Robotic and Bariatric Surgery at MUSC Health and the first surgeon in South Carolina to perform the complicated procedure.

"Patients who undergo duodenal switch typically lose 30 to 40 percent of their body weight within a year," says Pullatt.

BPD-DS is a two-part procedure combining the vertical sleeve gastrectomy, in which the stomach is stapled and ultimately reduced by as much as 70 percent, and an intestinal bypass. During the intestinal bypass, the duodenum is divided, and the last part of the intestine is pulled up and connected to the newly created stomach past the pylorus. About one half to three-fourths of the small intestine is bypassed.

"We do bariatric surgery as complex as anywhere in the United States"

The laparoscopic technique and the patient’s size make the procedure more demanding. “We do bariatric surgeries as complex as those anywhere in the United States, including complex revisions,” Pullatt says.

Duodenal switch, which can be performed as a primary procedure or as a conversion procedure for patients who have inadequate weight loss after sleeve gastrectomy, is the preferred procedure for patients with BMI over 50. In people with diabetes, the threshold for performing DS is 35. Pullatt’s typical patient has a BMI of 65, or a weight of 415 pounds, although he has operated on patients exceeding 600 pounds.  After 1-2 years, he’s seen an average weight loss of 170-200 pounds.

The DS surgery has been shown to help reduce obesity and related illnesses, including heart disease, high blood pressure and type 2 diabetes and change gut hormones to curb appetite and improve satiety.

Patients must follow a protein-rich diet – between 80 and 100 grams daily – lower their intake of carbohydrates and fats, and take high-quality fat-soluble vitamins. Through an interdisciplinary team of experts, patients are monitored closely for the first six months and annually for life.

“Our patients have been shuttled from place to place in search of a viable treatment,” he says. “They typically suffer from metabolic syndrome and complex psycho-social and dietary issues that are addressed by a team approach. Duodenal switch definitely improves quality of life.”