Duodenal Switch

Duodenal Switch (DS)

The Duodenal Switch (DS) is a weight loss surgery procedure that combines both a restrictive and a malabsorptive aspect. Malabsorptive surgeries restrict the amount of calories and nutrients that the body absorbs.

The restrictive portion of the surgery  involves reducing the size of the stomach by removing approximately 80% as with a Vertical Sleeve Gastrectomy (VSG). The remaining portion of the stomach is shaped like a banana and creates a long vertical pouch (about 4-6 oz). 

The malabsorptive portion of the Duodenal Switch involves rearranging the small intestine to separate the flow of food from the flow of bile and pancreatic juices. The food and digestive juices interact only in the last 18 to 24 inches of the intestine, resulting in malabsorption. This is done by re-routing a portion of the small intestine - which creates two seperate pathways with one common channel. The longer pathway (biliopancreatic loop) carries bile form the liver to the common channel. The contents of the digestive path mix with the bile from the biliopancreatic loop inside that portion of the small intestine (common channel) before emptying into the large intestine.

The objective of Duodenal Switch (DS) is to reduce the amount of time the body has to capture calories from food in the small intestine and to limit the absorption of fat. As a result, DS patients only absorb approximately 20% of the fat they intake.

Advantages of Duodenal Switch Surgery

The Duodenal Switch has the following advantages compared with other types of weight loss surgery:

• More rapid weight loss, compared with gastric banding procedures
• More complete disappearance of obesity-related illnesses
• The intestinal bypass portion of the surgery is partially reversible for patient's having malabsorptive complications 
• Reduced risk of developing ulcers
• Possibly greater long-term weight loss and less chance of regaining weight

Who is a Good Candidate for Duodenal Switch?

Studies have found that the Duodenal Switch is an effective weight loss option for people with a very high Body Mass Index (BMI) greater than 55. Those with a BMI above 45, or lower BMI's, but with obesity-related illnesses such as diabetes may also be candidates for the duodenal switch as well. This complex surgery does have more complications and may not be the right choice for certain high risk individuals, including those with heart failure and sleep apnea.

What to Expect After Duodenal Switch Surgery

The duodenal switch operation is lengthy, often lasting three to four hours. Most patient's require about three to four weeks of recovery after undergoing Duodenal Switch surgery.

Patient's may experience difficulty consuming liquids immediately after surgery because of swelling around the stomach and small bowel. The surgeon will most likely prescribe painkillers in the days after surgery. Most of the weight loss will occur during the first 12 to 18 months after surgery. Patient's can expect to lose about 70- 80% of their current weight.

Part of the recovery process involves getting re-accustomed to eating solid foods. People who undergo the duodenal switch can consume only fluids immediately following surgery. The diet will progress from clear liquids, full liquids, pureed or blended foods (mushies), soft foods then to solid foods.

The duodenal switch may result in more nutritional deficiencies than other weight loss surgeries because of the malabsorption it causes. As a result, patient's will need to take nutritional supplements daily for the rest of their lives, including vitamin A, vitamin D and Calcium. Some doctors may also recommend additional supplements of Potassium and Iron. Lifelong nutritional follow-up is needed after Duodenal Switch.

Compliance with nutrition guidelines is absolutely mandatory for duodenal switch patients, because failure to comply can lead to malnutrition and significantly unpleasant bowel changes. There are other nutritional considerations as well. For example, eating fatty foods tends to cause foul-smelling gas and diarrhea. In addition, some very starchy foods may cause gassiness. Note that everyone responds differently to different foods, so your experience may vary.