Understanding the Duodenal Switch

weight loss surgery resultsThe Duodenal Switch (DS) – also known as Biliopancreatic Diversion with Duodenal Switch – is a combination weight loss surgery procedure that has proven especially effective for super-obese patients. The procedure is both restrictive and malabsorptive. In other words, the surgery promotes weight loss in two ways: First, it restricts the amount of food you can consume by creating a smaller stomach pouch, and second, it prevents your bowel from absorbing most of the calories from the food you do eat.

How Duodenal Switch Surgery Works

During the procedure, the surgeon cuts away about 70 percent of the stomach, sewing the remaining stomach tissue into a narrow, banana-like shape. Since the stomach is now dramatically smaller, it can hold only a small amount of food at any given time, which drastically reduces the amount of calories you take in. This is the restrictive part of the procedure.

Next, the surgeon separates the stomach and the upper small intestine, or duodenum, from the portion of the small intestine that carries digestive juices. Foods mix with stomach acid and then move into the duodenum and small intestine, where they mix with bile and digestive juices. However, the malabsorptive part of the procedure bypasses most of the small intestine, where digested food is absorbed, drastically reducing the number of calories your body absorbs from the food that does get through. The stomach and duodenum are then connected to the lower part of the small intestine, called the common channel, where it again mixes with bile and other digestive fluids from the liver and empties into the large intestine.

Advantages of Duodenal Switch Weight Loss Surgery
The big advantage to the duodenal switch is its effectiveness, especially for patients with a high Body Mass Index (BMI). A literature review conducted by the National Institutes of Health (NIH) and published in 2003 found that patients who underwent biliopancreatic diversion/duodenal switch surgery lost an average of 70.1% of their excess weight afterwards.

Another advantage is that during the surgery the pylorus – the valve that controls when food leaves the stomach and enter the intestines – is not removed, thus allowing food from the stomach to reach the bowel at a natural rate. This reduces the chances of dumping syndrome, caused by food entering the intestines too quickly, which is common with gastric bypass surgery. DS patients may also have fewer stomach ulcers than gastric bypass patients, and as with other weight loss surgery procedures, they show rapid improvement in co-morbidities, such as Type 2 diabetes and high blood pressure. Finally, removing such a large portion of the stomach cuts the amount of grehlin (a hunger-producing hormone secreted by the stomach) in the system, which makes it even easier to eat smaller portions and lose weight rapidly.

Disadvantages of Duodenal Switch Weight Loss Surgery
The primary disadvantage of the duodenal switch is its risk. Due mainly to the large amount of resection (cutting) involved, DS is the riskiest form of weight loss surgery, with a 1.1% rate of fatal complications per 100 DS surgeries performed, according to the NIH. (In comparison, purely restrictive weight loss surgery procedures, like the Lap-Band, have a 0.1% operative mortality rate within 30 days of surgery, and the rate for gastric bypass surgery is 0.5%.)

You may also experience frequent bouts of diarrhea, intestinal gas and irritation, as well as food intolerance as your body adapts post-surgery. Other possible side effects include temporary hair loss, and the lifetime risk of protein malnutrition, anemia and bone disease. Post-operative DS patients must constantly monitor their vitamin, mineral, and nutrient levels to prevent the occurrence of serious complications, including premature death. For this reason, it is vital that you faithfully stay in touch with your surgeon if you have the duodenal switch procedure, and that you follow the necessary post-op care regimen for a lifetime.

Duodenal switch weight loss surgery is a major procedure that should be considered carefully. Although any surgery presents certain risks, DS can nevertheless be a lifesaver for the super-obese patient seeking to lose weight and keep it off. Before making any decisions regarding weight loss surgery, you should discuss all options with your doctor.

2 Responses

  1. Barbara

    Hi I had Duodenal Surgery Nov 2005 My Dr I had in Indiana doesnt see you after 5 years. I need to find a Dr near North Fort myers Florida That understands this surgery. I have to have blood work done every year. Malabsortion. I have Medicare and supplement Insurance.

  2. Shirley

    Barbara, could you tell me how you are doing? Any problems,would you do it again? Have you kepted the weight off?

    I am considering doing the ds surgery.