Duodenal Switch

What is duodenal switch surgery?

Duodenal switch is a type of bariatric surgery that removes part of your stomach and shortens your small intestine. It decreases how much food you hold, digest and absorb. This change leads to significant weight loss. It’s one of the less common weight-loss procedures for obesity, but it usually leads to greater total weight loss.

There are two types: The biliopancreatic diversion with duodenal switch (BPD/DS) is the traditional procedure, and the single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a newer modification.

How does duodenal switch surgery work?

The duodenal switch is a two-step surgery. First, your surgeon removes up to 80% of your stomach, making it much smaller and tube-shaped. This change prevents you from being able to eat too much food.

The second step is an intestinal bypass. Your surgeon shortens the length of your small intestine. They connect just the last section of your small intestine to your new stomach. When your food goes into your stomach, it bypasses most of your small intestine so that less of your food is digested. You can think of it as a shortcut in your digestion.

With duodenal switch, you end up eating less food, digesting that food quickly and absorbing fewer calories. This surgery also changes your metabolism and influences hormones that play a role in appetite and feeling full.

What conditions does a duodenal switch treat?

Duodenal switch is a procedure to treat Class III obesity. It’s not a weight loss surgery for everyone. Your healthcare provider carefully considers your health before deciding if this is the right weight-loss procedure for you.

Typically, duodenal switch is only for people who:

• Have a BMI of 40 or higher (class III obesity)
• Have a BMI of 35 or higher (class II obesity) AND a major obesity-related health condition

Examples of obesity-related health conditions are:

• Type 2 diabetes
• High blood pressure
• High cholesterol
• Heart disease
• Sleep apnea
• Metabolic dysfunction-associated steatotic liver disease

Duodenal switch surgery can help you lose weight and improve these or other obesity-related diseases.

What happens before duodenal switch surgery?

If your healthcare provider believes you’re a good candidate for surgery, you’ll enter a screening process. This could involve:

• Standard medical testing to make sure you’re in good health
• Screening for alcohol, tobacco and drug use and therapy to help you quit, if necessary
• Psychological counseling to make sure you’re prepared for the big life changes that your new digestive system will bring
• Enrolling in a seminar so you understand the surgery

Once you’ve met these benchmarks and scheduled your surgery, your healthcare provider will put you on a preoperative eating plan for a couple of weeks. This typically consists of eating meals that are low in fat and carbohydrates and high in protein.

How is a duodenal switch done?

Duodenal switch surgery is a laparoscopic surgery. The laparoscopic method is less invasive and uses small incisions instead of making a larger incision in your abdomen.

You receive general anesthesia so you’re asleep for the entire procedure.

There are two surgical methods to the duodenal switch: the traditional duodenal switch (biliopancreatic diversion) and the SADI-S.

• The first step in both methods involves removing part of your stomach and shaping what’s left of it into a narrow sleeve.

The differences are in the second part of the surgery — the intestinal bypass. Both versions begin the bypass by dividing your small intestine near the top, in the section called the duodenum. Then, they bring a lower section of your small intestine up to attach to the top, bypassing the middle.

1. The original duodenal switch surgery bypasses most of your small intestine, making it significantly shorter.
2. The modified version bypasses a little more than half of your small intestine.

The surgery typically takes between two and four hours.

What happens after duodenal switch surgery?

You’ll stay in the hospital for one to two days after surgery. It takes two to four weeks to make a full recovery. Your healthcare provider will give you instructions to follow during your recovery. This will include a list of what activities to avoid and what foods you can eat.

You’ll have frequent follow-up appointments with your healthcare provider in the first two years and periodic appointments for the rest of your life. The first two years will be your most dramatic weight-loss period. During this time, your provider will continuously monitor your progress and health.

Because there’s a risk of malnutrition, you’ll need to take nutritional supplements for the rest of your life. You’ll also need to give blood samples at regular intervals to make sure you’re getting enough nutrients.

Advantages and disadvantages of duodenal switch

Duodenal switch helps you lose weight and reduces your risk of serious obesity-related health problems. It can significantly improve your quality of life but requires that you make changes to your lifestyle.

Some more specific advantages are:

• Greatest overall weight loss results
• Most effective weight-loss procedure for people with Type 2 diabetes
• Allows for slightly larger meals when compared to other gastric bypass procedures
• Rarely causes dumping syndrome

One of the main disadvantages of the surgery is that it relies on malabsorption, which can help you lose weight. But it also requires you to follow a specific eating plan and take specific supplements to get the nutrition you need. You need to follow the eating plan to avoid loose bowel movements, as well.

Other risks may include:

• Infection
• Excessive bleeding
• Reactions to anesthesia
• Blood clots
• Hernias
• Small bowel obstruction
• Anastomotic leaks

How effective is the duodenal switch?

Duodenal switch surgery is one of the most successful bariatric surgeries. It results in a higher BMI loss (decreasing your BMI) when compared to gastric bypass. The surgery has a similar success rate for treating obesity-related health conditions like Type 2 diabetes.

What is the recovery time from duodenal switch surgery?

You’ll likely spend a few days recovering in the hospital, then a few weeks recovering at home. During your recovery, your body will go through huge changes, including rapid weight loss. You may have some temporary symptoms during this time, including:

• Fatigue
• Nausea
• Mood shifts
• Hair loss
• Body aches
• Feeling cold

Ask your healthcare provider what you can expect during your recovery, including what activities you should avoid.

Possible long-term complications of duodenal switch

Duodenal switch surgery makes drastic changes to your digestive system. There are several aspects of your health that your provider will monitor. These include:

• Malnutrition. Now that your small intestine will not be able to absorb as much nutrition from your food, you’ll have to take nutritional supplements daily. Your healthcare provider will test your blood for nutritional deficiencies for the rest of your life.
• Diarrhea. This is another side effect of malabsorption in your small intestine. Your small intestine won’t be able to digest your food as thoroughly. This can make for loose and more frequent bowel movements. Following a specific eating plan can prevent this, in most cases.
• Bile reflux. Surgery that affects your pyloric sphincter can cause it to malfunction. If it doesn’t close properly, one possible result is bile reflux.
• Gallstones. Rapid weight loss sends a large amount of cholesterol to your liver. When your liver sends bile to your gallbladder, it carries extra cholesterol with it. This extra cholesterol can build up in your gallbladder and cause gallstones.

What can’t you eat after duodenal switch?

You’ll also have strict food guidelines to follow during recovery. This is to give your digestive system time to heal and adjust to the new changes. It may take one to two weeks to progress through each stage on your way back to eating how you used to. Your provider can go over the steps in more detail, but they follow this order:

1. Clear liquid diet
2. Full liquid diet
3. Puréed foods
4. Soft diet

What is the weight-loss timeline following duodenal switch surgery?

Weight loss will vary from person to person, but there are some general trends. The most rapid weight loss happens in the first three months after surgery. During this time, you can expect to lose about 30% of your excess weight. Weight loss slows down a bit for the next three months after that. By the one-year mark, you may have lost 50% to 75% of your excess weight. Weight loss typically peaks between 12 and 18 months after surgery.

Is duodenal switch better than gastric bypass?

One isn’t better than the other. Both involve reducing the size of your stomach and changing the length of your small intestine The duodenal switch leans more on malabsorption, while gastric bypass leans more on eating less food. Your healthcare provider will recommend the best one for you based on your situation.

What is the difference between the duodenal switch vs. the gastric sleeve?

The duodenal switch is a two-part surgery that begins with a gastric sleeve. A gastric sleeve procedure reduces your stomach to about 75% of its original size. The duodenal switch goes a step further by having your food bypass most of the small intestine. This second part produces greater weight loss than the gastric sleeve alone, but also has more potential side effects.