Duodenal Switch
One of the most effective weight loss procedures for the super obese is the Duodenal Switch. The Duodenal Switch includes a restrictive component but is primarily a malabsorptive weight loss procedure. With Duodenal Switch weight loss surgery, the size of the stomach is reduced to limit food intake and the small intestine is "switched" around to alter the digestion process and limit food (calorie) absorption. This bariatric operation has greatly improved the health and quality of life for many seriously obese individuals by helping them achieve and maintain significant long-term weight loss.
The interest in Duodenal Switch has been increasing along with the popularity of weight loss surgery in general. Much of the attention is due to the fact that it provides excellent weight loss results while allowing an individual to eat more food than with gastric bypass surgery and does not cause dumping syndrome. The changes caused by this procedure are usually well tolerated by patients and individuals who have undergone the DS procedure are usually quite satisfied with the outcome.
Although the Duodenal Switch seems to have many advantages as a weight loss procedure, some of the potential complications are worth considering as well. Before any major surgery, it is important to consider both the benefits and risks of all your options. The following information will help you learn more about the Duodenal Switch procedure, but it should not replace the advice of your doctor who can best evaluate your overall health and determine a suitable treatment for your obesity and related health conditions.
Malabsorptive Weight Loss Surgery
The Duodenal Switch weight loss surgery was developed in the early 1980's as a modification to the Bilio-Pancreatic Diversion (BPD) procedure, another type of malabsorptive weight loss surgery. The Duodenal Switch offers the advantages of the BPD procedure but without some of the associated problems, such as ulcers, dumping syndrome, and serious protein-calorie malnutrition. The Duodenal Switch surgery is also called Bilio-Pancreatic Diversion with Duodenal Switch (BPD-DS), extensive gastric bypass with duodenal switch, or simply abbreviated as DS.
With the DS procedure, the left half of the stomach is permanently removed. The new stomach is crescent shaped, about the size and shape of a banana. The benefit of keeping the right side of the stomach intact is that the pylorus, which is the stomach valve that controls when food leaves the stomach and enter the intestines, is not removed. This reduces the incidence of dumping syndrome, caused by food entering the intestines too quickly, which is common with gastric bypass surgery. The amount of food that can be eaten is somewhat limited, but food restriction is much less than with gastric bypass surgery or adjustable gastric banding.
The primary component of Duodenal Switch surgery is the malabsorptive aspect, which is accomplished by bypassing a large section of the small intestine. The small intestine, which measures about 20 feet, is then cut at two locations. One cut is made about one to two inches past the pyloric valve (the first 10-12" of the small intestine is called the duodenum, thus the name duodenal switch) and then another cut is made eight feet from the lower end of the small intestine. The lower eight foot section, the alimentary limb, is then connected to the beginning of the duodenum near the stomach outlet. The cut out section of the small intestine, called the biliopancreatic limb, is where most digestion usually occurs but is now completely bypassed. The biliopancreatic limb continues to transport bile and pancreatic secretions, but is instead reconnected near the end of the small intestine. This last section of the small intestine where food and digestive enzymes finally meet is called the common limb. With such a short section of the intestines involved in digestion, the absorption of nutrients and calories is greatly reduced.
Advantages of Duodenal Switch Weight Loss Surgery
- Patients are able to eat more normal meals than with standard Roux-en-Y gastric bypass or adjustable gastric banding, resulting in higher degree of patient satisfaction
- Patients are able to achieve significant and long-lasting weight loss, due to the high level of malabsorption
- Patients do not experience dumping syndrome, common with Roux-en-Y gastric bypass surgery, because the pyloric valve between the stomach and small intestine is kept intact
- Reduces likelihood of stomal ulcers from occurring
- The intestinal rerouting can be reversed if medically necessary as no part of the small intestine is removed
- The hunger hormone, Ghrelin, is greatly reduced due to removing a large portion of the stomach
- Improvement in obesity comorbidities, such as type 2 diabetes and high blood pressure, shortly after surgery
- Super obese patients who are turned down for other weight loss surgeries may qualify for the DS procedure
- Very effective weight loss for patients with high BMI (BMI greater than 55)
- Average weight loss of 60-80% excess weight
Disadvantages of Duodenal Switch Weight Loss Surgery
- Malabsorption procedures have a period of intestinal adaptation causing frequent and very soft bowel movements (4-6 per day), which may or may not lessen over time
- May cause gas pains, bloating, frequent passing of very smelly gas
- May develop intolerance of certain foods (varies by patient)
- May experience changes in body odor
- Increased risk of gallstones and gallbladder problems
- Possible intestinal irritation
- Rapid weight loss may cause temporary hair loss
- Lifelong monitoring for protein malnutrition, anemia and bone disease
- Lifelong vitamin supplementation is required, otherwise health problems can occur
- Most complex surgical weight loss procedure
Overall, Duodenal Switch weight loss surgery is very effective in helping super obese patients lose weight and keep it off. As you consider the advantages and disadvantages of this bariatric procedure, it is important to remember that all weight loss surgeries involve some degree of risk. If you are interested in the Duodenal Switch procedure, the next step is to discuss your options with your bariatric surgeon. Your doctor can determine if you are a good candidate and will make sure you fully understand the lifestyle changes that will be required should you choose Duodenal Switch weight loss surgery.
