Overview of the Duodenal Switch
One of the most effective weight loss procedures for patients with a very high body mass index 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.
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 duodenal switch procedure are usually quite satisfied with the outcome. This weight loss surgery has greatly improved the health and quality of life of many bariatric patients with super obesity (BMI of 50 or more) by helping them achieve and maintain significant long-term weight loss.
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 duodenal switch procedure, the left half of the stomach is permanently removed. The new stomach is crescent shaped, about the size and shape of a banana. This gastric resection aspect of the duodenal switch closely resembles sleeve gastrectomy, or the gastric sleeve procedure.
The benefit of keeping the right side of the stomach intact is that the pylorus is not removed. The pylorus is the natural stomach valve that controls when food leaves the stomach and enters the small intestine. Preserving the use of the pylorus avoids the incidence of dumping syndrome, a condition of nausea and vomiting, that occurs when food enters the intestines too quickly and common with gastric bypass surgery.
After duodenal switch, the amount of food that can be eaten is somewhat limited, but food restriction is much less than with gastric bypass surgery or gastric banding. The smaller stomach helps to control eating and manage feelings of hunger, but patients are generally able to eat regular foods and normal portion sizes.
The primary weight loss 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 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
Duodenal Switch Patient Criteria
As the duodenal switch weight loss surgery is one of the most drastic, it is generally an appropriate option only for those patients with a very high body mass index. Duodenal switch patients should have a BMI of at least 40 and be between the ages of 18 and 65. For patients with a BMI of 50 or higher, the duodenal switch is often the preferred bariatric surgery option.
- The duodenal switch surgery is effective for patients with super obesity (Body Mass Index of 50 or greater).
Overall, Duodenal Switch weight loss surgery is considered very effective in helping patients with super obesity to lose a significant amount of weight and keep it off long-term. If you are interested in the Duodenal Switch weight loss surgery, the next step is to schedule a consultation with your bariatric surgeon to determine if the procedure is right for you and to learn more about lifestyle changes and follow-up care.