What is duodenal switch surgery?
The duodenal switch is a weight-loss operation that modifies your stomach and your small intestine. It combines a gastrectomy (removal of part of your stomach) with an intestinal bypass, which makes the path your food takes through your intestines shorter. This restricts how much food your stomach can hold, and also how much nutrition your small intestine can absorb from your food. (This makes it a “malabsorptive” procedure). It also reduces the hunger hormones that your stomach and small intestine normally produce.
There are currently two different forms of the duodenal switch in practice. The original form is called the biliopancreatic diversion with a duodenal switch (or sometimes, the gastric reduction duodenal switch). This is the version with the most history and research behind it. The newer version, the loop duodenal switch, was developed to simplify the procedure and reduce complications.
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Why is it done?
Your healthcare provider may recommend bariatric surgery if you have clinically severe obesity (class III), which means you're at high risk of or are already experiencing obesity-related diseases. These include metabolic syndromes such as high blood pressure, high cholesterol and high blood sugar, which are precursors to heart disease, kidney disease and diabetes. You may be diagnosed with class III obesity if you have a BMI of 40 or higher, or if you have a BMI of 35 and one of these related diseases.
Your healthcare provider may recommend duodenal switch surgery if your obesity and related conditions are more severe. That may mean a BMI of 50 or higher, or a severe form of obesity-related disease. The duodenal switch has the most profound weight loss results of all bariatric procedures, and it dramatically improves metabolic syndromes such as Type 2 diabetes. It also has a higher rate of complications. But for people with more severe conditions, the benefits outweigh the risks.
How does the duodenal switch compare with other common weight-loss surgeries?
The duodenal switch is less commonly performed than other bariatric surgeries because it is more complicated and more extreme. It involves more cutting and stitching in your digestive system and takes out or bypasses more of your gastrointestinal tract than other procedures do. This makes it somewhat riskier for complications, both during the procedure and afterward. However, the duodenal switch is also the most effective weight-loss surgery method, with the most profound and lasting results.
What is the difference between duodenal switch vs. gastric bypass surgery?
The duodenal switch is similar to the Roux-en-Y gastric bypass. Both involve reducing your stomach (weight loss by restriction) and bypassing part of your small intestine (weight loss by malabsorption). In general, the duodenal switch leans more on malabsorption, while the Roux-en-Y gastric bypass leans more on restriction. The duodenal switch reduces the size of your stomach by about 60% to 70% (vs. 70% to 80% with the Roux-en-Y). But it also bypasses about 75% of the small intestine (vs. about 30% with the Roux-en-Y).
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. In fact, the sleeve gastrectomy was originally developed as the first part of the duodenal switch. The gastric sleeve procedure reduces the stomach to a small, tubular “sleeve,” about 75% of its original size. The second part of the duodenal switch goes a step further by bypassing much of the small intestine. This second part produces greater weight loss than the gastrectomy alone, but also more potential side effects.
How much weight can you lose with a duodenal switch?
The average weight loss with a duodenal switch is 80% of excess weight over a two-year period. That’s well above the average weight loss from bariatric surgery overall, which is 50% to 60%. People who have duodenal switch surgery also maintain more weight loss over the long term. Studies show an average sustained weight loss of 70% of excess weight over ten years. That means that if you were 200 lbs. overweight, you would lose an average of 140 lbs., and keep it off.
How effective is the duodenal switch?
Duodenal switch surgery has a 90% success rate for weight loss. That means that 90% of people lose at least 50% of their excess weight. Most lose more. The surgery has a similar success rate for remission of related health conditions. As much as 90% of people with Type 2 diabetes are able to discontinue their medications after a duodenal switch. Because of its higher success rate, some people who fail to lose enough weight with other bariatric surgeries choose to have revision surgery with a duodenal switch.
What obesity-related conditions can duodenal switch surgery help treat?
Obesity raises the risk of disease in nearly every body system. Duodenal switch surgery helps reduce the risk and the effects of developing these diseases, including:
- Cardiovascular disease: hypertension, arterial disease, vascular disease, heart attack, stroke.
- Respiratory diseases: asthma, obstructive sleep apnea, obesity hypoventilation syndrome.
- Metabolic diseases: hyperlipidemia, insulin resistance and diabetes.
- Gastrointestinal diseases: nonalcoholic fatty liver disease, nonalcoholic steatohepatitis.
- Reproductive diseases: polycystic ovary syndrome, infertility.
- Musculoskeletal pain: back strain, weight-bearing osteoarthritis.
- Cancer: especially colorectal cancer and liver cancer.
FAQs
The duodenal switch is a weight-loss surgery designed to treat people who have severe obesity. It combines a sleeve gastrectomy with an intestinal bypass. The duodenal switch is the most complicated but also the most effective bariatric surgery. It's especially effective against Type 2 diabetes.
What is the life expectancy of a duodenal switch patient? ›
Results: Survival rate was 92% after DS. The risk of death (Excess Hazard Ratio (EHR)) was 1.2, almost that of the general population. After a mean of 7.3 years (range 2-15), 92% of patients with an initial BMI < or = 50 kg/m2 obtained a BMI < 35 and 83% of those with an initial BMI > 50 obtained a BMI < 40.
What is the disadvantage of a duodenal switch? ›
Specific disadvantages include: Greater risk for nutritional and fluid deficiencies (must be on life long vitamins) Gastric reflux.
Which is better, gastric bypass or duodenal switch? ›
Duodenal Switch Vs Gastric Bypass: Which To Choose
Gastric bypass surgery is the most common, ideal for patients with a BMI of 40-50, and takes only 2 hours. In contrast, the duodenal switch surgery works for patients whose BMI is over 50, is more invasive, and takes about 4 hours.
Can you eat normally after a duodenal switch? ›
After the surgery, you will be going through some specific diet plans to help your body adapt to the new changes. This diet consists of high-protein and low-calorie, and carbohydrate meals. You will start with liquid food, then gradually switch to pureed and solid meals.
Can you gain weight back after duodenal switch? ›
While you can regain weight after other bariatric procedures, DS patients are the least likely bariatric surgery patients to gain weight back. Another study of DS patients revealed that after a 7-year post-surgery average: 92% of patients with an initial BMI ≤ 50 reached a BMI < 35.
What is one of the top 3 causes of death after bariatric surgery? ›
Sixty three percent of these deaths occurred within 30-days of the initial bariatric surgery, 40% occurred after hospital discharge. Anastomotic leak was the most common underlying cause of death (36% of deaths), followed by pulmonary embolism (12%) and cardiac causes (9%).
Why does my body smell after a duodenal switch? ›
The duodenal switch is two bariatric procedures at once: sleeve gastrectomy and bypass. Some patients experience fat dumping, diarrhea and malabsorption of nutrients. They also might emit a gas that smells especially offensive.
Why do I poop so much after duodenal switch surgery? ›
It can take time for your intestines to adapt, so bowel movements can be very liquid and frequent after the procedure. This condition may lessen over time, but may be permanent. Abdominal bloating and foul smelling stool or gas may occur. Because this is a malabsorption procedure, vitamin deficiencies may occur.
Can your stomach stretch after duodenal switch? ›
Like any other body part, the stomach will adapt to what it considers the new normal. Again, if you are eating and drinking through your postoperative diet, your body will eventually adjust to the new reality and stretch to accommodate what it knows is coming.
Candy cane syndrome (CCS) is a particular case of the blind pouch syndrome after gastrectomy or gastric bypass, so named in a 2007 paper describing a small series of patients with gastrointestinal symptoms associated with a long blind loop proximal to the gastro-jejunostomy after gastric bypass and creation of an end- ...
Can you drink alcohol after duodenal switch? ›
Avoid alcohol for the first six months after bariatric surgery. When you get permission to start drinking alcohol again, avoid carbonated beverages and sugary drink mixers. Remember that after surgery, even small amounts of alcohol can cause intoxication and low blood sugar.
How much weight will I lose with a duodenal switch? ›
People who have duodenal switch surgery also maintain more weight loss over the long term. Studies show an average sustained weight loss of 70% of excess weight over ten years. That means that if you were 200 lbs. overweight, you would lose an average of 140 lbs., and keep it off.
How long does duodenal switch last? ›
How long does a duodenal switch take? The procedure may take a few hours and there are two steps of the surgery: sleeve gastrectomy which takes from 45 to 60 minutes. laparoscopic duodenal switch which takes longer to complete, approximately between 90 and 120 minutes.
What is life like after a duodenal switch? ›
You probably will lose weight very quickly in the first few months after surgery. As time goes on, your weight loss will slow down. You can expect most of your weight loss to happen in the first 12 months after your surgery. You will have regular doctor's appointments during this time to check how you are doing.
Can I ever eat popcorn again after gastric bypass? ›
Because of these characteristics, you must not eat popcorn soon after your bariatric procedure and should consider eliminating it altogether. However, if you decide to have an occasional popcorn snack once you're back to eating solid foods, it should be plain popcorn with no added butter or salt.
What is the long term success of duodenal switch? ›
The average weight loss with a duodenal switch is 80% of excess weight over a two-year period. That's well above the average weight loss from bariatric surgery overall, which is 50% to 60%. People who have duodenal switch surgery also maintain more weight loss over the long term.
When do you stop losing weight after duodenal switch? ›
There is a gradual slow down of weight loss between 6-9 months after duodenal switch surgery with peak weight loss occurring at 12-18 months post-op. Overall, patients who undergo loop duodenal switch surgery have the potential to lose 75-95% of their unhealthy body weight.
Is the duodenal switch worth it? ›
Duodenal switch surgery is considered the most reliable weight loss procedure with long-term results. It combines two different procedures — a sleeve gastrectomy and a gastric bypass — to aid in weight loss. People who undergo duodenal switch surgery typically maintain their weight loss for many years after.
Do duodenal switch patients get dumping syndrome? ›
Unlike the gastric bypass, patients who have the DS procedure do not experience dumping syndrome or marginal ulcers. Because the DS procedure bypasses a much greater length of small bowel than the gastric bypass, the DS carries a higher risk of malnutrition and vitamin deficiencies.
