Duodenal Switch Surgery
The Duodenal Switch (DS) procedure, also called biliopancreatic diversion with duodenal switch (BPD-DS), promotes weight loss by combining restriction (reduction of the stomach volume) and fat malabsorption (reducing the number of fat calories absorbed by the body via intestinal bypass). Due to the significant re-routing of intestines, the duodenal switch results in the greatest amount of weight loss compared to other bariatric procedures and the greatest resolution of co-morbidities, especially diabetes, high blood pressure, and high cholesterol. However, due to it's complexity, it also has the highest complication rate.
The duodenal switch procedure may be more appropriate for people with very high BMIs of 55 or greater. A study found that the duodenal switch produced more weight loss than the Roux-en-Y gastric bypass in patients with a BMI of at least 50. Some patients choose the duodenal switch because it provides the greatest amount of weight loss while allowing larger meals with less restriction of sugar compared to the gastric bypass.
Performed laparoscopically: leads to faster healing and less pain.
Combines restriction and malabsorption: highest amount of weight loss compared to other procedures and less chance of weight regain.
Less hunger: reduces hunger hormone ghrelin.
High patient satisfaction: allows larger meals and no dumping syndrome.
Greatest resolution of co-morbidities.
Stomach stapling: risk of leakage and other complications directly related to stapling.
Major surgery: risks of bleeding, blood clots, intestinal obstruction, wound infection, pneumonia, and death
Significant re-routing of the GI tract: risks of malabsorption of vitamins and minerals, protein malnutrition, chronic diarrhea, foul smelling stools and gas
At Nashville Weight Loss Solutions, we perform the Duodenal Switch as a minimally-invasive (laparoscopic) procedure where very small incisions allow abdominal access with small instruments. This approach leads to reduced pain, less scarring, and faster recovery. The surgery takes about 3 hours to perform, and most patients stay in the hospital 3 nights and return to work in 2 weeks.
The first part of the procedure involves reducing the stomach volume by dividing it vertically and removing approximately 70% of it (irreversible part of the operation). Similar to gastric sleeve surgery, the remaining stomach is about the size of a medium banana and can only hold 4-5 ounces of solid food. The nerves to the stomach and the stomach's outlet valve (pylorus) remain intact with the idea of preserving the function of the stomach while reducing its volume or capacity. By comparison, in a Roux-en-Y gastric bypass, the stomach is divided, not removed, and the pylorus is excluded and no longer functional.
Next, the intestines are divided and rearranged to separate food from the digestive juices, thereby creating malabsorption (minimizing the calories which are absorbed, as well as the nutrients). The food limb is attached to the duodenum and receives food from the stomach. This limb is usually 150 cm long. The digestive juices are now separated from the food and travel for over 500 cm in the bypassed small intestine. Both food and digestive juices mix together and travel together for 100 cm in the common limb or channel (portion where both food and digestive juices are located). Thus, food and digestive juices are separated for most of the length of the intestines. This prevents an individual who has undergone a Duodenal Switch from absorbing all of the fat calories that are consumed. By comparison, the intestinal bypass in a Roux-en-Y gastric bypass is much less extensive, and the common limb for digestive juices and food to mix is approximately 5 times longer. Because of this, the Roux-en-Y gastric bypass has minimal or far less malabsorption compared to the Duodenal Switch procedure.
Most of the weight loss with the Duodenal Switch occurs during the first 12 to 18 months after surgery. Based on patient averages, you can expect to lose about 80% of your excess weight or about 35-40% of your BMI.* Success rates of weight loss surgery are much higher when patients are active in a comprehensive aftercare program like offered at Nashville Weight Loss Solutions.
*Individual results may vary.
Am I a Candidate?
Visit our Pathway to Surgery page to find out if you are a candidate for bariatric surgery, see if your insurance will cover bariatric surgery, and learn how to take the next step.