The duodenal switch is a weight loss operation that has been performed for over 20 years, but has seen a significant increase in popularity over the last several years. It has some of the most substantial weight loss potential of all the operations available today.
It works by creating a sleeve gastrectomy for restriction and hunger control. Then, after the sleeve, the intestines are rerouted, a process similar to that of a gastric bypass.
How We’ve Improved the DS
The principal length measured in a duodenal switch is the common channel. This is the distance from where bile and food meet to the end of the intestines and determines the amount of malabsorption.
The ideal common channel distance in a DS has changed significantly over time. Initially, this number was 50-100 cm, and while it provided excellent weight loss, it left patients with nutritional deficiencies and diarrhea. We currently target a common channel length of 300 cm for most procedures. Deviations from this number are dependent on the patient’s needs, and this appears to be the sweet spot where weight loss is still excellent with fewer downsides.
Vitamin supplementation is important, and patients may have increased bowel movements.
Surgery takes approximately an hour and a half, and patients experience a similar recovery time to that of other procedures. The dietary progression is the same. Food enters the sleeve and is held there with the pylorus, just like a sleeve. Because of this, dumping syndrome does not occur, unlike the gastric bypass.
Ideal Patient & Expectations
The ideal patient for a duodenal switch has a significant amount of weight to lose. We know that patients will lose more weight than with other surgical options, particularly patients with a BMI over 50. Additional benefits include a lower incidence of ulcers compared to gastric bypass operations. This is particularly helpful for patients who need to take NSAIDs such as aspirin or ibuprofen.
Patients can expect to lose 80-90% of excess weight in the first year after a duodenal switch operation.* In summary, the duodenal switch offers:
- Greatest weight loss potential of all bariatric procedures
- Minimal risk of dumping syndrome
- Excellent diabetes control
- Minimal risk of ulcer disease
Duodenal Switch Risks &Disadvantages
- Standard surgical risks
- Increased risk of reflux disease
- Greater risk of nutrition deficiencies if not compliant
- Nausea and vomiting
- Leaks from the staple line
- Reflux
- Small Bowel Obstruction
Duodenal Switch Recovery Timeline
- Hospital stay is typically 24 to 48 hours
- Many patients return to regular activity within 1 to 2 weeks
- Heavy lifting is restricted for roughly 4 weeks
*Results will vary between patients