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Duodenal Switch

One of the most effective weight loss procedures for the super obese is the Duodenal Switch procedure. Duodenal Switch leads to more weight loss than gastric bypass, but also comes with a higher risk of serious complications. The Duodenal Switch includes a restrictive component, but is primarily a malabsorptive weight loss procedure. Therefore, patients are required to take numerous vitamins and to keep a close eye on nutritional requirements. 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 calorie absorption. The changes caused by this procedure are usually well tolerated by patients and individuals who have undergone the DS procedure, and they are usually quite satisfied with the outcome, achieving and maintaining significant long-term weight loss.

How Duodenal Switch Surgery Works

The Duodenal Switch surgery is also called Bilio-Pancreatic Diversion with Duodenal Switch (BPD-DS), extensive gastric bypass with duodenal switch, Gastric Reduction Duodenal Switch (GRDS), or simply abbreviated as DS. 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.
With the DS procedure, the left half of the stomach is permanently removed. The new stomach is crescent shaped and is 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 enters 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 skipping over 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 Surgery

The duodenal switch advantages, compared with other types of weight loss surgery include: a reduced risk of developing ulcers, more rapid weight loss, compared with gastric banding procedures, a more complete disappearance of obesity-related illnesses, possibly a greater long-term weight loss and less chance of regaining weight, consumption of larger meals, and the intestinal bypass part of the surgery is partially reversible for those having malabsorptive complications.

Risks of the Duodenal Switch Surgery

Although the Duodenal Switch seems to have many advantages as a weight loss procedure, some of the potential short-term and long-term complications are worth considering. The short-term complications one might experience are bleeding/blood loss, infection, blood clots, difficulty in consuming liquids immediately after surgery due to swelling around the stomach and a small bowel, leakage due to a perforation of the stomach, and death. The long-term risks of duodenal switch include chronic diarrhea due to having many loose bowel movements in a day and in turn causing foul-smelling stools and gas. Risks caused by nutritional deficiencies are night blindness due to mal-absorption of vitamin A, mal-absorption of protein leading to malnutrition that can lead to a second operation, and carbohydrates can be well absorbed, resulting in inadequate weight loss.