Bariatric Journal

Duodenal Switch

Complete Guide to Duodenal Switch

Duodenal switch surgery helps patients feel less hungry, lose most of their excess weight within the first year following surgery, absorb fewer calories from the food consumed and helps keep pressure off for a long period of time.

This weight loss procedure using the duodenal switch approach is showing better results than gastric bypass. It combines both malabsorptive and restrictive procedures that leads to long-term weight loss. Sometimes known as biliopancreatic diversion, it creates the smaller pouch that also bypasses a portion of the small intestine. Patients lose weight quick, but not with any nutritional issues. This new stomach pouch holds six ounces of food. According to the U.S. National Library of Medicine National Institutes of Health, duodenal surgery not only helps patients lose weight, but has helped patients resolve their diabetes and reduced their needs for asthma and high blood pressure medicine.

The surgery does remove a portion of the stomach, while the remaining part is then connected to the lower part of the small intestine. The pylorus valve is left intact, which controls drainage in the stomach. Because it is left intact, dumping syndrome symptoms are rare with this type of weight loss surgery, which is a plus. The surgery is typically done laparoscopically.

Duodenal switch surgery helps patients feel less hungry, lose most of their excess weight within the first year following surgery, absorb fewer calories from the food consumed and helps keep weight off for an extended period. Best of all, it helps resolve or improve several co-morbidities (obesity-related medical conditions) including high blood pressure, high cholesterol, asthma, sleep apnea or Type II Diabetes.

Do I Qualify for Duodenal Switch?

Typically, this bariatric surgery is for those who are super obese with a body mass index (BMI) of 50 or higher or whose weight is causing them serious health issues. Some surgeons allow patients with a BMI of over 40 or those with at least one comorbidity and a BMI of 35 or higher to have the surgery. While yes surgery can help lose weight, it is not a quick fix for a patient’s obesity. A regular exercise routine and a healthy diet helps patients to reach their weight loss goals successfully. A surgeon may not want to perform this surgery if a patient has a history of Gastroesophageal Reflux Disease (GERD) or Inflammatory Bowel Disease (IBD). Additional tests may be required before approval for this surgeon. They may recommend a different weight loss surgery that will be safer for the patient.

Expected Excess Weight Loss with Duodenal Switch Surgery

Many Duodenal Switch patients can expect to lose 75-80% of their excess weight. This is the patient’s current weight minus their ideal weight and 75-80% of that total. Some studies have shown that after 10 years following surgery, some individual do gain back 20-25% of their weight loss. This makes it especially important to be willing to commit to a long-term, lifetime lifestyle change.

While different patients will have different results, most will see this amount of weight loss. Regarding comorbidities, most patients saw a 98% reduction of Type II Diabetes cured, 99% of high cholesterol, 83% of high blood pressure and 92% of sleep apnea after their Duodenal Switch surgery.

Duodenal Switch surgery is great because it combines moderate caloric intake with calorie malabsorption results leading to high percentage of weight loss for patients. Also, much of the hunger hormone’s ghrelin’s production is taken out, so that reduces instances of hunger for patients too.

The diet after duodenal switch also is better tolerated, which leads to greater weight loss success. Best of all, the malabsorptive part is fully reversible because the small intestine itself is reroute and not removed. Duodenal Switch surgery statistically has the best weight loss success than any other weight loss surgery. It is a great choice for those with a diet high in fat and can be used with lap band or gastric bypass.

Duodenal Switch patients typically lose:

  • 30% of excess weight by month 3
  • 45% of excess weight by month 6
  • 65% of excess weight by month 12

By year two post-op, the average patient has lost the 70-80% of their excess weight loss rate. Some patients have even achieved 90%.

Pre-Op Surgery

Your bariatric surgeon will ask you to have a series of tests before undergoing your duodenal switch surgery. Some possible tests include: complete blood count, physical exam, psychiatric evaluation, EKG, chest x-ray, nutritional counseling and endoscopy. The week before your weight loss surgery you will be asked to stop taking any aspirin, vitamin E, Coumadin and ibuprofen, all of which make it hard for the blood to clot. Your weight loss surgeon will know the routine to insurance approval (if applicable) and the requirements associated with each insurer.

During Surgery

Duodenal switch surgery is done under general anesthesia. During the surgery, you will feel no pain and will be unconscious. Surgery is done laparoscopically with a small camera inserted into the stomach to allow the surgeon to perform the surgery successfully. They make multiple incisions to be able to allow instruments internally to perform the surgery. The duodenum (a portion of the small intestine) is attached to the lower portion of the small intestine. This will allow food to bypass the rest of the organ and go straight to the duodenum for weight loss results.

Diet and Life After Duodenal Switch

It is normal to have belly pain requiring pain medication for a week or so after surgery. The incisions will be tender and sore. The surgery does make the stomach smaller, so you will get full quick when you eat. Food also may empty into the small intestine too quickly known as dumping syndrome. Although this is rare for this type of surgery, diarrhea, weakness, nausea and vomiting may occur. You will need to avoid heavy lifting or strenuous exercise for four to six weeks following your surgery.

In terms of eating, for the first month following duodenal switch surgery, your stomach will only be able to tolerate small amounts of soft foods and/or liquids. Sipping water throughout the day will ensure you do not become dehydrated, which can lead to digestive issues. Bowel movements will not be regular right after surgery because of the eating changes and the use of pain medications, don’t be alarmed!

Slowly you will add solid foods back into your diet. Be careful to chew your food well and to stop eating the instance you feel full. This will involve an adjustment period, but you will get there. Do not drink high amounts of calories in liquids or you can jeopardize your weight loss efforts.

Because duodenal switch surgery removes a part of the intestine where many minerals and vitamins are absorbed, you will need to take iron, magnesium, B12, calcium and other supplements recommended by your weight loss surgeon. Eating plenty of protein will keep you full longer. You will be eating several small meals a day, which will be an adjustment for some patients. All of these things will help you lose weight you’re hoping to.

How to Maximize Weight Loss with Duodenal Switch 

After undergoing duodenal switch surgery, you will need to start a new way of eating to have success with losing weight. Be sure to take at least 20 to 30 minutes with each meal while consuming no more than one cup of food. This means chewing slowly and thoroughly. This will help you to learn when you are full. Never drink during a meal either. Follow all instructions from your bariatric surgeon and nutritionist closely.

Losing weight after duodenal switch surgery can improve many co-morbidities which makes it easier for some patients to lose weight. Eat low-fat protein options such as egg whites and whole eggs, fish, lean meats, beans and low-fat dairy products for the best and most filling diet.

Weight loss surgery alone, no matter what types, is a solution to losing weight. However, it does set you up to eat less. You will still need to choose the right foods, the right amounts and be active in order to lose weight. Ultimately, your weight loss is determined by the effort you put forth, the types of food you’re eating and how much and how active you remain post-op. Also, going to your regular checkups will help you stay on the road to success too. Duodenal switch surgery is a tool that can change lives. Contact a weight loss surgeon today to learn more.

  1. Costs of Duodenal Switch
  2. Life and Recovery ofDuodenal Switch
  3. Pre-OperativeDuodenal Switch Diet
  4. Post-OperativeDuodenal Switch Diet


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