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Duodenal Switch weight loss surgery, formally known as Biliopancreatic Diversion with Duodenal Switch (BPD-DS), is a two-step laparoscopic procedure. During the first phase of the procedure, a surgeon removes a portion of the stomach in the same manner as a Gastric Sleeve procedure. Next, the surgeon reroutes a portion of the small intestine called the duodenum through the lower intestine.
There are three mechanisms by which Duodenal Switch surgery helps patients lose weight:
Duodenal Switch surgery also affects the production of the hunger hormone ghrelin, which helps patients manage cravings.
Duodenal Switch surgery is more complex than other bariatric procedures such as Gastric Sleeve, but it also produces rapid weight loss and is an ideal option for many of our patients who are severely obese and suffer from comorbidities such as Type 2 Diabetes and sleep apnea. Some of the many benefits of Duodenal Switch include:
Duodenal Switch surgery can help patients lose more pounds more quickly than other bariatric surgery procedures, including Gastric Bypass surgery and Gastric Sleeve.1 Many patients lose 80-90% of their excess weight.2
Duodenal Switch is the most effective bariatric surgery procedure for treating Type 2 Diabetes.3 Diabetes remission is achieved in more than 90% of patients who undergo this weight loss surgery procedure.4
After Duodenal Switch surgery, up to 90% of patients are able to safely stop using their CPAP machines.5
Following Duodenal Switch, up to 88% of patients are able to decrease their asthma medication.6
More than 70% of patients see improvements in their cholesterol levels after Duodenal Switch.7
Up to 79% of patients see improved high blood pressure.8
The risk for dumping syndrome is much lower with patients who undergo Duodenal Switch than in patients who undergo Roux-en Y Gastric bypass.9
The key to feeling well-prepared for your Duodenal Switch procedure is to attend a private consultation with one of our experienced bariatric surgeons. Here, you will learn more about your weight loss surgery options and find out whether Duodenal Switch is the right procedure for you. If you are a good candidate for bariatric surgery, the team at Panhandle Weight Loss Center will help you prepare for this step in your weight loss journey. Once your procedure is scheduled, we will give you dietary instructions and other guidelines to follow before surgery as well as detailed information about what you can expect during the recovery period.
Some of our patients may be good candidates for a variation of Duodenal Switch surgery called Loop Duodenal Switch (Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy or SADI-S). As with a traditional Duodenal Switch procedure, the Loop Duodenal Switch involves dividing the duodenum and rerouting it to the lower intestine. However, with Loop Duodenal Switch, the intestine is rerouted at one connection point (anastomosis) rather than two.
Because only one anastomosis is formed during Loop Duodenal Switch, this laparoscopic procedure requires less time in the operating room and is associated with fewer complications. Additionally, since more of the small intestine is maintained during the Loop Duodenal Switch, patients often encounter fewer issues with vitamin deficiency and diarrhea.
| Duodenal Switch (BPD-DS) | Loop Duodenal Switch (SADI-S) | |
|---|---|---|
| Description |
– Reduces the size of the stomach by ⅔ – Reroutes a portion of the small intestine |
– Reduces the size of the stomach by ⅔ – Reroutes a portion of the small intestine |
| Anastomosis | 2 | 1 |
| Advantages |
– Rapid Weight Loss – Effective Treatment of Type 2 Diabetes – Improved Sleep Apnea – Improved Asthma – Improved High Cholesterol – Improved High Blood Pressure – Reduced Risk of Dumping Syndrome |
– Rapid Weight Loss – Effective Treatment of Type 2 Diabetes – Improved Sleep Apnea – Improved Asthma – Improved High Cholesterol – Improved High Blood Pressure – Reduced Risk of Dumping Syndrome – Shorter surgery time – Lower risk of vitamin deficiency – Lower risk of diarrhea – Lower risk of anatomy leaks |
| Disadvantages |
– May cause vitamin deficiencies, malnutrition – May cause discomfort – Stomach may stretch with excess food intake – Patients will need to take vitamins and supplements in perpetuity – Two Anastomosis – Longer surgery time – Higher risk of complications – Higher incidence of diarrhea – Higher risk of anastomotic leaks |
– May cause vitamin deficiencies, malnutrition – May cause discomfort – Stomach may stretch with excess food intake – Patients will need to take vitamins and supplements in perpetuity |
| Recovery | Required overnight stay | Home same day |
| Time Off Work | 1-2 weeks | 1 week or less |
| Complete Recovery | 3 weeks | 3 weeks |
| Time Off Work | 1 Week | 1-2 Weeks |
A laparoscopic Duodenal Switch procedure generally takes between 1 and 1.5 hours and patients can either go home the same day or stay overnight in the hospital.
There are two main steps to the Duodenal Switch procedure. The first stage is identical to a Gastric Sleeve procedure, where the surgeon uses a special stapling device to remove up to 80% of the stomach and creates a narrow sleeve from the remaining portion. This part of the surgery allows patients to feel fuller after eating significantly less food.
During the second part of the Duodenal Switch procedure, the surgeon changes the natural path of digestion by rerouting food from the upper part of the small intestine. To accomplish this, two incisions are made in the small intestine, one below the duodenum and another towards the lower end of the small intestine. The lower cut end is then brought up to the higher cut end, allowing food to bypass much of the small intestine. This second stage of Duodenal Switch surgery reduces the number of calories a patient’s body is able to absorb. It also releases endogenous hormones which raises a patient’s metabolism and reverses insulin resistance.
Following Duodenal Switch weight loss surgery, patients can expect to be up and walking shortly after the procedure. Some postoperative pain can be anticipated, but this should be tolerable and pain medication will significantly enhance patient comfort. Patients are cautioned not to do any heavy lifting (more than 10 pounds) for at least 3 weeks after Duodenal Switch surgery, and should refrain from strenuous exercise for at least 3 weeks. The majority of patients are able to return to work roughly 1 week after weight loss surgery.
After Duodenal Switch surgery, patients who adhere to our postsurgical and follow-up care regimen have better chances of long-term success. Two weeks after surgery, patients meet with their Physician Extender, who will monitor their healing, identify any potential complications, and make adjustments to their medications. Over the course of their weight loss journey, patients should continue to work with their Physician Extender as well as a health coach, dietitian, and psychologist as needed.
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