Biliopancreatic Diversion With Duodenal Switch

Often simply shorted to Duodenal Switch (DS), Biliopancreatic Diversion with Duodenal Switch is both the most complex of the bariatric surgery procedures we offer as well as the one with the greatest weight loss, disease resolution potential, and weight loss recidivism (resistant to weight regain after excess body weight has been lost).

Duodenal switch is both a restrictive (reducing the size of the stomach) and malabsorptive (bypassing the small intestine) procedure. This procedure is particularly useful for patients with extremely high BMIs. Much like the gastric bypass, the duodenal switch is very effective for patients suffering from poorly controlled type-2 diabetes or poorly controlled acid reflux.

How the Duodenal Switch Works

The duodenal switch is most often performed as a single procedure, however, it can be split into two distinct surgeries, if necessary. The procedure is almost always performed using laparoscopic or minimally invasive techniques. Robotic surgery is also an option for the duodenal switch. 4 to 5 small incisions are made in the abdomen and carbon dioxide is pumped into the abdominal cavity to make space for surgical instruments. A small, high-definition camera is used to visualize the surgical field. The camera provides an enlarged and very clear visualization of the internal organs allowing the surgeon to have excellent vision.

The first part of the duodenal switch is the gastric sleeve. In fact, the gastric sleeve was developed as a standalone bariatric procedure after many patients found that they did not need the second, malabsorptive part of the duodenal switch. One significant difference however is that less of the stomach is cut away during the duodenal switch – 60 to 70% of the stomach versus 75 to 80% of the stomach during gastric sleeve.

The second part of the duodenal switch involves bypassing a significant portion of the small intestine. This bypass reduces the surface area of the small intestine and patients will absorb fewer calories. It will also trigger powerful hormonal changes in the body leading to improved blood sugar control, which leads to a decreased need for diabetes medication requirements and decreased blood cholesterol levels. In fact, most patients stop ALL of their diabetes medications after surgery and may not need to resume them afterward.

The procedure takes about 120 to 180 minutes with the patient under general anesthesia. Recovery requires one to two nights in the hospital.

Benefits of the Duodenal Switch

• Like a gastric bypass, the combination of restriction and malabsorption allows for greater weight loss potential than purely restrictive procedures. However, since a larger portion of the small intestine is bypassed, the duodenal switch offers even greater weight loss and disease resolution potential than the gastric bypass. Patients may lose up to 80% of their excess body weight and most obesity related diseases are improved dramatically.
  • Weight regain resistance- given the complex new anatomical formation and hormonal changes, weight regain after the duodenal switch is very uncommon.
• Because the pyloric valve – the valve between the stomach and small intestine– is left intact after surgery, the risk of dumping syndrome, known as rapid gastric emptying, is significantly reduced versus gastric bypass.
• While it is mandatory that patients improve their dietary habits after surgery, duodenal switch patients may have greater latitude with their diet versus gastric bypass.

Risks of the Duodenal Switch

• Because of the longer bypass of the small intestine, some patients may develop severe nutritional deficiencies. We screen for these at follow-up appointments, but patients must be diligent with their vitamin supplementation.
• Patients may experience increased flatulence which can be mitigated with dietary changes.
• Patients may experience loose stools or diarrhea and may have particularly foul smelling bowel movements which can also be mitigated with dietary changes.
• The staple line creating the gastric sleeve may leak, requiring a follow-up surgical procedure.
• Other risks associated with any major abdominal surgery include bleeding, infection, and in rare cases, death. However, these risks are very low and the risk of not doing anything about one’s obesity is multiple folds higher than the surgical risks.

Risks of any surgery, including the duodenal switch, can be mitigated by employing a highly experienced surgeon. We encourage you to contact our office to learn more about the options for bariatric surgery including the duodenal switch.