One of the most effective weight loss procedures is the Duodenal Switch.
The Duodenal Switch includes a restrictive component (Vertical Sleeve Gastrectomy) but is primarily a malabsorptive weight loss procedure. With a Duodenal Switch procedure, the size of the stomach is reduced to limit food intake (VSG) and the small intestine is “switched” around to alter the digestion process and limit food (calorie) absorption.
This bariatric operation has greatly improved the health and quality of life for many individuals by helping them achieve and maintain significant long-term weight loss.
The interest in Duodenal Switch has been increasing along with the popularity of weight loss surgery in general. Much of the attention is due to the fact that it provides excellent weight loss results while allowing an individual to eat more food than with gastric bypass surgery and does not cause dumping syndrome. The changes caused by this procedure are usually well tolerated by patients and individuals who have undergone the DS procedure are usually quite satisfied with the outcome.
Malabsorptive Weight Loss Surgery
The Duodenal Switch weight loss surgery was developed in the early 1980’s as a modification to the Bilio-Pancreatic Diversion (BPD) procedure, another type of malabsorptive weight loss surgery. 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. The Duodenal Switch surgery is also called Bilio-Pancreatic Diversion with Duodenal Switch (BPD-DS), extensive gastric bypass with duodenal switch, or simply abbreviated as DS.
The primary component of Duodenal Switch surgery is the malabsorptive aspect, which is accomplished by bypassing 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.
- Patients are able to eat more normal meals than with standard Roux-en-Y gastric bypass or adjustable gastric banding, resulting in higher degree of patient satisfaction.
- Patients are able to achieve significant and long-lasting weight loss, due to the high level of malabsorption.
- Patients do not experience dumping syndrome, common with Roux-en-Y gastric bypass surgery, because the pyloric valve between the stomach and small intestine is kept intact.
- Reduces likelihood of stomal ulcers from occurring.
- The intestinal rerouting can be reversed if medically necessary as no part of the small intestine is removed.
- Improvement in obesity co-morbidities, such as type 2 diabetes and high blood pressure, shortly after surgery.