The Duodenal Switch: An Excellent Weight Loss Surgery Option for Extreme Obesity
The Duodenal Switch is a very complex procedure that is usually only recommended if you are suffering from extreme obesity (also known as being super obese). It is a well-established surgical procedure that provides excellent weight loss and long-term resolution of multiple medical conditions. Due to its complexity, most surgeons and centers do not even offer this procedure. At Acadiana Weight Loss Surgery, we’re proud to offer you individualized weight loss procedures to meet your unique needs.
This operation is usually, but not always, reserved for super obese patients (BMI > 50) or as an acceptable procedure for failed weight loss. The special benefit of this procedure is that you may expect to lose 85% of your excess weight, allowing you to achieve a truly healthy weight.
While these operations reduce the size of the stomach, the stomach pouch created is slightly larger than with other procedures. The goal is to restrict the amount of food consumed and bypass the majority of the normal digestive process. The anatomy of the small intestine is changed to divert the bile and pancreatic juices so they meet the ingested food closer to the middle or the end of the small intestine.
Since food bypasses the duodenum, all the risk considerations discussed in the gastric bypass section regarding the malabsorption of some minerals and vitamins also apply to these techniques, only to a greater degree.
Trocars are inserted into the abdominal wall to allow access to the abdominal organs. A vertical sleeve gastrectomy is performed removing 80% of the stomach. The duodenum is then divided preserving the pyloric valve (where food exits the stomach) with the remaining stomach. The small bowel is divided and the distal end is connected to the duodenum creating an “alimentary’ limb that is, on average, eight feet long.
The proximal end of the small bowel is the “biliopancreatic” limb (biliopancreatic juices are yellow in the video) and it is connected to the alimentary limb three feet from the colon. This creates a “common channel” out of the last three feet of the alimentary limb (green is the mixture of the food and biliopancreatic juices). The common channel is where calories and nutrition are absorbed into the body.
Although this is a more extensive operation than other weight loss surgical procedures, most patients only have a two- to three-day hospital stay. The surgery is performed laparoscopically and requires about two to three hours of operating time depending on the patient’s history and BMI. The post-operative dietary phases and schedule are the same as with the Gastric Bypass. Patients can return to office-style work in two weeks and have unrestricted activity at one month. Even though the percentage of excess weight loss with other procedures decreases as the BMI increases, patients with BMI’s > 50 can expect excess weight loss of 85%. Because of the outstanding results with this procedure, it is used as a primary operation for patients with a BMI > 50 and as a revisional procedure for patients with failed gastric bypass, vertical sleeve gastrectomy and laparoscopic adjustable gastric bindings. Patients must be prepared to follow the prescribed diet or they may suffer from diarrhea and flatulence.