A duodenal switch (DS) is a type of bariatric, or weight loss, surgery. It is also called a vertical gastrectomy with duodenal switch, or a biliopancreatic diversion with duodenal switch (BPD-DS). This particular type of surgery is a complicated procedure. It combines the two main approaches to, or methods used by, weight loss surgery.
The first approach to bariatric surgery is the restrictive approach. This method restricts how much food the patient is able to eat, thereby preventing overeating. The second approach is called the malabsorptive method. With this, the patient is not restricted in how much food he is able to consume, but his body is prevented from absorbing all of the consumed food. This can also lead to weight reduction.
Not all patients are ideal candidates for this procedure. Candidates must have a body mass index (BMI) of more than 40. Sometimes, patients with a lower BMI may qualify for bariatric surgery because they also suffer from illnesses related to obesity, such as diabetes. Other medical conditions may preclude a patient from undergoing this procedure, such as sleep apnea and heart failure. These conditions may increase the risk of complications.
To perform the duodenal switch, a surgeon will first make a series of incisions on the patient’s abdomen. Using the restrictive approach, the surgeon removes about 85% of the patient’s stomach, creating a smaller pouch. This drastically reduces the amount of food a person can eat at one time. The surgeon will also remove a muscle that holds food in the stomach.
After the stomach is sutured, or stitched closed, the surgeon will then manipulate how food is absorbed into the body. The small intestine is arranged so that the body’s digestive juices do not interact with food until it moves further down the intestine. This prevents the body from absorbing the full amount of nutrients and calories.
Only fluids can be consumed for a short time following this type of surgery. Patients will need to gradually progress to soft, pureed foods before eating solids. Recovering from a duodenal switch typically takes three to four weeks. Surgeons will prescribe pain medication to alleviate any discomfort.
Bariatric surgery does not negate the patient’s responsibility to maintaining healthy nutrition. Patients typically need to commit to life-long nutritional monitoring following a duodenal switch. Due to its malabsorptive approach, a duodenal switch may result in malnutrition, meaning the body may be unable to absorb all the vitamins, minerals, and other nutrients it needs. These patients will need to take vitamin pills every day, under the direction of their doctor to insure adequate nutrients are taken in. Some patients may also need to avoid certain foods, such as very starchy or fatty foods, as they may cause unpleasant bowel symptoms.
While considering this surgery, patients should discuss the possible risks with their doctor. This surgery may result in blood clots, blood loss, and infection. The stomach and small intestine may swell immediately following surgery, resulting in a difficulty in drinking liquids. This surgery can result in death for a small number of patients. A duodenal switch may also cause long-term complications due to nutritional deficiencies, such as osteoporosis, night blindness, and malnutrition.
Although there may be risks associated with weight loss surgery, there are also possible benefits. Patients have the opportunity for long-term healthy weight management, as well as a lowered risk of obesity-related illnesses. For patients with nutritional deficiencies, part of the surgery may even be reversed. Patients should carefully weigh the possible risks versus the benefits before undergoing any type of weight loss surgery.