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Duodenal Switch (DS) Surgery

 

Duodenal Switch Surgery

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This malabsorptive surgery works by shortening, by half, the path food follows through the small intestine. At this time, DS surgery may be done using open surgery methods or laparoscopically.

Before beginning duodenal switch surgery, the surgeon must check the condition of the patient’s gastric sleeve. The surgeon would only continue surgery if the stomach sleeve and the stomach opening to the duodenum (called the pylorus) are healthy.

DS involves three (3) steps:

  1. The surgeon will cut small intestine in two (2) places: across the duodenum just below the pylorus and about halfway into the intestine. This leaves two (2) sections of small intestine, each about eight (8) to 10 feet long:
    • The biliopancreatic limb – the first part of the small intestine, including the duodenum with connections to the gall bladder and the pancreas.
    • The alimentary limb – the second half of the small intestine.
  2. The surgeon will sew and staple the top of the biliopancreatic limb closed and attach the bottom to the alimentary limb about three (3) feet from where the small intestine meets the large intestine.
    • The connection of the biliopancreatic limb to the alimentary limb for the last three (3) feet of the small intestine – the common channel – enables enzymes from the gallbladder and pancreas to aid in digestion.
  3. When the surgeon attaches the alimentary limb to the pylorus where the duodenum used to be, the duodenal switch is complete.
    • Food from the stomach will now move through only about 10 feet of small intestine, instead of 20 feet. This cuts calorie and nutrient absorption in half.

Advantages

  • BPD-DS is the most helpful for patients who have a very high BMI and severe or multiple health risks.
  • People are often satisfied with BPD-DS because they can eat larger meals than with a purely restrictive procedure like LAP-BAND® or standard Roux-en-Y gastric bypass procedure.
  • BPD-DS patients can lose the most weight (usually about 70% of excess weight) because these procedures cause the highest rates of malabsorption.
  • You can maintain good health as long as you:
    • Eat a healthy diet and take the right vitamin and mineral supplements
    • Work with our dietitian to develop a healthy eating plan
    • Continue your follow-up diet, exercise and behavioral program.

Risks & Disadvantages

  • Anytime you have anesthesia or surgery, there is a risk of bleeding, blood clots, other complications or death.
  • Gastric surgery puts you at higher than normal risk of developing gallstones and gallbladder disease.
  • There is a period when the intestines adjust and bowel movements can be liquid and frequent. This condition may lessen over time, but may be a lifelong condition.
  • You may have abdominal bloating and foul-smelling stool or gas.
  • Changes to the intestinal structure can increase the risk of forming gallstones and the need for removal of the gallbladder.
  • BPD-DS increases the possibility of intestinal irritation and ulcers.
  • Do not smoke. Smoking would put you at high risk for infection, blood clots, slow healing and other life-threatening complications.
  • You will have to eat differently for the rest of your life.
    • Foods that you eat now may cause discomfort, nausea or vomiting after your surgery.
    • If you eat sugars and sweets, you can trigger dumping syndrome -- symptoms can include nausea, weakness, sweating, anxiety and heart palpitations after eating. This is not usually a serious health risk, but it can be painful.
    • Bypassing a large part of your intestine limits your body’s absorption of important nutrients, vitamins and minerals: protein, fat-soluble vitamins A, E, D and K, iron, calcium, Vitamin B-12 and folic acid. You will need to take daily supplements for the rest of your life.
    • If you over eat, you can stretch your stomach pouch.
    • You and your primary care physicians should monitor for protein malnutrition, anemia, and bone disease throughout your life. You must take the prescribed vitamin supplements for the rest of your life. NOTE: Research shows that 25 percent of patients who do not follow eating and vitamin supplement instructions closely develop problems that require treatment.
    • You will not lose your excess weight or maintain your weight loss if you do not follow your healthy diet and exercise regularly. This is the reason we stress long-term follow-up with our center and with your doctor.

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