Duodenal Switch Surgery

Overview

What is duodenal switch surgery?

Duodenal switch, or biliopancreatic diversion with duodenal switch (BPD-DS), is a complex bariatric surgery procedure that involves both reducing the size of the stomach and rerouting the digestive tract to bypass part of the small intestine.

The duodenal switch uses both restrictive and malabsorptive techniques to help patients lose weight. Restriction is due to the small stomach size, which limits the amount of food you can eat at one time. Malabsorption is due to the fact that most of the food you eat will not be digested, limiting the calories and nutrients absorbed.

Are you a candidate?

You might be a good candidate for duodenal switch surgery if you:

• Have a body mass index (BMI) of 40 or higher
• A BMI of 30 to 40 with weight-related health problems

This is a complex and intensive surgery, so it may not be the right choice for high risk patients who already have serious health complications. Your doctor will discuss options for bariatric surgery and help determine which is best for you.

In order to qualify for surgery, patients must have tried, unsuccessfully, to lose weight by making diet and lifestyle changes. Because of the complexity of the procedure, you will likely undergo an extensive screening process to qualify.

You must be willing to make permanent diet and lifestyle changes both before and after surgery. This monitoring will help you lose and keep off the excess weight.

Benefits of duodenal switch

In addition to weight loss, the duodenal switch can also help treat weight-related health problems such as:

• High blood pressure
• High cholesterol
• Heart disease
• Stroke
• Type 2 diabetes
• Sleep apnea
• Infertility

Treatment details

The duodenal switch is often performed laparoscopically, using a small camera and special surgical instruments. On average, the procedure takes 3 to 4 hours to complete, which is more time than most other bariatric surgeries, due to its complexity.

1. The patient is given general anesthesia to put them to sleep for the procedure.
2. During surgery, the stomach is divided vertically, and up to 85% of it is removed to create a cylinder-shaped pouch connecting the esophagus to the top of the small intestine. The duodenum (the first part of the small intestine) remains attached to the stomach.
3. After this, the surgeon makes two cuts: the first is just below the duodenum; the second is further down, near the lower end of the small intestine.
4. Then, the two cut ends are connected in order to bypass a large portion of the small intestine.

Alternatives to duodenal switch

There are other types of bariatric surgery that can provide weight loss benefits similar to the duodenal switch. These include:

• Adjustable gastric band: A band is placed around the upper part of the stomach to separate it from the main part of the stomach; the smaller part will fill up with food faster and empty slowly into the rest of the stomach, limiting food intake. A type of gastric banding procedure is Lap-band surgery.
• Roux-en-Y gastric bypass (RYGB): With gastric bypass surgery, a portion of the stomach is stapled off to form a gastric pouch; the small intestine is then attached in a “Y” formation to the pouch to bypass the lower stomach and intestines.
• Vertical sleeve gastrectomy: A gastric sleeve is the same procedure that is performed at the beginning of a duodenal switch, where the stomach is divided vertically and between 70% to 85% is removed to create a cylinder-shaped pouch.

Risks and side effects

All surgeries come with risks, including:

• Blood clots
• Excessive bleeding
• Infections
• Lung or breathing problems
• Negative reactions to anesthesia

The duodenal switch will cause rapid weight loss in the first 3 to 6 months after surgery. As your body adapts, you may experience side effects such as:

• Mood changes
• Feeling cold and tired, similar to flu symptoms
• Dry skin
• Hair thinning and loss
• Muscle aches and fatigue

This procedure involves rearranging the digestive tract, which has its own risks. The stomach or intestines may become perforated, causing their contents to leak into the surrounding tissues. This can cause infection and require surgery to repair the damage.

Some patients may also experience chronic diarrhea after a duodenal switch. Because the procedure reduces the body’s ability to absorb nutrients in the intestine, there is a risk of nutritional deficiencies. To prevent these deficiencies, you will take a multivitamin, calcium supplement, and vitamin B12.

Recovery time

After surgery, most patients stay in the hospital for 1 to 2 nights before going home to heal.

You should expect around 1 month of recovery time.

For the first 2 weeks, you will follow a restricted liquid-only diet, followed by another 2 weeks of pureed foods.

Eventually, you will transition into solid foods as tolerated. This gradual change gives the stomach and digestive tract time to heal from surgery.

It is common to have some abdominal pain, which can be controlled with painkillers prescribed by your surgeon.

What type of results to expect

Patients can expect to lose 60% to 80% of their excess body weight within 2 years of the surgery. Studies and clinical trials have shown that this weight loss is sustainable, with most patients keeping off 70% of their excess body weight beyond 10 years.

Cost of duodenal switch

The cost of duodenal switch surgery ranges from $20,000 to $30,000. This takes into account hospital stay and fees, surgeon fees, lab tests, x-rays, anesthesia fees, and more.

Insurance companies may cover some or all of the cost, or they may require a different surgery to be done in place of the duodenal switch. Before moving forward with the surgery, contact your insurance provider to verify the costs.

Other factors that influence the cost of this procedure include your location, and whether your surgeon is in-network with your health insurance.