Duodenal Switch surgery, in a simple concept, is a combination of the gastric bypass surgery and the gastric sleeve surgery. This type of procedure is typically only attempted when there has been a failed attempt at a gastric band surgery. The surgery does pose some issues for those in need of it and they will likely have to supplement their daily intake of food with vitamins for the remainder of their life. The surgery is complicated and requires a fair amount of recovery time.
With Duodenal Switch surgery:
- Weight loss will occur.
- You may experience a deficiency in nutrition requiring lifelong supplemental intake.
- It may reduce your hunger levels.
- Sugar will not cause dumping syndrome if you take in sugar as the gastric bypass will.
- May require as many as 6 hours of surgery time.
- Is not widely offered by bariatric surgeons.
- Dietary changes will be requires for healthy calorie intake through foods.
- Morbid obesity comorbidities will likely be cured or greatly improved.
- Recovery time will likely be lengthy requiring frequent follow ups.
Candidates for DS Surgery
Duodenal switch surgery is for individuals who are deemed obese or morbidly obese with a body mass index (BMI) of 50 or more or for those whose weight is causing them serious health problems. Some surgeons may allow those with a BMI of 40 or more or those with a body mass index of 35 or more with at least one comorbidity. Some examples of these obesity-related health conditions include high blood pressure, high cholesterol, obstructive sleep apnea, Type II Diabetes and heart disease. It’s important to remember that obesity surgery is never a quick fix for one’s weight problem. Regular exercise and a healthy diet help patients to continue to lose weight after surgery too.
Types of Duodenal Switch Surgery Procedures
The biliopancreatic diversion portion of this bariatric surgery removes a part of the stomach. The remaining portion of the stomach is connected to the lower part of the small intestine. Duodenal switch surgery is considered a high-risk surgery as it can cause long-term health issues to those who have it. This is because the body will have a harder time absorbing nutrients. Ultimately, the pylorus valve is left intact. This valve is responsible for controlling the food drainage in the stomach itself.
Ultimately both of these bariatric surgery procedures can be done in an open style or by making several small cuts laparoscopically.
How Duodenal Switch Surgery Works
The Duodenal Switch surgery (also known as biliopancreatic diversion with duodenal switch) requires that the surgeon staples of up to 70% of the stomach with the balance connected to the first part of the intestine also known as the duodenum. The intestine is cut before it reaches the appendix and it is reattached lower in the intestine. The concept is to prevent bile and digestive juices to start the food processing lower in the body so that they don’t have as long to work on the food pulling out the least amount of calories. This allows the food to pass to the colon faster than others leaving the patient with less calorie intake overall.
The process is both restrictive in nature and malabsorptive as it reroutes the entire part of the small intestine that leads into the new different pathways and common channel. Ultimately the overall objective for this bariatric surgery is to reduce the amount of time that it takes for the body to absorb calories into the small intestine and to lower the overall absorption of fat. Essentially patients will only absorb 20% of the fat that they consume. After duodenal switch surgery, patients will feel fuller faster than when their stomach was a normal size.
Risks Associated With Duodenal Switch Surgery
There are some common risks associated with all weight loss surgeries that can occur with duodenal switch surgery too. Some of these things include: anemia, gallstones, infection at the incision site, pulmonary embolism and osteoporosis. Some patients may also have dumping syndrome, a medical condition that causes patients to feel nauseous, to vomit, to feel faint or to have diarrhea. This diarrhea occurs because of the poor absorption of protein, fat, iron and vitamins such as A, D, E, K and B12.
What to Expect After DS Surgery
Some belly pain following surgery will occur. Pain medication will be needed for at least the first week following this bariatric surgery. The incision site itself may also be tender and sore. Because this weight loss surgery procedure makes the stomach smaller, the patient will feel full quicker. This makes a strict diet extremely important post op.
For the first month following DS surgery, the patient’s stomach will only be able to handle soft foods or liquids while healing. It also is important patients remain hydrated and sip water throughout the day. Never drink before a meal however. It is also normal for bowel movements to be irregular. Ultimately when solid foods are later added back into a diet, it’s important patients chew their food thoroughly and stop eating when they feel full immediately.
Because this surgery removes a portion of the small intestines, patients must take regular vitamin and mineral supplements for a lifetime. A dietitian can help patients devise a plan for meals and supplements.
Also depending on how duodenal switch surgery was performed, patients will need to avoid strenuous exercise as well as any heavy lifting. Generally recovery takes 4-6 weeks for those with an open surgery and 1-2 weeks for those who had duodenal switch surgery laparoscopically.
Success Rates With Duodenal Switch Surgery
According to recent studies, duodenal switch surgery patients can expect to lose 75-80% of their excess weight. The same studies report that nearly 10 years following their weight loss surgery, some individuals have gained 20-25% of their weight back. This makes committing to a healthy lifestyle for a lifetime important in order to keep the weight off.
Amount of Weight Loss to Expect
Although every patient has different results, most patients see a 70% to 80% loss in excess weight loss with the Duodenal Switch surgery. This is an excellent number with an 80% success rate for on most patients. There is a significant reduction in comorbidities with 98% of Type 2 diabetes cured, 99% of hyperlipidemia cured, 83% of hypertension cured and 92% of sleep apnea cured after the procedure.
Advantages of Duodenal Switch Surgery
One of the biggest advantages to this type of weight loss surgery is the fact that it combines moderate caloric intake and malabsorption results with a high percentage of excess weight loss. Also, because the pyloric valve remains intact, many patients do not experience dumping syndrome common in gastric bypass (Roux-en-Y) patients. When a portion of the stomach is removed, the production of ghrelin, the hunger hormone, stops. Many patients say that the diet following their duodenal switch surgery is tolerable; it is better tolerated then many other weight loss surgeries. The malabsorptive portion of this surgery is also fully reversible as the small intestine was just rerouted and wasn’t removed in any sense.
According to statistics, duodenal switch surgery has the greatest weight loss success overall than any other weight loss surgery procedure. It also has the highest resolution rates for high cholesterol, high blood pressure and Type II Diabetes. Ultimately, duodenal switch surgery is an effective option for those with a high fat diet. DS surgery can also be used as a two part procedure with gastric banding or gastric bypass for patients who need to lose enough weight in order to qualify safely for these weight loss procedures.
Disadvantages of Duodenal Switch Surgery
Many say that the biggest disadvantages with this type of weight loss surgery are the amount of time that the operation itself takes. It has been proven that the longer that a patient is under anesthesia, the higher their overall risk for complications following surgery. Typically this type of surgery can take anywhere from three to six hours. Also, there are less qualified duodenal switch surgeons because of the intensity of the procedure overall.
While the malabsorptive portion of the surgery is reversible as it was rerouted and not removed, the partial gastrectomy part is not reversible. Once the stomach is removed from the body, it cannot be reattached or rebuilt in any way.
Many patients have a higher chance of protein deficiency (anemia) and metabolic bone disease if a proper diet is not maintained following duodenal switch surgery. Patients of DS surgery will need regular blood work and labs to check for deficiencies that can affect overall health. Duodenal switch surgery can also lead to gas or flatulence issues in patients as well as loose stools and diarrhea.
Cost of Duodenal Switch
Duodenal switch surgery is one of the most expensive bariatric surgery procedures available. This is because it includes two different procedures – malabsorptive and restrictive – in one surgery. The price range for this bariatric surgery itself falls anywhere between $22,000-$42,000 though costs can vary state by state. Some things that affect the cost are surgeon’s fees, anesthesiologist’s fees, facility fees, pain medication and antibiotics, hospital stay costs as well as all follow up visits.
Some insurance companies will cover a portion of the operation or even all of it. Every insurer will want different documentation and verification to deem if your need for the surgery is valid. This may include medical history documents, failing health proof or a testimony from your primary care physician and/or weight loss surgeon explaining what surgery will do for your health. Most insurance companies will make patients take a 6-month medically supervised diet program to make sure that they are committed to following the healthy lifestyle needed in order to receive optimal results from DS surgery.
Medicare will cover duodenal switch surgery 100%. While they have unique requirements for candidacy, these patients will receive the surgery and all of its post-op costs free of cost. Medicaid does not cover the duodenal switch surgery procedure, but it does cover other types of bariatric surgeries. Ultimately, always take time to weigh the cost with the risks to make sure this bariatric procedure is the best option for your particular health and overall weight loss goals.