The ”switch,” or duodenal switch procedure, is a weight loss operation that combines qualities of both the sleeve gastrectomy and the gastric bypass. The operation is performed in two steps. First, we conduct a sleeve gastrectomy, removing around 80 percent of the stomach and converting the remainder into a slender tube.
We then divide the small bowel that normally connects to the stomach (called the duodenum) to create the bypass. Consumed food would normally go from the sleeve into the initial part of the small intestine, but it is re-routed or ”switched” to the lower part of the small intestine. There are several ways to go about the bypass part of the operation. At BMI of Texas, we perform a single anastomosis switch, where we bypass a significant length of the small intestine (much more than with gastric bypass) and then create a single connection between the bottom of the sleeve and the small bowel.
Of the four operations we offer, this is the most drastic. As a result, it creates the most weight loss and offers the greatest chance of eliminating diabetes.
Why duodenal switch weight loss surgery helps people lose weight
This operation works by decreasing caloric intake, reducing absorption and changing the hormonal balance in the GI tract. Similar to the bypass and sleeve, this metabolic surgery will lead to a decrease in ghrelin (the hunger hormone), an increase in insulin sensitivity (possibly via the hormones Pyy and GLp-1) and a decrease in the body’s desire to store extra energy in the form of fat. This operation is also shown to change the types of bacteria that live in our GI tract (microbiome). Good bacteria will replace bad ones, which has been shown to help with weight loss and weight management.
Who should consider loop duodenal switch?
Generally, high-BMI (>50) diabetic patients are best suited for this procedure. In some instances, we may elect to do the operation in stages, with the sleeve being created initially and the bypass portion following in six to 18 months.
With the switch, patients can expect to lose between 70-100 percent of their excess weight. Long-term success is amongst the highest seen in any bariatric surgery. As with the other operations, routine follow-ups with our staff are critical to long-term success. Other benefits associated with the switch include as high as a 95 percent resolution of diabetes, a 68-75 percent resolution of high blood pressure and a 70-57 percent resolution of high cholesterol.1
Life after the duodenal switch procedure
The duodenal switch (along with the sleeve and the gastric bypass) causes fairly rapid weight loss during the first six months following surgery
You will not likely experience dumping syndrome with the switch operation. You will need to take additional regular daily vitamins (even more than other surgery patients) for the rest of your life. If you stop taking any prescribed vitamins, you will be more likely to develop a vitamin or mineral deficiency.
To the average person, not getting enough vitamins may not sound like a big deal. However, when you change the plumbing with a duodenal switch, it can become a life-threatening problem. Nutritional complications with the duodenal switch include deficiencies in protein, iron, calcium, copper, zinc and fat-soluble vitamins. You may be asked to eat differently if protein deficiency is to occur.
The BMI Texas team will prescribe supplements after surgery, such as:
- Multi-vitamin/mineral support
- Additional calcium
- Additional iron
- Fat-soluble vitamins (A,D,E, and K)
- Probiotics (beneficial bacteria found the intestinal tract)
Routine blood tests and follow-ups with your doctor are MANDATORY to make sure your body is getting enough protein and supplements. You'll often be asked to meet with a nutritionist and dietitian around the same time as your check-ups with your doctor.
Bowel movement changes are more common with the DS than with other types of surgery. On average, DS patients will have two to five bowel movements per day, but some patients have more. It is not uncommon to have problems with diarrhea or loose stools, as well as foul-smelling stools or flatulence.
Recovery from the duodenal switch
Patients are usually kept in the hospital for one to three days following surgery. Your surgeon will want to see you for a follow-up visit two weeks after surgery, and then you will need to get onto a regular BMI of Texas follow-up schedule.
If you are interested in learning more about San Antonio duodenal switch surgery, contact BMI of Texas at 210-615-8500.
(1)Prachand VN, Ward M, Alverdy JC. Duodenal switch provides superior resolution of metabolic comorbidities independent of weight loss in the super-obese (BMI > or = 50 kg/m2) compared with gastric bypass. J Gastrointest Surg. 2010 Feb;14(2):211-20.