Duodenal Switch

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 board certified team at BMI Texas 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 movements

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.

New Lifesaving Duodenal Switch Procedure at BMI of Texas

Doctor explaining the loop procedure to a patient

San Antonio is a wonderful place to live, but you’re statistically more likely to be overweight if you call the Alamo City home. According to Cities Journal, our town is the 11th most overweight city in the country, with a 31.1 percent obesity rate. Texas as a whole doesn’t fare much better; it’s the 15th most overweight state in the country, according to The State of Obesity.

Have you experienced persistent weight problems for two years or more? Do you have a body mass index of 50 or higher? Do you suffer from weight-related diseases and health issues, such as diabetes, high cholesterol, hyperlipidemia or sleep apnea?

You’re certainly not alone if you answer yes to these questions. Fortunately, your situation means you may qualify for duodenal switch surgery, the newest weight loss surgery option from BMI of Texas. Of the four weight loss procedures we offer, this operation offers the most drastic results and provides the greatest chance of eliminating weight-related health problems.

What is Duodenal Switch Surgery?

Also called loop surgery, a duodenal switch procedure combines qualities of sleeve gastrectomy and gastric bypass. The operation occurs in two steps:

  • Step one is to perform a sleeve gastrectomy, which involves removing about 80 percent of the stomach. The remaining portion is converted into a slender tube.
  • Step two is to reroute consumed food to the lower part of the small intestine, thus bypassing the upper part of the digestive tract known as the duodenum. In some instances, step one is followed by step two six to 18 months later.

Several options are available for completing step two of duodenal switch surgery. Weight loss physicians at BMI of Texas perform what’s called a single anastomosis switch, which involves bypassing a significant part of the small intestine and rerouting food directly from the bottom of the sleeve into the small bowel with a single connection.

How Duodenal Switch Surgery Stimulates Weight Loss

A combination of factors come together to make the duodenal switch procedure one of the most effective weight loss surgery options available today. The operation works by:

  • Reducing caloric intake
  • Decreasing absorption from food
  • Altering the GI tract’s hormonal balance
  • Lowering the hunger hormone called ghrelin
  • Increasing insulin sensitivity (which can resolve diabetes in up to 95 percent of cases)
  • Reducing the body’s desire to store extra energy in the form of fat
  • Replacing bad bacteria that live in the GI tract with good ones

After the procedure, you can expect to lose 70 to 100 percent of your excess weight within the first year along with lifestyle changes, bringing your body mass index down to a healthy level. The success rate of sustaining permanent weight loss following duodenal switch surgery is the highest among all bariatric weight loss options.

Recovering From Duodenal Switch Surgery

While more of the small intestine is bypassed with this procedure than with gastric bypass, the amount is much less than in older, similar procedures. The bypassed section of small intestine is not removed from the body, resulting in a significantly shorter recovery time than other established methods of surgical weight loss.

You can expect a hospital stay of one to three days following the procedure. You’ll need to visit your doctor for a follow-up appointment two weeks after surgery and regularly after that to check on your weight loss progress and address any concerns you may have.

To learn more about our new duodenal switch surgery, please see our press release on the subject. When you’re ready to schedule your appointment, contact BMI of Texas online or call us at 210-615-8500.

Why Pay More?

Gastric Sleeve Surgery can range drastically in price, but you aren't necessarily getting better service for your money. BMI of Texas's state of the art facility allows us to cost effectively provide this proceedure while providing top quality service.

Example of how our Gastric Sleeve Sleeve Pricing Compares to the Competition
Dallas A$13,400
Dallas B$11,000
Houston A$16,000
Houston B$14,300
Houston B$14,300
Los Angeles A$12,000
Los Angeles B$25,000
BMI of Texas$9,900

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