Duodenal Switch

Duodenal Switch Procedure Complete Overview

The Duodenal Switch procedure is a restrictive and malabsorptive weight loss surgery.

Restrictive Component:

Approximately 70% of the stomach is removed along the greater curvature. This is also called a Vertical Sleeve Gastrectomy (VSG). The remaining stomach is fully functioning, banana shaped and about 3 - 5 oz. in size; which restricts the amount you can consume. The pylorus, part of stomach, continues to control the stomach emptying into the small intestine; as a result patients do not experience "dumping". The upper portion of the duodenum remains in use; food digests to an absorbable consistency in the stomach before moving into the small intestine.

Malabsorptive Component:

The intestines are re-routed so that food from the stomach, alimentary limb, and the digestive juices, biliopancreatic limb, that are needed for the absorption of fat and proteins can travel separate paths; this is so they don't mix until they meet up towards the end of the small intestine.

The common channel, also known as the common tract or common limb, is the point from where the alimentary and biliopancreatic limbs meet in the small intestine to move into the large intestine. The common channel is where a DS patient's food, bile and digestive juices mix; the majority of the fat, protein and the associated nutrients are absorbed. Since the common channel makes up such a small portion of the small intestine the dietary starches, fats and complex carbohydrates may not fully absorbed.

The most commonly quoted absorption percentages following DS are approximately 20% of fats, 60% of protein, 60% of complex carbohydrates, but 100% of simple carbohydrates. The 2005 study by Gagner et al. [68] demonstrated that DS surgery decreased fat absorption by 81%. The Bariatric Nutrition: Suggestions for the Surgical Weight Loss Patient review reports information from a study by Slater et al. stating that "After BPD/DS procedures, the amount of protein should be increased by ~ 30% to accommodate for malabsorption, making the average protein requirement for these patients approximately 90 g/d." [65]

The malabsorption of fats interferes with absorption of the fat-soluble vitamins A, D, E & K. As a result all Duodenal Switch patients are required to take vitamin and mineral supplements for life. Patients must be diligent with the required supplements and have blood work monitored regularly. Also, they must adjust their supplements as needed to maintain normal levels of these vitamins and minerals.

Duodenal Switch Benefits

Weight loss surgery in general can provide those who are severely overweight or morbidly obese with numerous improved health benefits. Losing weight as a result of Duodenal Switch surgery can help treat the following symptoms:

• Type 2 Diabetes
• Asthma
• Sleep Apnea
• Depression and Anxiety
• Heart Disease

Amongst other bariatric surgery options available today, the Duodenal Switch procedure has similar risks to other weight loss surgeries but the extent of the intestinal changes mean that DS has a higher risk of nutritional deficiencies developing over time without lifelong dietary follow up. Most recipients of the Duodenal Switch procedure experience 60 to 85 percent excess weight loss after 18-months which is usually higher than that seen in other weight loss surgeries. .

The Duodenal Switch procedure is also effective at treating Type 2 diabetes because of its ability to reduce the body's need for insulin or oral hypoglycemic medicine post-surgery. According to some studies, duodenal switch surgery is effective in curing Type 2 Diabetes in 99% of cases.