Duodenal Switch Surgery

Duodenal Switch (DS) surgery is a procedure designed to help individuals who are extremely morbidly obese. It is the most complex but also the most effective bariatric surgery available, resulting in greater overall weight loss and the most improvement or even resolution of many obesity-related diseases, especially type 2 diabetes. 

What is Duodenal Switch Surgery?

The duodenal switch surgery modifies both the stomach and small intestine. It combines the best of both the sleeve gastrectomy and the gastric bypass surgeries.

  • A gastrectomy is a surgery that removes part of the stomach. 
  • An intestinal bypass changes the path the food takes through your stomach so that it’s shorter. 

By doing both of these, your stomach is not able to hold as much food, and your body is not able to absorb as much of the nutrition from food in the small intestines. Hunger hormones found in your stomach and small intestine are also reduced in the duodenal switch surgery, making you feel less hungry. 

Types of Duodenal Switch Surgeries

The original procedure, referred to as “traditional DS,” has been the standard version of this surgery for several years. Today, there is also the loop duodenal switch procedure approved by the American Society of Metabolic Surgery. This modified duodenal switch surgery, also called a single anastomosis duodenal switch (SADI-S), is less invasive than the traditional DS but just as effective. 

Benefits of Duodenal Switch Surgery 

The primary benefit of duodenal switch surgery is the significant amount of weight loss that can be achieved. Most patients can expect to lose 75 to 90 percent of their excess body weight over a 1-year period, which is well above the average weight loss of other types of bariatric surgeries, such as gastric bypass or sleeve gastrectomy. 

In addition to weight loss, duodenal switch surgery offers advantages such as: 

  • Improve or even reverse a range of obesity-related health conditions such as heart disease, type 2 diabetes, sleep apnea, and joint pain. 
  • The ability to eat is still restrictive in amount but not in the variety of diet since the stomach continues to digest food normally after the procedure is performed. 
  • Reduction or elimination of side effects like dumping syndrome, ulceration, and intestinal blockages, which are commonly related to Roux-en-Y gastric bypass surgeries.
  • Enhanced quality of life and increased longevity.

How the Procedure Works

The duodenal switch is a complicated procedure that should be done by a gastrointestinal surgery specialist like Dr. Drew Howard. The procedure consists of two distinct steps. 

1. Sleeve Gastrectomy

The first part of the procedure involves a sleeve gastrectomy in which a large portion (about 75-80%) of the stomach is removed, leaving a smaller tube-shaped stomach, similar to the shape of a banana. This reduces the capacity of the stomach, leading to earlier satiety and decreased food intake. The pyloric valve, which is at the end of the stomach, is a sphincter muscle that releases food to the small intestine. The pyloric valve remains, as does a small portion of the small intestine that usually connects to the stomach (called the duodenum). 

2. Intestinal Bypass

The second part of the procedure involves an intestinal bypass in which the small intestine is rearranged to create two separate pathways. This is achieved by dividing the duodenum, the first part of the small intestine, and attaching it to the last part of the small intestine, the ileum. The second part of the procedure allows food to bypass a portion of the small intestine, where calories and nutrients are typically absorbed. This is different from the traditional gastric bypass, which bypasses the duodenum and the pylorus altogether.

How Duodenal Switch Works to Help Lose Weight

This combination of a smaller stomach and a shorter pathway allows food to bypass a significant portion (about two-thirds) of the small intestine which allows reduced calorie absorption.

By limiting how much food the stomach can hold and reducing the absorption of nutrients, including proteins and fats, an overall greater amount of weight loss can be achieved and maintained long-term. 

Two key advantages to the duodenal switch are that a vast majority of the stomach is removed, along with Grehlin, which is a hormone that makes you hungry. The pylorus is left intact, which means that the stomach still holds food in the small stomach until it is ready to enter the small bowel. These are two major advantages of the duodenal switch over the gastric bypass.

Dr. Howard can perform this surgery robotically for patients in The Woodlands, the greater Houston area, and even sees patients from all over the United States. 

Risks of the Duodenal Switch

Like any surgical procedure, duodenal switch surgery carries some risks, including the potential for infection, bleeding, leakage at the surgical site, and nutritional deficiencies. However, these risks can be minimized with proper preoperative assessment and postoperative care.  Nutritional deficiency is the largest long-term concern for DS patients.

Who is Eligible for Duodenal Switch Surgery?

To receive duodenal switch surgery, patients must meet the following eligibility criteria: 

  • Patients who have had a sleeve or other weight loss surgery and have not had the results they wanted
  • Unsuccessful non-operative weight loss treatments
  • Usually, a BMI greater than 50
  • Psychological evaluation
  • No medical contraindications to surgery
  • Willing and able to follow through with diet and exercise recommendations made by your healthcare team

Duodenal Switch as a Revisional Surgery

Oftentimes, DS is the right surgery for someone who has had a previous weight loss operation and did not get the results they expected with the previous operation. This is especially true for patients who have had a sleeve gastrectomy and really need to lose more weight by adding an intestinal metabolic weight loss function to the restriction they already have with the sleeve. Dr. Howard can ‘add on’ the intestinal bypass portion of the duodenal switch to the sleeve patients already have to achieve even more weight loss.  

Preparing for Duodenal Switch Surgery

If you qualify for a DS, Dr. Howard will advise you on how to prepare for surgery during your comprehensive consultation. In some cases, lab tests, radiology exams, or other exams may be needed prior to surgery. 

What to Expect After Duodenal Switch Surgery

Initial Recovery

After the surgery, you will usually spend 24 to 48 hours in the hospital for close monitoring. You may experience some pain, discomfort, and dietary restrictions during this time. The medical team will guide you on pain management, diet progression, and physical activity.

Long-Term Lifestyle Changes

Duodenal switch surgery requires a lifelong commitment to dietary and lifestyle changes. You will need to adopt a nutrient-dense, balanced diet, take vitamin and mineral supplements as advised by your healthcare team, and engage in regular exercise to support your weight loss and overall well-being. It is a must that you have your vitamin levels checked yearly by a healthcare provider.

Duodenal Switch Surgery is Available in The Woodlands

Duodenal switch surgery can be a life-altering solution for individuals struggling with severe obesity. It provides an effective way to achieve significant weight loss, improve overall health, and regain control over one's life.

Schedule a consultation with Dr. Drew Howard to learn more about the duodenal switch and your options for surgery.