The Duodenal switch, or “switch”, 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 perform a sleeve gastrectomy removing around 80% of the stomach and converting the stomach into a slender tube. The sleeve part of this duodenal switch surgery is sometimes slightly larger than what we would make for a standard sleeve gastrectomy depending on patient needs.
We then divide the small bowel that normally connects to the stomach (called the duodenum) to create the bypass portion of the surgery. After food enters the “sleeved” stomach it goes into the initial part of the small intestine, but then it is re-routed or ‘switched’ to the lower part of the small intestine (the ileum). There are several ways to go about this “bypass” part of the operation. At Grayson Surgical we perform a single anastomosis switch (loop switch) where we bypass a significant length (much more than with gastric bypass) of the small intestine and then create a single connection between the bottom of the sleeve and the small bowel.Of the four operations that we offer this is the most drastic and as a result, it creates the most weight loss and the greatest chance to eliminate diabetes. There is usually no dumping syndrome with this operation.
This operation works by decreasing caloric intake, decreasing absorption, but also by changing the hormonal balance in the gastrointestinal tract. Similar to bypass and sleeve, this is a metabolic surgery that will lead to decreases in ghrelin (hunger hormone), increases in insulin sensitivity (possibly via the hormones Pyy and GLp-1), decreases in the bodies 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 and this has been shown to help with weight loss and weight management.Since the stomach is significantly smaller and only a small portion of the intestine has a chance to digest food before the food enters the colon, this procedure is both restrictive and malabsorptive.
Risks of Duodenal Switch
Similar to the sleeve gastrectomy and roux en y gastric bypass, patients can develop bleeding or a leaking from their staple line and/or anastomosis. In the operating room we make every effort to prevent this by using intra-operative endoscopy – a camera inside the stomach. These risks are generally low (1/500). We do require all Duodenal Switch patients to stay on a liquid diet for 3 weeks after surgery.
Just like the sleeve gastrectomy operation, patients might have nausea after the Duodenal Switch surgery. The nausea goes away usually within a couple of days but occasionally it can linger for longer. In addition, there might be some chest discomfort while drinking liquids initially. We believe that this is because your body is used to having more stomach to push food and liquid into. Your body needs to adjust to the fact that your stomach is no longer there. Again, this is something that gets better after surgery.With the duodenal switch there is a greater opportunity for malabsorption. Protein calorie malnutrition can be seen in “switch” patients and may require modification of the surgery to allow for more absorption. Also, there is a greater chance that patients can develop mineral and vitamin deficiencies. Specifically vitamins which dissolve in fat (A, D, E, K) need to be supplemented and closely monitored. Trace mineral deficiencies can also occur (copper, zinc) if patients are not taking the correct supplements and followed closely.
Other complications include internal hernias [<2%], developing gallstones, some temporary hair loss, bleeding, or developing an incisional hernia. These are very infrequent.It is important to understand that a duodenal switch cannot be reversed and is a permanent operation.Not necessarily a risk or complication, but due to the significant length of bypassed intestine, patients will experience more frequent bowel movements. Patients will experience at least 2 to 6 bowel movements a day. These can also be greasy in texture or foul in odor due to the poor absorption of fat. There are some medications that people can take to decrease the odor. Devrom, might be carried at your pharmacy, or you can order online.