Duodenal Switch

In some cases a bariatric surgeon may suggest an open laparoscopic biliopancreatic diversion with duodenal switch (BPD-DS). This typically depends on the patient’s BMI and co-morbidities. The duodenal switch is a modification of the BPD designed to prevent ulcers, minimize the incidence of dumping syndrome, increase the amount of gastric restriction, and reduce the severity of protein-calorie malnutrition. In addition, a larger incision might be necessary if a laparoscopic BPD-DS cannot be accomplished using small incisions. Although the BPD-DS operation involves removing part of the stomach, it leaves a considerable portion of it intact, including the pyloric valve which is responsible for regulating the passage of stomach contents into the small intestine. In this procedure, the intestines are re-routed to a greater degree than in the gastric bypass procedure. An “alimentary limb” is created by dividing the small intestine and attaching one end to the small stomach pouch. This is done to provide a digestive path which completely bypasses most of the small intestine. Digestive juices from the pancreas and stomach pass through the “biliopancreatic limb” and do not mix with ingested food until the two limbs join to form a common limb close to the colon.

After the procedure weight loss initially occurs because patients eat less, and long-term weight loss occurs because fat and carbohydrates are not fully absorbed, however sugars are. This procedure provides the most malabsorption of the weight loss procedures. Weight loss results are extraordinary with patients losing up to 80% of their excess weight as far out as 10-12 years. It is important to keep in mind that this weight loss is accompanied by a much greater risk of malnutrition, malodorous flatulence, and loose stools.

Duodenal Switch Surgery Benefits

  1. This procedure offers maximal weight loss which can be maintained long-term.
  2. Patients can eat normally after a while because the capacity of the stomach is greater than a gastric bypass.
  3. Dumping syndrome does not occur with this surgery.

Duodenal Switch Risks

  1. Leaks and infection can occur from where the intestines are re-routed or where part of the stomach is removed.
  2. A narrowing can occur where the duodenum is connected to the intestine.
  3. A wound infection can occur in the incision which may require further therapy.
  4. Pancreatitis or inflammation of the pancreas can occur which can be severe.
  5. Protein malnutrition occurs 3-10% of the time which may require hospitalization
  6. Vitamin, calcium and iron deficiencies can also occur.
  7. Patients experience 4-10 foul smelling bowel movements initially after the surgery and 3-6 per day for the rest of their lives
  8. A hernia may develop in the incision site that will require further surgery to repair.
  9. This procedure is not reversible.

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