The Duodenal Switch/Loop Duodenal Switch (also called DS, BPD-DS, SADI Biliopancreatic Diversion-Duodenal Switch) is a weight-loss procedure that brings together two types of bariatric concepts — restriction and decreased absorption. It is a complex procedure that aids weight loss by a sleeve gastrectomy paired with an intestinal bypass. It has the potential to help you lose more weight than either gastric bypass or gastric sleeve surgeries and has been shown to help reduce obesity-related illnesses such as heart disease, high blood pressure and type 2 diabetes.
This surgery may be considered for people with a BMI of 50 or greater or a BMI of 40 or greater with obesity-related conditions, diabetes in particular.
84.5lbsDuodenal switch median excess weight loss one year post-op
76%Duodenal switch: excess weight loss median 1 yr. post-op
14.6ptsMedian BMI change one year after duodenal switch
This procedure consists of three steps, all performed during one ~90-minute operation. The first step involves performing a sleeve gastrectomy to restrict the size of your stomach to limit the amount of food you can ingest. The second step decreases absorption by creating a partial loop bypass to limit the body’s caloric intake, similar to the gastric bypass but with a greater amount of bowel bypassed. The third component of the duodenal switch surgery alters the way that bile and digestive juices break down food, cutting back on how many calories your body is able to absorb, leading to further weight loss. The combination of these three steps is what leads to the resolution of type 2 diabetes in 98.9% of patients.
One of the advantages of the duodenal switch is that it leaves the valve at the bottom of the stomach (the pylorus) intact. This both minimizes dumping and lengthens the amount of time food stays in the stomach, which gives you a longer feeling of fullness. Another advantage of the duodenal switch is that the type of bypass performed (duodenum to ileum) limits the amount of fat that is absorbed from your food intake. Finally, the duodenum to ileum bypass is fully reversible and adjustable since the small intestine is rerouted, not removed. The duodenal switch has more sustainable long-term weight loss than other procedures with national averages of 98.9% remission of type 2 diabetes, 99% remission of hyperlipidemia (high cholesterol), 92% remission of sleep apnea, and 83% remission of hypertension (high blood pressure).
Several drawbacks of the procedure include the potential for vitamin and mineral deficiencies and protein-calorie malnutrition. This can be avoided by regularly taking supplements. Patients may also experience foul-smelling stools and flatulence, with the occasional occurrence of diarrhea. This is less frequently seen with the newer loop technique we most commonly use, and it can be minimized by reducing fat intake found in rich foods. It’s vital that you go for regular blood testing and continue lifelong follow-up with your bariatric team to ensure you are getting the nutrients and vitamins your body needs.
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Duodenal switch patients should expect to stay in the hospital for 1-2 nights and will likely need at least 1-2 weeks off of work. It’s also vital that you adhere to a vitamin routine that will start after surgery, led by our registered dietician nutritionists. You will be taught to take specific supplements for life to decrease potential deficits that may otherwise be seen after your duodenal switch procedure.