Duodenal Switch (DS) Surgery

Overview

The duodenal switch (BPD-DS) is a type of bariatric surgery designed to treat people with severe obesity, combining a sleeve gastrectomy with an intestinal bypass. It's considered the most effective but also the most complex bariatric surgery, with particularly strong results for treating type 2 diabetes.

During this procedure, approximately 60 to 70 percent of the stomach is removed to create a tubular "sleeve." The small intestine is subsequently rerouted to reduce calorie absorption. The procedure is performed laparoscopically or robotically, allowing for smaller incisions and typically faster recovery.

Candidates for duodenal switch (DS) surgery

Patients considered for this weight loss surgery have a body mass index (BMI) of 35 or higher, often with other severe obesity-related health conditions. These conditions can include:

• Heart disease
• High blood pressure
• Sleep apnea
• Type 2 diabetes
• Obesity-related respiratory diseases
• Metabolic diseases
• Gastrointestinal diseases

Expectations from DS surgery

DS surgery often takes two to three hours – you will be under general anesthesia for the entirety of it.

Most patients can expect to lose 60 to 80 percent of their excess body weight over a two-year period, with studies showing an average sustained weight loss of 70 percent over 10 years. The surgery preserves the pylorus (stomach outlet muscle), which means dumping syndrome is unusual.

However, due to the malabsorptive nature of the procedure, patients typically experience more frequent and looser bowel movements and increased flatulence.

Risks associated with duodenal switch surgery

There are a few risks associated with DS surgery. Similar to any other type of bariatric surgery, these include:

• Wound infection at the incision points
• Bleeding or clotting

Risks specific to duodenal switch include:

• Looser bowel movements, including diarrhea
• Lowered vitamin levels due to malabsorption
• Acid reflux
• Gallstones formed from extra cholesterol buildup in the gallbladder

With proper planning and periodic testing, most of these risks can be avoided. Ensure to discuss with your health care provider a long-term plan for getting adequate nutrient intake, often in the form of daily nutritional supplements.

Recovery from DS surgery

After your surgery, you should expect to remain in the hospital for two to three nights. Most patients return to daily routines within one to two weeks. Your recovery process will include:

Initial hospital stay criteria for discharge

• Ability to eat liquid foods without vomiting
• Movement without excessive pain
• No longer requiring IV pain medication

Dietary progression

• Liquid diet for three weeks
• Gradual progression to soft foods
• Eventually incorporating regular bariatric diet foods focusing on high-protein, low-carb options
• Lifelong commitment to vitamin, mineral and protein supplements

When you should consider duodenal switch surgery

Duodenal switch surgery may be right for you if:

• You have a BMI of 40 or higher
• You have a BMI of 35 or higher and have other obesity-related health concerns
• Previous weight loss attempts have been unsuccessful
• You're committed to lifelong follow-up care and strict vitamin compliance
• You have the proper resources and support system for long-term success