Duodenal Switch

When we talk about the gastric sleeve or sleeve gastrectomy, a duodenal switch (DS) often comes up. This is because the gastric sleeve is used as the first (restrictive) stage of the two-part duodenal switch procedure. When you going to patient’s overall health, both stages may be performed in one surgery or they may be staggered over time.

The duodenal switch is a combination restrictive and malabsorptive procedure, much like the gastric bypass. While it offers some of the highest weight loss potential of any bariatric surgical procedure, it has not gained major procedure status and largely remains a niche procedure. Many insurance companies do not cover the duodenal switch.

The procedure is performed in a minimally invasive manner like most other bariatric surgeries. In the first part of the procedure, a gastric sleeve is formed by cutting away 70 to 80% of the existing stomach pouch and removing it from the abdomen. The second part of the procedure involves the rerouting of the small intestine in a way that is significantly more complex than a gastric bypass. Essentially the DS separates food from gastric enzymes in the small intestine. By creating two separate intestinal pathways (alimentary and biliopancreatic limbs), connected only at the very end (common channel), the duodenal switch eliminates much of the absorption of calories in the small intestine.

Unlike the gastric bypass, the pyloric valve (the valve that separates the stomach form the small intestine) is preserved, avoiding dumping syndrome. Further, studies have shown that weight loss and disease resolution potential is exceptional, possibly greater than a gastric bypass. However, as with any major surgical procedure, there are risks and considerations. Beyond the inherent risks of surgery, duodenal switch patients have a higher risk of vitamin mineral deficiencies that requires regular monitoring and supplementation as needed. Some duodenal switch patients also complain of significant gas, bloating and diarrhea. This is exacerbated by poor dietary choices. Some patients may also experience bowel obstruction.