The duodenal switch (DS) procedure, also
known as biliopancreatic diversion with duodenal switch (BPD-DS) or
gastric reduction duodenal switch (GRDS), is a weight loss surgery
procedure that is composed of a restrictive and a malabsorptive
The restrictive portion of the surgery involves
removing approximately 70% of the stomach along the greater
The malabsorptive portion of the surgery reroutes
a lengthy portion of the small intestine, creating two separate
pathways and one common channel. The shorter of the two pathways,
the digestive loop, takes food from the stomach to the common
channel. The much longer pathway, the biliopancreatic loop, carries
bile from the liver to the common channel.
The common channel
is the portion of small intestine, usually 75-150 centimeters long,
in which the contents of the digestive path mix with the bile from
the biliopancreatic loop before emptying into the large intestine.
The objective of this arrangement is to reduce the amount of time
the body has to capture calories from food in the small intestine
and to selectively limit the absorption of fat. As a result,
following surgery, these patients only absorb approximately 20% of
the fat they intake.
The primary advantage of duodenal
switch (DS) surgery is that its combination of moderate intake
restriction with substantial calorie malabsorption results in a
higher percentage of excess weight loss versus a purely restrictive
gastric bypass for all individuals In a Systemic Meta Analysis of
the weight loss surgical procedures Buckwald et.al . Type 2
diabetics have had a 98% "cure" (i.e. became euglycemic) almost
immediately following surgery which is due to the metabolic effect
from the intestine switch. The results are so favorable that some
surgeons in Europe are performing the "switch" or intestinal surgery
on non-obese patients for the benefits of curing the diabetes.Novel
operations are geared toward the treatment of diabetes and not
necessarily to induce weight loss. Among the most prominent of these
operations are the duodenal-jejunal bypass and ileal transposition
where duodenal switch is a part of the operation.
following observations were reported on the resolution of obesity
related comorbidities following the duodenal switch: type 2 diabetes
99%, hyperlipidemia 99%, sleep apnea 92%, and hypertension 83%.
Because the pyloric valve between the stomach and small
intestine is preserved, people who have undergone the DS do not
experience the dumping syndrome common with people who've undergone
the Roux-en-Y gastric bypass surgery (RNY). Much of the production
of the hunger hormone, ghrelin, is removed with the greater
curvature of the stomach.
The summarized data can be found on
a poster- comparative poster
Diet following the DS is more
normal and better tolerated than with other surgeries.
malabsorptive component of the DS is fully reversible as no small
intestine is actually removed, only re-routed.
The malabsorptive element of the DS
requires that those who undergo the procedure take vitamin and
mineral supplements above and beyond that of the normal population,
as do patients having the RNY surgery. Commonly prescribed
supplements include a daily multivitamin, calcium citrate, and the
fat-soluble vitamins A, D, E and K.
Because gallstones are a
common complication of rapid weight loss following any type of
weight loss surgery, some surgeons may remove the gall bladder as a
preventative measure during the DS or the RNY. Others prefer to
prescribe medication to reduce the risk of post-operative
Like RNY patients, DS patients require lifelong
and extensive blood tests to check for deficiencies in life critical
vitamins and minerals. Without proper follow up tests and lifetime
supplementation RNY and DS patients can become ill. This follow-up
care is non-optional and must continue for as long as the patient
DS patients also have a higher occurrence of smelly
flatus and diarrhea, although both can usually be mitigated through
diet, including avoiding simple carbohydrates.
restrictive portion of the DS is not reversible, since part of the
stomach is removed. However, the stomach in all DS patients does
expand over time, and while it will never reach the same size as the
natural stomach in most patients, some stretching does occur.
All surgical procedures involve a
degree of risk however this must be balanced against the significant
risks associated with severe obesity.
Some of the surgical
risks or complications for this procedure are: perforation involving
small bowel, duodenum, or stomach causing a leak, infection,
abscess, deep vein thrombosis (blood clot), and pulmonary emboli
(blood clot traveling to the lungs).
Longer term risks
include the possibility of vitamin and mineral deficiency, hernia
and bowel obstruction. There is little information as to the
longer-term risks (greater than 15 year), as this procedure was very
rarely performed prior to the year 2000.
Malnutrition is an
uncommon and preventable risk after duodenal switch.
For more information or to schedule a Duodenal Switch please send us
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