Duodenal Switch – A Comprehensive Guide
The duodenal switch is an extremely effective weight-loss operation with significant benefits for obese patients with multiple health conditions. This operation is a two-stage approach: partial stomach removal (gastric reduction) followed by limited calorie absorption through rerouting the intestines (intestinal bypass).
The duodenal switch stands out because it can lead to long-term weight loss and metabolic benefits, especially for patients with type 2 diabetes or extreme obesity.
In this blog, we take an in-depth look at the duodenal switch — how it works, its advantages, pre-operative and post-operative expectations, downsides and whether it might be the best choice to help you meet your weight loss goals.
What is Duodenal Switch Surgery?
Duodenal switch is a two-step weight loss surgery that involves restricting and limiting the amount of food you can eat (food intake) and restricting and limiting the calories your body can absorb (calorie absorption).
It consists of a restrictive procedure and removal of about 70% of the stomach. “And then they create a little sleeve-shaped neck of the stomach, like a sleeve gastrectomy, which is essentially going to limit how much a person is able to eat at one time.”
The second characteristic is malabsorptive. It requires rerouting much of the small intestine, where the majority of nutrients and calories enter the body. This redirection reduces how much the body can absorb in terms of fat and calories, bolstering 1-2 year weight loss results.
This two-way action also results in significant weight loss and benefits to diseases such as type 2 diabetes, sleep apnoea and high blood pressure. Typically the procedure is advised for people with a BMI greater than 40, or 35 and higher if they also have comorbidities.
Source: Johns Hopkins Medicine – Duodenal Switch
Gastric Reduction Duodenal Switch: How It Works
Duodenal switch: An effective duodenal switch is carried out by starting with the surgical reduction of the stomach. Surgeons create a small stomach pouch to restrict the amount of food a person can eat at one time.
Then, part of the duodenum, the upper portion of the small intestine, is bypassed. That means food passes from the shrunken stomach to the lower small intestine, bypassing a large portion of the absorption phase.
This combination changes the levels of hormones that affect feelings of hunger and fullness, leading to less hunger. And less is absorbed — not only does the retained fibre help maintain long-term weight control, but also the reduced absorption means fewer calories and nutrients are taken in.
Though more involved than other bariatric procedures, the approach typically results in more weight loss long term and serves as a viable choice for bariatric patients who are morbidly obese.
Before and After Duodenal Switch: What to Expect
Before Surgery
Patients will undergo conventional clinical examinations that include blood tests, imaging and appointments with the bariatric team. An important part of this is the psychological evaluation, to confirm that the candidate is emotionally and mentally ready for the journey ahead.
Preoperative diet adjustments
For many patients, diet adjustments are initiated prior to surgery by reducing the consumption of calories, sugar and fatty foods. It is important to appreciate that this surgery involves lifelong supplements and nutritional monitoring.
After Surgery
During the first 1–6 weeks, patients are on a very restricted liquid diet with a progressive adaptation to soft foods and then to regular solid meals. Smaller portions and meal timing become more significant due to issues such as dumping syndrome.
The percentage of excess weight loss (%EWL) at 6 and 12 months averages 60–80% for most people. There are also generally marked improvements in people with diabetes, hypertension, and sleep apnoea.
Long-term follow-up is important, with periodic blood testing to check nutritional levels and maintain your health and success.
Long-Term Side Effects of Duodenal Switch
The long-term effects are what separate the duodenal switch from other procedures.
Although it is a very effective surgery for patients, the duodenal switch does come with long-term implications. Given the bypassed sections of the small intestine, your body will absorb less of the food you eat, resulting in:
- Hair loss
- Osteoporosis (especially in cases of severe malnutrition)
- Deficiencies in vitamins such as A, D, E, K, iron, and calcium
Others may have persistent diarrhoea or foul-smelling stools from fat malabsorption. Protein undernutrition may also become a concern where dietary guidelines are not followed.
The side effects necessitate lifelong vitamin replacement, and a high-protein diet must also be maintained, with the patient monitored by a health professional to ensure that nutritional status is maintained and general health is sustained.
Is Duodenal Switch Right for You?
It is an appropriate form of surgery for people with a BMI of 40 or more, or for those with a BMI between 35 and 40 if they have coexisting health issues related to obesity, such as diabetes or sleep apnoea.
It is not suitable for individuals who are not prepared to make the lifestyle and dietary changes that such treatment entails. These commitments range from taking daily supplements, attending periodic check-ups to maintaining a healthy lifestyle.
Compared to other bariatric procedures such as gastric bypass or sleeve gastrectomy, the duodenal switch often results in more weight loss but requires more nutritional responsibility.
When considering what type of surgery to undergo, be sure to speak with a bariatric surgeon about the best solution for your health and lifestyle.
Conclusion
The duodenal switch offers a durable option for patients seeking weight loss and metabolic improvement. These results can be life-changing, but they require a solid commitment to lifestyle changes and ongoing medical follow-up.
For more information on duodenal switch, visit Johns Hopkins Medicine.
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