Duodenal switch surgery is the most complicated of weight-loss surgeries and accounts for less than 10% of all bariatric surgery options. While you can have more food with this surgery than the others, the food will pass through a large section of the intestines undigested. This makes malabsorption a concern.
Due to greater nutritional deficiencies, you will be required to take vitamins and supplements, including vitamin A, vitamin D, and calcium every day for the rest of your life. You also may be required to take potassium and iron daily and will need lifelong nutritional follow-ups. If you do experience malabsorption-related complications, your doctor may choose to partially reverse your duodenal switch.
Duodenal Switch Surgery Facts
Duodenal Switch medical criteria:
BMI of 40+ although duodenal switch is typically reserved for the “super obese” (50+ BMI). Extensive screening process via a bariatric psych evaluation will evaluate your psychological status (depression, sexual abuse, eating disorders, etc). A poor status will not disqualify you from bariatric surgery, but it may postpone it.
Your medical history will be reviewed to look for risk factors that could make duodenal switch surgery unsafe. You may have to get lab work and a physical exam.
Brief description/How it works:
Duodenal switch is a combination bariatric surgery. The first part is to create a gastric sleeve. Normally, after food passes through the stomach it enters the duodenum where it mixes with digestive juices from the pancreas and bile from the gall bladder. This is the second part of the revised digestive process. Duodenal switch separates the digestive process. Food travels down undigested, bypassing a large part of the intestine and mixes with bile and digestive juice in the last 18-24 inches of the intestine.
Duodenal switch can be done laparoscopically and is still a sought after surgery because it has the potential for the most weight loss. There is also less chance of regaining weight and it is the most effective surgery for eliminating obesity-related illnesses.
Duodenal Switch cost:
Some insurance companies still consider duodenal switch experimental and thus may not cover any part of the procedure, which costs an average of $20,000. However, many patients have been successful in writing an appeal letter that gets the surgery covered.
Duodenal Switch recovery:
3-5 days in hospital after surgery. Two to three days on a liquid diet, followed by a bariatric diet of pureed foods with a low fat content for 2 weeks. As long as vomiting and diarrhea do not present, you can move back onto solid foods. Duodenal switch requires a lifetime dietary change to reduce painful and unusually foul gas and prevent malnutrition. Malabsorption is a concern. Failure to conform to nutritional guidelines can result in blindness (lack of vitamin A) or osteoporosis (lack of calcium and vitamin D).
Average weight loss: Excess weight loss of 66%-69% within first year (compared to 55% with bypass).
Duodenal Switch success:
Far more effective at eliminating the need for medications to treat diabetes, hypertension and dyslipidemia than gastric bypass surgery. It also results in a lower average BMI (33 as opposed to 37 with gastric bypass). Long term excess body weight loss of 66%, compared to 50-55% with gastric bypass.
Next, learn about Duodenal Switch Risks and Complications.
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Photo: Jassira Espaillat-Batista