Duodenal Switch Bariatric Surgery


The duodenal switch bariatric surgery (DS) results in more weight loss than any other procedure. But what does this mean for you in terms of life-long commitments and surgery-related complications?

What is duodenal switch bariatric surgery?

duodenal switch bariatric surgeryThis 3 1/2 to 4 hour procedure could be classified as a Gastric Bypass/Gastric Sleeve combination with a twist.  It is one of the most difficult and complex procedures to perform, but it’s also associated with some of the best results. And, while it is still sometimes performed as an open surgery, it is routinely performed laparoscopically.

Imagine your digestive system as a series of pipes that food and digestive juices must pass through.  Before surgery, food is swallowed and goes down a tube (the esophagus) to your stomach. From your stomach it passes through a small chamber called the duodenum, then through your 11 to 40 feet of small intestines (the small intestine length can vary from person to person by almost 30 feet!).

While in your small intestines, your food is mixed with digestive juices that break it down to help your body absorb nutrients. The food and digestive juices then pass into the large intestines (colon) and out of your body.

With the duodenal switch…

  1. A large portion of the stomach is removed to create a cylinder-shaped pouch connecting the esophagus to the top of the small intestine.
  2. The top of the small intestine is cut, but the surgeon leaves part of the duodenum (the top part of the small intestine where most chemical digestion occurs) attached to the stomach.
  3. The surgeon then cuts the small intestine several feet up from the end where it meets the large intestine/colon. The part that is still attached to the large intestine (colon) is connected to the duodenum.
  4. The loose part of the small intestine (the part that was not just attached to the stomach) is then attached to the small intestine, allowing the digestive juices it creates to mix with the food coming from the stomach in roughly the last 15 – 20% of the small intestine.
  5. Since the stomach is shrunk and only a small portion of the intestine has a chance to digest food before the food enters the colon, this procedure is both restrictive and malabsorptive.

The DS is effective both from the restrictive component AND the malabsorptive component. In fact, most of the early weight loss comes from the restriction and the long term weight loss maintenance (lack of weight regain) is from the malabsorption.

What are the risk with the surgery?

As with other types of bariatric surgery, the complication rates rise with a higher BMI.  But the 6.7% to 7% rate of serious/major complications for patients with a body mass index under 50 is higher than other procedures.

The more serious and/or impactful complications related to the DS include…

  • Vitamin deficiencies are a big risk due to the malabsorbtive nature of the surgery, especially Vitamin A, Vitamin D, Vitamin E, Vitamin K, Iron, Calcium and Protein. This is the reason that so many bariatric vitamins and other medications are essential for DS patients
  • Complications related to malnutrition are a serious concern
  • Gastroesophageal reflux disease (GERD)
  • Problems with bowel movements, including diarrhea, foul-smelling stools and flatulence
  • Although rare, a narrowing of the newly created (reduced) stomach has also been observed

It is important to recognize that in many cases, the patient is completely to blame for complications. Properly educating yourself prior to surgery and following the advice of your doctor and dietitian are both essential steps towards lowering your post surgery risks.

What life-changing events can occur after lap band surgery?

  • Addiction swapping, replacing your food addiction with another addiction (like drugs, shopping, etc…)
  • Divorce, relationship problems
  • Need for additional operations because of problems with weight loss
  • Multiple adjustments on the lap band, which are required to be done in your doctor’s office
  • Failure to lose enough weight if you snack on high-calorie foods and don’t exercise

After duodenal switch bariatric surgery, now what do I do?

It’s important to stop and change your unhealthy habits right away.  For most of us this includes:

  • Addressing your addictive personalities and relationship issues
  • Exercising daily
  • Drinking water daily (and lots of it)
  • Taking daily vitamin supplements (for the rest of your life)
  • Eating a healthy diet with 6 small meals per day
  • Sleeping 8 hours a night to allow your body to heal itself (we do put it through a lot during the day)
  • Enjoy your new body that allows you to do even more than before

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