Duodenal Switch

Duodenal Switch

The duodenal switch is a weight loss operation that has been done for over 20 years but has increased in frequency significantly in the last several years. It has the greatest weight loss potential of all the operations available. It works by creating a sleeve gastrectomy for restriction and hunger control. Then, after the sleeve, the intestines are rerouted similar to a gastric bypass. The principle measured length with a duodenal switch is the common channel. This is the distance from where bile and food meet to the end of the intestines and determines the amount of malabsorption.

This common channel distance is an important number and has changed significantly over time. Originally this number was 50-100 cm and while it provided excellent weight loss, it left patients with nutritional deficiencies and diarrhea. Deviations from this number are dependent on the patient’s needs and this appears to be the sweet spot where weight loss is still excellent with fewer downsides. Vitamin supplementation is important and patients may have some increase in the number of bowel movements.

Advantages of Duodenal Switch

• Greatest weight loss potential of all bariatric procedures
• Minimal risk of dumping syndrome
• Excellent diabetes control
• Minimal risk of ulcer disease

Disadvantages of Duodenal Switch

• Increased risk of reflux disease
• Greater risk of nutrition deficiencies if not compliant

Risks

• Standard surgical risks
• Nausea and vomiting
• Leaks from staple line
• Gastric reflux
• Small bowel obstruction