The Benefits and Risks Duodenal Switch

A duodenal switch is one of the more aggressive bariatric surgeries performed today. A duodenal switch is often performed at the same time as one or more other procedures including biliopancreatic diversion and vertical sleeve gastrectomy. In its purest form, duodenal switch is a malabsorption procedure which means that it prevents most of the nutrients that you swallow from being absorbed across the wall of the intestine into the bloodstream. Even though you can still eat relatively large amounts of food, since many of the calories are passing through in the stool, you lose weight. Duodenal switch is often associated with a profound weight loss.

 

The duodenum is the first part of the small intestine and it is where food arrives immediately after leaving the stomach. It is also where bile and digestive enzymes are mixed with swallowed food after it leaves the stomach. While most people incorrectly think it is the stomach, the duodenum is the location where most nutrients that we eat are absorbed into the bloodstream. In the duodenal switch procedure, the stomach is separated from the duodenum and reattached much later in the digestive tract, near the large intestine. The duodenum is then simply a long tube for bile and digestive enzymes to be carried to point later in the tract. Swallowed food mixes with digestive juices near the colon. Since the food does not pass through the duodenum, very little is actually absorbed into the bloodstream.

The major benefits of this type of surgery are that patients can continue to eat relatively large meals but also lose a lot of weight, as much or more than other bariatric procedures. The weight loss is quite rapid so patients can easily see the pounds melting away. Unlike other restrictive only surgeries, the patient does not need to adhere to small meal/portion size as closely which improves outcomes and patient compliance. Since weight loss is more profound, obesity-related illnesses are more likely to be corrected or cured after duodenal switch surgery. Also, the procedure is partially reversible is certain malabsorption side effects become a problem.

There are several major drawbacks to the procedure that need to be considered, however. Some patients lose too much weight. While that may seem like a silly risk for someone that is severely obese, it is not. Patients can lose too much, too fast, which is unhealthy and sometime dangerous. It is common for patients undergoing duodenal switch to have major vitamin and nutrient deficiencies including profound protein deficiencies and disruptions in fat soluble vitamins. Vitamin B12 deficiency is quite common. The number of bowel movements increases dramatically and the waste s particularly foul smelling because it is not always fully digested. Finally, the surgery itself is associated with more complications than other weight loss surgeries and the overall risk of mortality is higher with duodenal switch than with restrictive surgeries.

The decision to undergo a duodenal switch procedure is not one to be made lightly. While the procedure promises extreme and rapid weight loss, duodenal switch is associated with many risks that need to be considered ahead of time.