What is duodenal switch surgery?

Duodenal switch surgery is a type of weight loss surgery that reduces the size of the stomach and reroutes the small intestine. In this type of weight loss surgery, the small intestine is divided. The first part (duodenum) is connected to the end of the small intestine (ileum), bypassing the mid-section where most nutrient and calorie absorption occurs.

These changes limit how much food your stomach can hold and alter how food is digested and absorbed, leading to weight loss.

Although duodenal switch surgery (often called biliopancreatic diversion with duodenal switch or BPD/DS) is much less common than other types of weight loss surgery, it can also be quite effective, particularly for people with obesity-related medical conditions. According to the American Society of Metabolic and Bariatric Surgery, duodenal switch surgery is the most effective metabolic surgery for the treatment of Type 2 diabetes.

Types of duodenal switch

Duodenal switch surgery removes part of the stomach and part of the small intestine. There are two types of duodenal switch surgery.

Biliopancreatic diversion with duodenal switch is the traditional duodenal switch procedure. During the procedure, your surgeon splits the small intestine at the duodenum (the first part of the small intestine) and reattaches it in two places.

The single anastomosis duodenal switch, also called a modified duodenal switch or a loop duodenal switch, is a more recent innovation that’s a less complex and quicker procedure. Your surgeon splits the small intestine at the duodenum and reattaches it directly to the ileum (the bottom part of the small intestine).

Duodenal switch vs. gastric sleeve surgery

Duodenal switch surgery and gastric sleeve surgery are both types of weight loss surgery, but they work in different ways. During a gastric sleeve procedure, a bariatric surgeon removes a large portion of the stomach and creates a smaller sleeve that limits how much food the stomach can hold.

Duodenal switch procedures go a step further. Your surgeon reduces the size of the stomach, creates a stomach “sleeve,” then shortens and reroutes the small intestine. Both types of duodenal switch surgeries are more complex than a gastric sleeve procedure, but they can lead to more successful and longer-lasting weight loss.

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Am I a good candidate for a duodenal switch?

Your doctor or a bariatric surgeon may recommend a duodenal switch if you have obesity and haven’t successfully lost weight with diet, exercise and medication.

Your doctor can help you determine whether you’re a good candidate for duodenal switch or another form of weight loss surgery, but in general, you may be a candidate for duodenal switch if you:

The duodenal switch procedure

Duodenal switch surgery is more complex than other forms of weight loss surgery since it reduces the size of the stomach and reroutes the small intestine.

Knowing what to expect before, during and after the procedure can help you determine whether duodenal switch surgery would be right for you.

Before the procedure

You may see several different doctors to ensure you’re physically and mentally healthy enough to have the duodenal switch and make the lifestyle changes necessary after surgery. As part of this process, you may undergo testing, such as an upper endoscopy and heart and lung assessments.

As you prepare for surgery, you’ll receive educational materials and counseling about the surgery and the lifestyle changes you’ll need to make. You’ll meet with a registered dietitian to learn about a healthy diet to prepare you for surgery and how to eat after surgery.

Many of the lifestyle changes that will help you lose weight and stay healthy after surgery should begin before surgery. Your team will help you quit tobacco if you smoke and lose a small amount of weight, which helps ensure a more successful surgery.

Duodenal switch risks

Duodenal switch surgery is usually safe and effective, but as with any type of surgery, it carries the possibility of complications. Just after surgery, potential risks include infection, excessive bleeding, blood clots, bowel obstruction, intestinal leaks and anesthesia reactions.

This type of weight loss surgery can also cause longer-term complications, typically related to malabsorption. These complications can include nutritional deficiencies and osteoporosis. You might also experience digestive issues such as chronic diarrhea, smelly gas or frequent bowel movements.

Duodenal switch recovery time

Your recovery time following duodenal switch may vary based on several factors, including whether you experience any complications. In general, most people take around three weeks to a month to recover after surgery.

Your surgeon and other members of your care team will let you know when you can resume specific activities, including work.

Frequently asked questions