Duodenal Switch Overview
Duodenal Switch Surgery (DS) is a powerful weight loss procedure that reduces the stomach size while rerouting or “switching” the small intestines.
Initially, about 70% of the stomach is removed, causing restriction as the first component of weight loss. This restrictive portion of the duodenal switch creates a new “sleeve-stomach” exactly as the gastric sleeve surgery (VSG).
Next, malabsorption is applied through “switching” the intestines which reduce the time for the digestion process significantly. Through bypassing a large portion of the small intestine, the amount of food, calories, and fat that gets absorbed into the body because of the shortened digestion process is diminished remarkably. This malabsorptive component is similar to gastric bypass surgery and mini gastric bypass surgery.
What is Duodenal Switch Surgery?
The duodenal switch surgery is one of the newest bariatric procedure available. It is gaining popularity because of it’s highest expected weight loss and largest reduction in comorbidities compared to other procedures.
This procedure is known medically as biliopancreatic diversion with duodenal switch (BPD/DS). A significant benefit of the DS procedure is the preservation of the pyloric valve, leaving the bile and pancreatic fluid intact.
There are two weight loss components to duodenal switch surgery:
In the duodenal switch procedure, the stomach is made restrictive by vertical division at the larger curvature of the stomach reducing gastric capacity and acid production. The stomach is cut and stapled along the bougie (introduced through the mouth) to form a new stomach with 30% of its original capacity. Removing a large part of the fundus reduces the level of an appetite-stimulating hormone (hunger hormones – ghrelin) and changes the hormonal balance in the GI tract.
The malabsorptive part of the DS/BPD is performed by creating two limbs:
- A gastric limb – carries the undigested food
- A biliopancreatic limb – carries biliopancreatic juices
The “new stomach” is detached from the small intestine* and is “switched” to the last part of the small intestine (3 meters). The other 2.75 meters of the small intestine is bypassed which accounts for the malabsorption part of the DS. This creates a biliopancreatic diversion, which diverts all the digestive juices (bile and pancreatic fluids) from the small intestine that is attached to the new stomach to be mixed at the last part of the small bowel, called common channel (75 cm). The rerouting of the intestine reduces the caloric intake.
* The total length of the small intestines varies from patient to patient, averaging about 6 meters, or 20 feet long.