Now we come to the end of this 4 part article series: duodenal switch. It was not accidental that I left this option for last. Duodenal switch is the most complicated of the four we have discussed and only accounts for less than 10% of all bariatric surgeries. While you can consume more food with this surgery than the others, the food will pass through a large section of the intestines undigested, so malabsorption is a large concern.
Due to these greater nutritional deficiencies, you will be required to take nutritional supplements, including vitamin A, vitamin D and calcium, every day for the rest of your life. You also may be required to take potassium and iron daily, and you will require lifelong nutritional follow-up. If you do experience malabsoprtive complications, your doctor may choose to partially reverse your duodenal switch.
Name of surgery: Duodenal switch
Medical criteria: BMI of 40+, however duodenal switch is typically reserved for the "super obese" (50+ BMI). Extensive screening process that will evaluate your psychological status (depression, sexual abuse, eating disorders, etc.) which will not disqualify you from your bariatric surgery, but it may postpone it.
They also will review your medical history looking for risk factors that could make surgery unsafe for you and have you undergo a physical exam and lab work.
Brief description/How it works: Duodenal switch is a combination bypass surgery. The first part is to create a gastric sleeve. Normally, after food passes through the stomach, it enters the duodenum where it mixes with digestive juices from the pancreas and bile from the gall bladder. This is the second part of the revised digestive process. Duodenal switch separates the digestive process, so food travels down undigested, bypassing a large part of the intestine, and then mixes with bile and digestive juice in the last 18-24 inches of the intestine.
Duodenal switch can be done laproscopically and is still a major contender in bariatric surgery because it has the potential for greater weight loss, less chance of regaining weight and is the most effective in eliminating obesity-related illnesses.
Cost: Most insurance companies consider duodenal switch experimental and will NOT cover any part of the procedure, which on average, costs $20,000. However, many patients have been successful in writing an appeal letter and thereby getting the surgery covered.
Recuperation time: 3-5 days in hospital after surgery. Two to three days on a liquid diet, followed by pureed foods with a low fat content for 2 weeks. As long as vomiting and diarrhea are not present, then you can move back onto solid foods. Duodenal switch requires a lifetime dietary change to reduce painful and unusually foul gas, bowel changes and to prevent malnutrition. Malabsoprtion is a serious concern not to be taken lightly. Failure to conform to nutritional guidelines can result in blindness (lack of vitamin A) or osteoporosis (lack of calcium and vitamin D).
Average weight loss: Excess weight loss of 66%-69% within first year (compared to 55% with bypass).
Long-term success rate: Far more effective at eliminating the need for medications to treat diabetes, hypertension and dyslipidemia than gastric bypass. It also results in a lower average BMI (33 as opposed to 37 with gastric bypass). Long term excess body weight loss of 66%, compared to 50-55% with gastric bypass.
Previous article: Is Gastric Sleeve the Right Surgery for You?
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You can read about my decision to have weight loss surgery back in 2003 and my journey to maintain a lifetime of obesity disease management since that time. My wish is to help you on your own journey of lifetime obesity disease management with shareposts along the way to help you navigate that journey successfully.
Published On: December 23, 2011