What’s a Duodenal Switch?
The biliopancreatic diversion with duodenal switch, abbreviated BPD/DS and often simply called a “duodenal switch,” is a version of the original gastric bypass procedure. It combines a sleeve gastrectomy with a bypass of a part of the small intestine. It affects the amount of food consumed, although food consumption often returns to near-normal levels; the greater effect is on the absorption of nutrients, especially fat, from the diet, and on hormonal factors that influence weight loss and diabetes. This procedure results in a larger average weight loss than any of the other bariatric surgical procedures and reverses diabetes in 99% of cases, but also has the highest rate of complications from surgery.
If you’re considering bariatric surgery, make sure you’re choosing it because you really want it, not to please someone else or to fit an imagined ideal. No one else can make the choice for you; it’s your body, and you’re in charge of it. After you do your research and understand the procedure, if you believe that a duodenal switch is right for you, then proceed. To help you in your decision-making process, we have some information about the risks and benefits of having a duodenal switch at Duodenal Switch: Risks and Benefits. For more about the many resources Doctor Review has to offer, you can check out our Bariatric Surgery Overview page.
Please note that this page is for informational purposes only, and is not a substitute for qualified, individualized medical advice. You should discuss your potential elective surgery with your own doctor(s), including your primary care physician and the surgeon who will perform your surgery if you decide to proceed.
How it’s done
This procedure may be done laparoscopically. That means that there are only a few very small incisions in your abdomen; during surgery, the abdomen is inflated with air, and cameras and instruments are passed through the small openings to perform the surgery. You will not have any large scars from the surgery if it’s done laparoscopically. However, as it’s a fairly complicated procedure, it may also be done as an open surgery, meaning that the abdomen would be opened with a scalpel, and then closed after surgery with layers of suture; a more significant scar would result.
You’ll be under general anesthesia for this surgery. After the anesthetic takes effect, the area is cleaned with liquid (sometimes the liquid used will temporarily stain the skin yellow). The small incisions are made and the abdomen is inflated, if the procedure is laparoscopic; if open, the abdomen is opened with a scalpel. The stomach is then divided into two parts, a smaller part that includes both the opening from the esophagus and the opening into the small intestine, and a larger part that includes around 80% of the stomach. The larger part is removed, and the edges of the smaller part are attached together into a sleeve-shaped thin tube that is the new stomach.
Next, the small intestine is cut into two parts, a few feet down from where the stomach normally empties into it. The lower part of the small intestine is brought up to the new, sleeve-shaped stomach pouch. Food will now pass directly into this part of the small intestine from the stomach pouch.
Into the upper part part of the small intestine, the pancreas and liver normally empty digestive enzymes and bile, which are needed for digestion of food. Bile is needed for digestion and absorption of fat, while pancreatic enzymes digest protein. To allow these factors to mix with food, the upper part of the small intestine is connected into what is now the main part of the small intestine. This connection is created by the surgeon just a short way up from the end of the small intestine (where it connects to the large intestine).
Now, food will be swallowed into the esophagus, then pass into the small stomach sleeve, and then directly into the lower part of the small intestine. Stomach acid and digestive enzymes will be emptied into the upper small intestine from the large stomach pouch, liver, and pancreas, will pass through the upper small intestine, and then into the lower small intestine through the surgically created opening, where they will mix with the food. The gastric bypass is complete. The instruments are removed, the abdomen is deflated, and the openings in the skin are closed with fine suture, medical tape, or skin adhesive.
Preparing for the procedure
Choosing your surgeon
When choosing a surgeon, you want a highly-trained professional with experience in this type of surgery. A surgeon who’s a member of the American Society of Metabolic and Bariatric Surgeons (ASMBS) is a well-trained surgeon who regularly performs bariatric surgical procedures; these surgeons are also certified by the American Board of Surgery. Also, choose a surgeon with whom you feel comfortable and safe, and who listens to you and tries to understand your goals. If you have friends who’ve had bariatric surgery, and you like their results, ask for a referral. While cost may be a consideration, don’t allow this to override more important factors in your decision. Your safety and the quality of your results are worth a little extra spending.
For more help in your search for a plastic surgeon, visit our How to Find the Best Bariatric Surgeon page. At Doctor Review, you can also search providers for patient reviews to help you find the very best.
Getting ready for surgery
You will have at least one appointment with your surgeon before your surgery, during which you’ll discuss your options, ask any questions you have, and make the decision about proceeding with the surgery.
The day before your surgery, you should eat and drink enough healthy food and water, and get enough sleep the night before. You will need to stop eating 8 to 12 hours before your surgery. If you smoke, you should stop for at least 24 hours before the surgery. If you take daily medications to prevent blood clots, such as aspirin, you will likely be asked to stop those for 24 to 48 hours before the surgery (proceed as directed by your doctor, and don’t stop any medication without talking to your doctor first).
You will stay in the recovery room for several hours following surgery, for the anesthesia to wear off. You will then spend several days in the hospital, where you’ll be monitored to ensure your recovery from the surgery. You’ll slowly be able to resume eating and drinking. Your surgeon will discharge you to your home when you are able to eat and drink and when he or she determines that you’re stable enough to go home safely.
You can resume your normal activity at the direction of your surgeon, who will see you for at least one postoperative visit several days after surgery. If you have sutures that weren’t removed before leaving the hospital, they’ll likely be removed at this appointment.
Even after you’re cleared to resume normal activity, you should expect to have some soreness and swelling for around 4-6 weeks after surgery. It may take a year or even longer for the tiny incision marks to fully fade, though they will eventually become nearly invisible in most people.