A gold-standard procedure suited to those with type-2 diabetes and reflux
The duodenal switch is a long-standing, proven, and effective bariatric surgical procedure that combines both restriction and malabsorption to achieve the highest weight loss potential of any bariatric procedure offered in the United States. In addition to the exceptional potential for weight loss, it comes with significant health benefits, including improving type 2 diabetes, gastroesophageal reflux disease (GERD), high cholesterol, and high blood pressure. When researching bariatric surgery, you may not have encountered the duodenal switch. Indeed, the DS is performed less frequently than the gastric sleeve or gastric bypass, primarily because it is a more complex procedure.
The duodenal switch always begins with a sleeve gastrectomy. This restrictive portion of the procedure cuts away approximately 75% of the existing stomach pouch. You may have heard of the gastric sleeve and know it is also used as a standalone weight loss surgery procedure. However, when combined with the rest of the duodenal switch, its effects are significantly enhanced.
One of the great benefits of the gastric sleeve portion of the DS is that the fundus of the stomach is removed during the procedure. This is the primary production center for ghrelin, a hormone that regulates hunger. As such, most patients experience a significantly reduced sensation of hunger after surgery.
The DS also involves a malabsorptive component that bypasses much of the duodenum, or the first part of the small intestine, in a technically similar manner to a gastric bypass. However, a greater length of the small intestine is bypassed, allowing for more significant malabsorption.
As with most bariatric surgeries we offer, the DS is performed using minimally invasive, robotic technology. The robot enables us to achieve better visualization and a more ergonomic position, ensuring the fastest and safest possible procedure. Small incisions are made in the abdomen through which specially made tools are passed. The robotic hands, in particular, can articulate 360° within the abdomen, approximating a surgeon’s wrist without requiring a large incision.
Of course, the success of a weight loss procedure is typically measured in the amount of excess body weight lost. In this regard, the duodenal switch is without parallel. Patients can lose up to 90% of their excess body weight, and some can lose all their extra body weight with dedicated focus and effort after surgery. The DS most definitely offers the most significant potential for disease resolution, significantly improving several markers of obesity-related diseases.
Patients who undergo the Duodenal Switch will usually spend one night in the hospital. This, of course, will depend on the speed at which the patient is recuperating and healing.
The most significant advantage of the DS is in the results, allowing patients to lose more weight than any other bariatric procedure while also improving many of the diseases associated with morbid obesity, most notably type two diabetes. The switch also reduces the risk of ulcers that gastric bypass patients may otherwise have.
The DS is a more complex surgery that requires a skilled and knowledgeable surgical team, such as those at our practice. Because more of the small intestine has been bypassed during surgery, there is a greater risk of malabsorption, including deficiencies in vitamins and minerals. These are managed well with regular follow-up appointments and appropriate supplementation. There is a slightly higher risk of intestinal obstruction, but the overall risk of this complication is very low.
Speaking to Dr. Ghanem about the duodenal switch or any other bariatric surgical procedure is the next step in understanding which approach is best. After a consultation and preoperative testing, we can help you select the most suitable method for your specific situation.