The Duodenal Switch is a surgical weight loss procedure which restricts the size of the stomach and reroutes the small intestine and digestive loop. It is performed as keyhole surgery.
What is a duodenal switch?
Duodenal Switch surgery is a variation of gastric sleeve surgery (gastrectomy), which is both restrictive (reducing the size of the stomach) and malabsorptive (reducing absorption of food).
What’s involved in a duodenal switch?
A duodenal switch procedure begins in a similar way to a gastrectomy or ‘gastric sleeve’ procedure, and sometimes this stage is performed by itself, with the second stage performed at a later date. In a duodenal switch the stomach size is also reduced, but usually not quite so drastically as in a standard gastric sleeve procedure. Then the surgeon goes on to cut the small intestine, leaving part of the duodenum (the top part of the small intestine, where digestion occurs) attached to the stomach. The surgeon then cuts the small intestine again, several feet above where it joins the large intestine (the colon), and removes this loose section. The duodenum is then rejoined to the reduced length of small intestine that is still attached to the colon. Sometimes your bile duct and pancreatic duct are then rerouted into the lower part of your small intestine as with a biliopancreatic diversion procedure.
Duodenal switch surgery is performed under general anaesthetic. The gastrectomy stage will take around an hour, while the second stage can take up to two hours.
What are the pros and cons of the duodenal switch?
After a duodenal switch, patients typically lose 75—80% of their excess body weight in five years, so it’s an extremely effective weight loss surgery. Also, by keeping the pyloric valve intact, the duodenal switch procedure reduces the likelihood of ‘dumping syndrome’ when eating sugary foods, and the risk of marginal ulcers and blockages which can occur with other bariatric surgeries. By preserving the pyloric valve and a portion of the duodenum, the switch procedure ensures that food can be digested to an appropriate consistency for absorption, allowing a nutrient absorption that may be closer to a healthy norm than that achieved by gastric bypass surgery, but you will still have to take daily supplements.
Duodenal switch surgery is longer and more complex than most other bariatric surgeries, which increases the risk of complications. The risks of a duodenal switch, beside those of general anaesthetic, are bowel obstruction, blood clots, bleeding, leakage, infection and gallstones due to rapid weight loss. You may also experience flatulence and loose bowel movements for the first few months.
How long is the recovery time for a duodenal switch?
You should be able to return to work around two weeks after surgery, but you may need longer if your work is manual. Lifting, strenuous activity and driving should be avoided for four to six weeks.
How much does a duodenal switch cost?
If you have a BMI of 40, or a BMI of 35 together with a serious health condition that is aggravated by obesity, you may be referred by your doctor for surgery under the NHS.
Privately, the price of a duodenal switch procedure is £10,000 - £13,500.