Duodenal Switch

The Duodenal Switch is considered the most effective surgery that leads to 70 to 80 % of excess weight loss within two years that follows the procedure, including significant improvement in obesity-related medical co-morbidities such as type II diabetes, immobilizing joint pain, sleep apnea, asthma, hypertension, and high cholesterol. It is my right, an aggressive procedure that is recommended for individuals with a BMI of 60 or higher.

In addition to losing a significant amount of weight and improving comorbidities, the duodenal switch surgery does not cause substantial digestive problems, and the stomach continues to digest food generally following surgery. Consequently, patients can enjoy a variety of healthy and satisfying well-portioned meals during the healing process. After surgery, duodenal switch patients have been seen to maintain their weight loss results better because the strict pre-approval requirements call for them to make many positive post-operative lifestyle choices that help them keep the weight off and live healthier lives.

Also called the Biliopancreatic Diversion with Duodenal Switch (BDDS), the duodenal switch involves two separate surgeries. The first procedure is similar to gastric sleeve surgery or vertical sleeve gastrectomy where a surgeon removes most of your stomach to leave a small banana-shaped stomach that is closed with staples. The second procedure is performed in order redirect food to bypass most of your small intestine by reattaching the bypassed section to the last part of the small intestine, allowing digestive juices to mix with food.

What to expect before and after a duodenal switch

A duodenal switch can help you lose weight and, in the process, boost your life expectancy. Therefore, anything that you do before your procedure can either hamper your weight loss goals and reward you greatly. For example, the duodenal switch can benefit anyone with a BMI of 40, but it comes highly recommended for individuals with a BMI of 60 or greater. If you fall into this category, chances are you will be mandated to lose a few pounds to get you to an appropriate weight before surgery. Failure to do so is an early prediction of weight loss failure, proper post-operative and worse, insurance denial.

Preoperative weight reduction is known to lessen the mortality rates of any Bariatric surgery. Studies also show that losing weight before weight loss surgery reduces the risks of respiratory issues, bleeding, gastrointestinal problems, food intolerance, cardiac issues, leakage and wound infections, as well as thromboembolism, acute renal failure, urinary issues, and stricture.

You may be considered a likely candidate for a duodenal Biliopancreatic bypass operation if some of the following pre-operative requirements are met:

• You have a BMI greater than 40 or a lower BMI but with obesity-related comorbidities such as type II diabetes, high cholesterol, hypertension, or joint pain
• Lose between 5 to 10% of excess body weight before surgery to minimize your hospital stay and speed up your post-operative weight loss
• If you meet with a registered dietitian to discuss the various changes in your diet that need to be followed both before and after weight loss surgery
• Provide documentation to show that you have had a comprehensive evaluation by a mental health professional
• Commit to a physical examination to make sure that there are not issues such as ulcers, bacterial infections, polyps, or tumors in the stomach before surgery
• You must quit smoking at least eight weeks before and after weight loss surgery because it increases the risk of complications such as fatal blood clots, pneumonia, and other lung issues after surgery
• You may be considered a high-risk patient for this aggressive surgery is you have a history of complications such as severe sleep apnea or heart failure

Diet and Exercise

After a duodenal switch surgery, which is six months and beyond, you will be expected to follow a healthy diet. Getting enough protein can be challenging after weight loss surgery and most patients require between 60 to 120 grams of protein daily depending on lean body weight. You can get your daily recommended protein intake from food sources such as protein shakes that have less than 200 calories, 6 gm of sugar, 4 gm of fat and have between 20 and 30 grams of a protein such as Whey. It’s essential to avoid protein shakes with collagen as part of the ingredients because it is poorly absorbed.

Other ideal sources of protein are lean meats and chicken, fish, egg whites, Greek yogurt, or extra-firm tofu. All the vegetables you eat should be non-starchy and avoid things like corn, peas, potatoes, including white starches such as bread and pasta. Starches that are ideal for you include those high in fiber or whole grains.

Avoid eating sweets, such as cookies, cakes, candy, and sweetened beverages because they exasperate symptoms of dumping syndrome and commit to a regular workout regimen for best weight loss results.

Complications

Vitamin and mineral supplementation is essential since there are higher risks of nutritional deficiencies with the duodenal switch procedure. You will be required to be on a slew of dietary supplements such as calcium, B12, and folate as well as vitamins A, D, E, K and mineral supplements for the rest of your life.  You will also be required to commit to a lifelong follow-up with your Bariatric surgeon whose job will be to ensure that you are taking all the supplements as recommended.

You may also develop dumping syndrome with symptoms tend to improve over time with dietary changes. If your symptoms persist, speak with your doctor.

It is prudent to increase your water including high fiber foods and vegetable intake if you experience constipation. Periodic abdominal pain, bloating, and gas or developing intolerances to red meat, lactose, or gluten may occur after a duodenal switch surgery. It is advisable to keep a food diary that will help you determine the foods that are causing you discomfort and avoid them. Swelling of the stomach and small bowel can make consuming liquids challenging soon after surgery. Hospital re-admission, in this case, is necessary for rehydration.