Duodenal Switch

Doctors have performed the duodenal switch since 1985, but it is the least common bariatric operation because it is technically difficult and has a higher level of short- and long-term risk.

How the Duodenal Switch Works

Similar to the sleeve gastrectomy, with duodenal switch most of the stomach and appetite-related cells are removed. The remaining portion of the stomach is transformed into a 2-4 ounce pouch. The pouch is slightly bigger than a sleeve gastrectomy pouch, allowing a person to eat more protein to offset the losses from the intestinal bypass.

The pouch is connected to the enteric limb, diverting food and preventing it from mixing with digestive juices. Food bypasses 40-60 percent of the small intestine (more than in a gastric bypass), resulting in less food absorption and potentially greater weight loss.

Staging the duodenal switch by doing the sleeve gastrectomy first and then the intestinal bypass 6 months to 2 years later can make the procedure much safer.

Benefits

• The duodenal switch has the best weight loss results over time.
• The procedure has the best cure rate of diabetes
• The operation does not increase risk of ulcer problems like a gastric bypass does.

Considerations and Risks

• Because of the higher risk from the intestinal bypass, duodenal switch is only recommended for people with severe diabetes or people over 400 pounds.
• Duodenal switch is not offered by most surgeons because it is highly technical.
• It requires more intense follow up because of the extreme amount of intestinal bypass.
• It carries a risk of intestinal blockages.
• Risk of vitamin deficiencies is higher than with other bariatric operations.