What is Duodenal Switch Surgery?

The duodenal switch procedure, also known as the “switch,” is a weight loss surgery that combines features and benefits of gastric sleeve and gastric bypass.

The switch is performed in two steps. First, a gastric sleeve is performed. Eighty percent of the stomach is removed, and the remainder is converted into a slender tube. Second, Dr. LeGrand divides the small bowel from the stomach, the duodenum, to create the bypass. Consumed food will then go into the sleeve and then “switched” to the lower part of the small intestine bypassing the initial part of the small intestine. This portion of the surgery is similar to gastric bypass except a more significant length of small intestine is bypassed to create a single connection between the bottom of the sleeve and the small bowel.

Duodenal Switch Surgery

(Before and After)

How does the duodenal switch help people lose weight?

With the duodenal switch, patients lose more weight and faster than gastric bypass and gastric sleeve procedures. The smaller stomach decreases caloric intake. Bypassing a significant portion of the small intestines reduces food absorption and changes the hormonal balance of the GI tract. Ghrelin (the hunger hormone) decreases along with an increase in insulin sensitivity. Less energy is stored as fat, too. The duodenal switch also changes the types of bacteria that live in the GI tract replacing bad bacteria with good bacteria to promote optimal digestion.

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What are the advantages of gastric bypass surgery?

Weight Loss

Patients can expect to lose 70% to 100% of their excess weight.

Fewer Risks

Decreased chance of experiencing dumping syndrome as compared to gastric bypass.

Improved Health

Up to 95% chance to resolve diabetes.

Rapid Results

Weight loss can be experienced quite rapidly within the first six months of surgery.

Long-term Success

Long-term success is the highest seen in any bariatric surgery.

Additional Benefits

Up to 75% resolution of both high blood pressure and high cholesterol.

What are the side effects and disadvantages of duodenal switch surgery?

Dietary Changes

  • Taking regular daily vitamins is necessary to avoid life threatening vitamin or mineral deficiencies; multi-vitamin/mineral support, additional calcium, additional iron, fat-soluble vitamins (A, D, E and K), probiotics
  • Additional diet changes may become necessary if a protein deficiency develops
  • Routine blood tests are mandatory to make sure enough protein and supplements are being supplied to the body
  • Routine doctor visits are required and paired with visits with a nutritionist and dietician

Bowel Movements

  • The number of daily bowel movements increased to two to five per day or more
  • Diarrhea and loose stools are not uncommon
  • Foul-smelling stools or flatulence is also more likely
  • Post-op hospital stays range from one to three days, which may be longer than other weight loss procedures

Who is a good candidate for duodenal switch surgery?

Body Mass Index (BMI)

  • Individuals with a body mass index (BMI) of at least 50, meaning at least 100 pounds overweight
  • Depending on BMI, some individuals may not be good candidates for duodenal switch. Dr. LeGrand will discuss those other weight loss surgery options or do the operation in stages. The sleeve would be created first and the bypass six to eighteen months later.

Patients with Diabetes

Poor Results with Prior Diet

Inability to achieve healthy weight loss sustained for a period of time through prior weight loss efforts.

Overall Health

If you’re considering duodenal switch surgery, you may also have weight-related health issues; however, you’ll need to be able to withstand the physical stress of surgery. Dr. LeGrand will review your medical history and current health. Additional tests may be needed to ensure you’re able to physically handle the surgery and recovery.

Commitment to Diet Maintenance

Our dietician can help you follow a plan that meets your dietary requirements and maximizes nutrition. Following a plan will help you avoid eating more than you should in the long term. You’ll learn some important guidelines and will need to follow them strictly including:

  • Chew everything well before swallowing. Begin this practice even before surgery. You will become a more mindful eater through this healthy habit.
  • Consume your food and drink separately. Extra fluid with food will make you feel full too fast and prevent you from getting proper nutrition.
  • Drink a liquid 30 minutes before each meal. Hydration is vital to good health. You would normally get a substantial amount of liquid from the foods you eat. Since you won’t be able to eat as much following surgery, you still need to be mindful about getting adequate water for healthy kidneys, liver, skin and every part of your body.
  • Avoid calorie-packed foods and drinks that have little nutritional value. You’ll be eating less food after surgery, so you need to ensure the foods you do eat will deliver the nutrition your body needs. You won’t have much room for anything else.

Moderators vs. Abstainers

Moderators are able to very occasionally and selectively have junk food. If you have trouble moderating, you should become an abstainer. You will be more successful abstaining completely because once you get a taste of foods low in nutritional value, you will have trouble stopping. Make a commitment to yourself and your health. Avoid buying things you shouldn’t eat or drink. Start these techniques before surgery to keep your weight loss commitment.

Commitment to Exercise

Exercise is important to achieving post-surgery success. Exercising three or more times per week is highly recommended. Find various activities you enjoy so you remain engaged. You will notice exercise and all activities will get easier as you lose weight.

Willingness to Take Nutritional Supplements

Taking multiple vitamin and mineral supplements the rest of your life will become necessary as eat less food. Even nutrient dense foods will be limited by your stomach’s size. Recommended supplements include a multi-vitamin, calcium and vitamin B12.

Psychological Readiness and Support

Physical changes aren’t the only effects you will experience after gastric banding surgery. You will notice psychological effects, too. For example, if overeating was your common response to stress, continuing to do so after surgery could stretch your stomach and regain the weight you’ve worked so hard to lose. Your relationships might change, too. Surround yourself with people who support you in making your health a priority.

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How is duodenal switch performed?

Dr. LeGrand performs the procedure laparoscopically, a minimally invasive approach, in about two to three hours. General anesthetic is used to put patients to sleep. Several small incisions will be made in your abdomen. Dr. LeGrand will insert narrow tubes in the incision that contain cameras and small surgical tools.

Duodenal switch is then performed in two steps. First, a gastric sleeve is performed. Eighty percent of the stomach is removed, and the remainder is converted into a slender tube. Second, Dr. LeGrand divides the small bowel from the stomach, the duodenum, to create the bypass. Consumed food will then go into the sleeve and then “switched” to the lower part of the small intestine bypassing the initial part of the small intestine. This portion of the surgery is similar to gastric bypass except a more significant length of small intestine is bypassed to create a single connection between the bottom of the sleeve and the small bowel.

What should I expect post-op following duodenal switch weight loss surgery?

Many duodenal switch patients are discharged the one to three days after surgery. Your first goals after surgery are to walk frequently and do breathing exercises with a tool called an incentive spirometer. You will be given blood-thinning medications to prevent blood clots. Patients are typically allowed to sip liquids a few hours after surgery.

Day 1 | Post Op

Transition completely from IV fluids and medications to oral intake and liquid pain medications.

Day 2 | Discharge

Most patients are discharged, but everyone is different. You should be completely comfortable before going home, which may require an extra hospitalization day.

Post-Hospital Recovery

Your post-op regimen begins. You band will limit what you can eat and how much. You will revisit the healthy eating and lifestyle habits you began adopting before surgery, including exercise.

Taking multiple vitamin and mineral supplements the rest of your life will become necessary as your new, smaller stomach will hold less food, even nutrient dense foods. Recommended supplements include a multi-vitamin, calcium and vitamin B12.

What type of weight loss can be expected following duodenal switch surgery?

Duodenal switch typically produces the greatest, and fastest, weight loss when compared to gastric bypass and gastric sleeve surgeries. Patients can expect to lose 70% to 100% of their excess body weight. Maintaining weight loss long term is also more likely with duodenal switch. Diabetes is resolved for up to 95% duodenal switch patients. Sixty-eight to seventy-five percent of patients experience a correction in their blood pressure. High cholesterol is lowered among 70% to 75% of duodenal switch patients.

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How is duodenal switch surgery different from gastric bypass surgery?

One difference between duodenal switch and gastric bypass surgeries is the shape of the new, smaller stomach left behind when the largest portion of the stomach is removed. During gastric bypass, Dr. LeGrand makes a small pouch that bypasses the lower part of the stomach. With duodenal switch, the remaining stomach is converted into a slender tube instead of a pouch, more like gastric sleeve surgery.

The second difference between the two procedures is that Dr. LeGrand divides the small bowel from the stomach, the duodenum, to create the duodenal switch bypass. Consumed food will then go into the sleeve and then “switched” to the lower part of the small intestine bypassing the initial part of the small intestine. This portion of the surgery is similar to gastric bypass except a more significant length of small intestine is bypassed to create a single connection between the bottom of the sleeve and the small bowel.

Duodenal Switch

Surgery (Before and After)

Gastric Bypass Surgery

(Before and After)

How do I prepare for my surgery date?

Leading up to surgery, you’ll complete several evaluations and education preparing you for post-op success. You’ll practice new, healthy lifestyle skills early on because it takes time to develop new habits. Your results and success completely depend on your ability to permanently adopt healthy habits.

You may experience weight loss even before surgery because of your lifestyle changes. You should be encouraged by this weight loss and gain confidence in your long-term success. The duodenal switch surgery, as well as support from your medical and personal teams, will help you remain successful.

When will my new diet begin?

Two weeks before surgery, you’ll begin a very strict diet. Calories and carbohydrates will be restricted while your intake of lean proteins will be increased. These dietary changes will help shrink the liver and prepare your body for a smooth transition to a new lifestyle. An oversized liver could compromise your success and make the surgery more dangerous.

Two days before surgery, you will switch to a liquid diet that may include broth and protein shakes. You may also be able to drink decaffeinated coffee and tea and eat Jell-O. Avoid caffeine as it could impact your procedure. No two patients are alike, so Dr. LeGrand’s orders may vary.

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