Laparoscopic Duodenal Switch
The Duodenal Switch (DS) Surgery is performed under general anaesthesia using keyhole (laparoscopic) surgery. Small incisions are created in the abdominal wall to allow small instruments to be passed into the abdominal cavity, guided by a special surgical telescope with a video camera, in order to perform the operation.
The DS procedure is often, but not always, performed in two stages some 12-18 months apart. The first stage is a laparoscopic sleeve gastrectomy involves converting the stomach into a long tube by stapling the stomach along its entire length and then removing of approximately 50% of it. After approximately 12 months period of weight loss with the sleeve gastrectomy procedure and when the weight loss has plateaued, the second stage of the DS is carried out and this involves a bypass of a large portion of the intestine (which usually measures 4-5 meters long) leaving approximately the last meter of small intestine for absorption.
The principle concept of the DS is to reduce capacity of the stomach by approximately 50% (as the gastric tube created at the sleeve gastrectomy is relatively wide compared to that performed when the procedure is intended to be a stand-alone weight loss operation), but rely mainly on a considerable degree of malabsorption of calories (as most of the small intestine is bypassed) in order to achieve superior weight loss. It also causes dumping syndrome (feeling dizzy and lightheaded if you eat too much carbohydrates or sweets due to food high in sugar passes quickly from the stomach pouch into the remaining small intestine) that will deter from overindulgence in carbohydrates and chocolates.
As the DS is usually reserved to patients who are extremely heavy or who have genetic disorders precipitating weight gain, the surgery is more complex and takes longer time than a gastric bypass procedure. The first-stage sleeve gastrectomy component takes approximately 45-60 minutes, while the second-stage DS procedure takes approximately 90-120 minutes to complete.
As most patients undergoing the DS procedure are heavier and perhaps have more health-related issues, it is reasonable to expect a longer hospital stay than after other weight loss procedures. Most patients however could be discharged home 2-3 days after surgery.
Whilst the DS can be performed for indications similar to those reported for the gastric bypass, this procedure is often reserved for patients who are on the very heavy end of the weight spectrum (for example those with BMI greater than 60 kg/m2) as well as those with genetic disorders causing super-obesity such as the Laurence-Moon-Biedle syndrome.
However, the need for surgery to aid weight loss and the choice of surgical procedure is dependent on discussion with the bariatric team who will provide you expert and comprehensive advice.
- Greater weight loss than that generally seen after gastric bypass. On average, some 75% of the excess weight is lost.
- Marked improvement or resolution in health conditions related to obesity, particularly type-2 diabetes (approximately 90% chance of resolution), hypertension (75% chance of resolution), obstructive sleep apnoea (90% chance of resolution), asthma, polycystic ovary syndrome (PCOS) and associated infertility, liver disease, high cholesterol, and painful osteoarthritis.
- Improvement in overall physical and psychological health.
As with any surgical operations there are associated short and long-term complications such as internal bleeding, blood clot in the legs (deep vein thrombosis; DVT), blood clot in the lung (pulmonary embolism), infection, malabsorption of vitamins and micronutrients (which may lead to anaemia, weakness, osteoporosis and neurological problems), internal small bowel hernia (1%), and weight regain. In particular, the literature reports a higher risk of anastomotic leak with the DS compared to gastric bypass (approximately 1%) and a higher risk to life (approximately 1%).
Also, it is worth noting that there is approximately 10% risk of severe malnutrition, especially if you are not taking the recommended daily amount of proteins, and this could necessitate reversal of the bypass element of the DS surgery. It is very essential therefore that you commit to a long-term follow up programme. One of the notable advantages of the DS over a gastric bypass is the almost absence of risk of ulcer formation and perforation./
Professor Basil Ammori (based in Manchester, UK) ) always gives his personal number to all his private patients (this is in addition to the contact numbers of the bariatric nurse, dietitian and the ward) so that they might reach him without delay in case of emergency.
Although the weight loss with the DS is more durable, 1-in-20 people might regain the weight within 10 years of surgery. The stomach could stretch, the hunger could return, the intestine adapts and the dumping fades away. It is essential therefore to adopt a new life style and carry it on for a durable result.