What is a Duodenal Switch?

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There are various procedures available when it comes to weight loss surgery. One such type is duodenal switch surgery.

Although part of this procedure, which involves a sleeve gastrectomy, is relatively well known, less is known about the second stage of this procedure, the duodenal switch.

We are going to provide an overview of what a duodenal switch is, what is involved in this type of surgery and how it works to achieve weight loss.


What is a duodenal switch?

A duodenal switch is a form of permanent weight loss surgery that uses both the reduction of stomach size and malabsorption of calories to achieve weight reduction.

The duodenum is the first part of the small intestine and is where partially digested food from the stomach is mixed with digestive juices from the liver and pancreas. It is during this process that most of the calories and nutrients from food are absorbed by the body, including vitamins, minerals, carbohydrates, fats and proteins.

Duodenal switch surgery is comprised of two steps; the first is to perform a sleeve gastrectomy to remove approximately 75 per cent of the stomach to reduce its size and create a smaller stomach pouch. The second step involves rerouting the small intestine by creating two pathways; the first allows food to travel from the stomach into the small intestine. The second is created to keep digestive juices from the liver and pancreas separate until the two pathways join together before entering the large intestine.


How does a duodenal switch work?

A duodenal switch achieves weight loss in two ways. Firstly, the sleeve gastrectomy significantly reduces your stomach size and affects the ghrelin, or ‘hunger hormone’ in your gut, decreasing your appetite and helping you feel fuller quicker, reducing your food intake.

Secondly, the small intestine is where most of the calories and nutrients from your food are absorbed, so rearranging the small intestine so your food has less time to mix with digestive juices means your body has less time to absorb calories from the food you eat.

The reduction in food intake and lower absorption of calories make a duodenal switch an effective weight loss procedure.


What is removed during a duodenal switch?

During the initial sleeve gastrectomy, up to 75 per cent of your stomach will be removed in order to create a much smaller stomach pouch.

During the second stage of duodenal surgery, although the function of your small intestine is altered, none of the small intestines is actually removed. Instead, the usual pathway is rerouted to reduce the amount of time your food can mix with digestive juices from the pancreas and liver, and therefore reduce the number of calories your body can absorb.


How long does duodenal switch surgery take?

A duodenal switch is usually performed laparoscopically through keyhole surgery, which usually takes 2 to 3 hours.

Occasionally, a duodenal switch may need to be performed in two separate stages, with the sleeve gastrectomy performed first, followed later by the duodenal switch. However, in most cases, both parts of the procedure will be performed at the same time.


What are the dangers of a duodenal switch?

As with any surgery, some complications can occur post-operatively, such as infections, deep vein thrombosis or excessive bleeding, however, you will be observed in the hospital for the first few days following surgery to monitor for any potential complications.

A common side effect of a duodenal switch is a change in bowel movements. Some people report having more frequent loose bowel movements following surgery because of the changes within the digestive system. While for some this will only last short term, for others it could last much longer.

Due to the body absorbing a lower amount of nutrients from food, this surgery can put people at risk of developing malnutrition, anaemia and bone disease. For this reason, those who undergo a duodenal switch will be required to take lifelong vitamins, minerals and supplements as a preventative measure.

Further duodenal switch complications may also include bowel obstruction, loose skin, intestinal irritation, ulcers and gallstones that can often occur as a result of rapid weight loss or when significant changes have occurred to the production and circulation of bile and other digestive fluids.

Regular follow-up appointments and blood tests with your healthcare provider will help to monitor for any changes.


Is a duodenal switch worth it?

Duodenal switch surgery is usually only performed on those with a high body mass index (BMI) of 40 or above and who suffer from obesity-related health conditions, such as hypertension, high cholesterol and type II diabetes. There has proven to be a high success rate for long term weight loss amongst those who undergo a duodenal switch, with a marked reduction in BMI in the years following surgery.

This type of weight loss surgery is also known to positively impact obesity-related health conditions. Many individuals who have undergone a duodenal switch have shown a return to normal cholesterol and blood pressure levels. In addition, those with type II diabetes have shown a return to normal blood sugar levels, which is thought to be related to the hormone changes that can occur post-surgery which help to boost insulin sensitivity.

Your healthcare provider will advise you if they feel a duodenal switch is the most appropriate surgery for you based on your individual circumstances.


How much does duodenal switch surgery cost? 

As this type of surgery involves two procedures, the cost for duodenal surgery can be higher than some other types of weight loss surgery. Although costs vary throughout the UK, duodenal surgery usually starts from £13,000 but can reach over £15,000.

At Ramsay Health Care, we offer a range of weight loss surgeries, including gastric bypass, gastric sleeve and gastric band. If you would like to learn more about the different types of surgery we offer, take a look at our weight loss surgery page for all the latest information, or contact us to discuss further.

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