Duodenal Switch Procedure
The Duodenal Switch procedure (DS), offered at Mexico Bariatrics, is a restrictive and malabsorptive weight loss surgery. The numerous benefits of Duodenal Switch further enhance the superiority of this weight loss surgery when compared to other procedures.
These benefits include successful post-op and long-term excess weight loss (EWL), resolution of obesity related comorbidities, and a improved quality of life.
Duodenal Switch Procedure Explained
Approximately 70% of the stomach is removed along the greater curvature. This is also called a Vertical Sleeve Gastrectomy (VSG). The remaining stomach is fully functioning, banana shaped and about 3 – 5 oz. in size; which restricts the amount you can consume.
The pylorus, part of stomach, continues to control the stomach emptying into the small intestine; as a result patients do not experience “dumping”. The upper portion of the duodenum remains in use; food digests to an absorbable consistency in the stomach before moving into the small intestine.
Compared to gastric bypass procedures, this allows for better absorption of nutrients like vitamin B12, calcium, iron and protein. A benefit of removing a portion of the stomach is it greatly reduces the amount of ghrelin producing tissue and amount of acid in the stomach.
Ghrelin is the “hunger hormone” and by reducing the amount the hormone produces, the appetite is suppressed. The stomach will stretch over time; 9-12 months post-op, it will eventually double in size and patients will be able to consume approximately 50% of what they did before surgery.
The restrictive component of the Duodenal Switch procedure is not reversible.
The intestines are re-routed so that food from the stomach, alimentary limb, and the digestive juices, biliopancreatic limb, that are needed for the absorption of fat and proteins can travel separate paths; this is so they don’t mix until they meet up towards the end of the small intestine.
The common channel, also known as the common tract or common limb, is the point from where the alimentary and biliopancreatic limbs meet in the small intestine to move into the large intestine. The common channel is where a DS patient’s food, bile and digestive juices mix; the majority of the fat, protein and the associated nutrients are absorbed. Since the common channel makes up such a small portion of the small intestine the dietary starches, fats and complex carbohydrates may not fully absorbed.
The most commonly quoted absorption percentages following Duodenal Switch are approximately 20% of fats, 60% of protein, 60% of complex carbohydrates, but 100% of simple carbohydrates.
The malabsorption of fats interferes with absorption of the fat-soluble vitamins A, D, E & K. As a result all Duodenal Switch patients are required to take vitamin and mineral supplements for life. Patients must be diligent with the required supplements and have blood work monitored regularly. Also, they must adjust their supplements as needed to maintain normal levels of these vitamins and minerals.
The intestinal switch portion of the Duodenal Switch procedure is fully reversible.
There is no dispute that Duodenal Switch produces the best-sustained weight loss, and has the best resolution rate for most comorbidities of all weight loss surgical procedures. These results cannot be simply explained by the restrictive and the malabsorptive component of DS.
The general consensus is: that there are a number of hormonal regulatory changes involving Ghrelin, GLP-1, Enteroglucagon, Insulin, and others hormones (enzymes) that regulate the complex endocrine pathways.
Staged Duodenal Switch
Duodenal Switch is sometimes performed in two stages when the surgeon determines it is too risky for the patient to undergo the whole procedure at once. This is usually a result of a patient’s age, BMI, comorbidities or for a more difficult revision surgery.
The surgeon will perform stage one, restrictive component, then when the patient has lost some weight and the other health issues clear up then stage two, intestine switch, is performed.