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About The Duodenal Switch

An excellent option for powerful weight loss in the hands of an experienced surgeon

Why choose the Duodenal Switch?
  • Statistically greatest weight loss of all weight loss surgeries or procedures
  • Highest resolution of diabetes, hypertension (high blood pressure) and hyperlipidemia (high cholesterol and high triglycerides)
  • Effective choice for patients with a diet high in fatty foods
  • NO dumping syndrome due to preservation of the stomach's "pyloric valve"
  • Dramatic reduction in hunger and appetite due to the removal of the portion of the stomach which produces GHRELIN (hunger hormone)
  • Superior weight loss to the Lap-Band and Gastric bypass in high BMI/very heavy patients

The Duodenal Switch procedure (also called vertical gastrectomy with duodenal switch, biliopancreatic diversion with duodenal switch, DS or BPD-DS) promotes weight loss by restricting the amount of food that can be eaten (via vertical gastrectomy or reduction of the stomach volume) and restricting the number of calories absorbed by the body (intestinal bypass or duodenal switch). Because the duodenal switch is a more metabolically active surgery, the procedure results in the greatest weight loss and the greatest resolution of co-morbidities; especially diabetes, high blood pressure and high cholesterol. This procedure was primarily developed for those individuals who primarily consume fatty foods because of the operation's selective fat malabsorption.

The duodenal switch is a technically challenging surgery, and because of this few surgeons (<50 in the world) have the expertise or experience to offer it to their patients. LAPSF has been performing the DS since the 1990s and has successfully performed more than 1000 duodenal switches TOTALLY LAPAROSCOPICALLY!

It is more controversial due to the significant component of malabsorption (bypass of the intestinal tract), which enhances and aids in maintaining long-term weight loss. This is the most powerful and effective of the four weight loss surgery procedures, but may be associated with more complications. Virtually all insurance companies will approve the DS. Only approximately 50 bariatric surgeons worldwide perform this procedure due to the technical complexity, concerns of malabsorptive long term effects, and the necessary extensive post-operative follow-up.

Duodenal Switch: How it works. BOTH restriction and malabsorption: The key to effective long-term weight loss

Restriction (Vertical or Sleeve Gastrectomy) The stomach volume is reduced by dividing it vertically and removing more than 85% of it. This part of the procedure is not reversible. The stomach that remains following this is shaped like a slim banana and measures from 2-6 ounces (60-180cc) depending on the surgeon performing the procedure. The nerves to the stomach and the stomach's outlet valve (pylorus) remain intact with the idea of preserving the function of the stomach while reducing the volume or capacity. By comparison, in a Roux-en-Y gastric bypass, the stomach is divided, not removed, and the pylorus is excluded and no longer functional.

Malabsorption (Duodenal Switch or Intestinal Bypass) The intestines are divided and rearranged to separate food from the digestive juices, thereby creating malabsorption (minimizing the calories which are absorbed. The food limb is attached to the duodenum and receives food from the stomach. This limb is usually 150 cm long. The digestive juices are now separated from the food and travel for over 500 cm in the bypassed small intestine. Both food and digestive juices mix together and travel together for 80-150 cm in the common limb (portion where both food and digestive juices are located). Thus, food and digestive juices are separated for most of the length of the intestines. This prevents an individual who has undergone a Duodenal Switch from absorbing all of the calories that are consumed. By comparison, the intestinal bypass in a Roux-en-Y gastric bypass is much less extensive, and the common limb for digestive juices and food to mix is approximately 5 times longer. Because of this the Roux-en-Y gastric bypass has minimal or far less malabsorption compared to the Duodenal Switch procedure.

The Advantages of the Duodenal Switch Weight Loss Surgery Procedure

Laparoscopic Associates remarkable results:

  • Estimated weight loss >90%
  • Resolution of diabetes 99%
  • Resolution of obstructive sleep apnea 99%
  • Resolution of hyperlipidemia (high cholesterol and triglycerides) >90%
  • Resolution of hypertension >90%
  • The more normal stomach allows for better eating quality
  • No dumping syndrome because the pylorus is preserved
  • Removes the portion of the stomach that manufactures the hormone Ghrelin (the hormone that stimulates hunger), therefore drastically reducing appetite and hunger
  • No increase in ulcer formation with the use of anti-inflammatory drugs
  • Very effective for high BMI patients (BMI>55 kg/m2)
  • The intestinal bypass is partially reversible for those having malabsorptive complications
  • Totally laparoscopic approach is the standard method at Laparoscopic Associates (no large incision or hand-port needed)

The Disadvantages of the Duodenal Switch Weight Loss Surgery Procedure

  • Greater chance of chronic diarrhea, foul smelling stools and gas
  • Significant malabsorption can lead to anemia, protein deficiency, vitamin deficiency and metabolic bone disease (Osteoporosis) in up to 10%-15% of patients
  • Excessive carbohydrate consumption can lead to crampy abdominal pain, inadequate weight loss and long-term weight regain
  • Because of the technical complexity and extended operative time, the duodenal switch may not be the most appropriate procedure for high-risk patients

Duodenal Switch: Risks and Complications in our practice

Patients choose Laparoscopic Associates due to our below average complication rates. Please view our Weight Loss Surgery results. As with any surgery, there can be complications. This list can include:

  • Vitamin deficiency 10%
  • Post-operative nausea 1-2%
  • Gastric leak and fistula <1%
  • Duodenal leak <0.5%
  • Postoperative bleeding 0.5%
  • Small bowel obstruction <1.0%
  • Anemia 5%
  • Deep vein thrombosis 1%
  • Excessive weight loss <0.1%
  • Reflux/GERD <1%
  • obstruction <0.1%
  • Mortality/Death 0%

Weight-Loss Surgery Solutions, Duodenal Switch, with Laparoscopic Associates

Laparoscopic Associates is proud of their record of superior weight loss and minimal incidence of complications (far below the national average). As recognition of this, they have been named THE #1 SURGICAL WEIGHT LOSS SURGERY PROGRAM IN CALIFORNIA BY HEALTHGRADES SINCE 2009!

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How the Duodenal Switch works