Duodenal Switch

A biliopancreatic diversion with duodenal switch (BPD/DS), sometimes referred to by just duodenal switch, is a less-common bariatric that entails two major components:

The first component is a sleeve gastrectomy in which about 70 percent of the stomach is removed, leaving a smaller tube-shaped stomach that looks like a sleeve or a small banana.

The second component is a significant rearrangement of the small intestines by attaching the end portion of the intestine to the duodenum near the stomach. This rearrangement creates a much shorter segment of intestines where food travels and gets absorbed.

BPD/DS both limits how much one can eat and reduces the absorption of food, leading to the most weight loss as compared to the other procedures currently performed. Patients may be able to lose 70 to 80 percent of their excess weight within two years. The procedure is generally recommended for people with a body mass index (BMI) greater than 50.

We perform the sleeve gastrectomy laparoscopically or robotically, which allows for minimal pain and a very quick recovery. BPD/DS is generally performed as a single procedure; however, in select circumstances, the procedure may be performed as two separate operations — sleeve gastrectomy first followed by intestinal bypass at a later stage.

A modification of the classic BPD/DS, the Single Anastomosis Duodeno-Ileostomy (SADI), has recently been introduced. Learn about it here.

What are the main disadvantages of the duodenal switch?

The duodenal switch is a complex procedure that carries various risks. Because of the intestinal bypass, there is a real risk of malnutrition and vitamin deficiencies. Compliance with life-long supplementation and regular follow-up is critical to avoid and/or treat such deficiencies.

Patients should also be aware of a higher occurrence of smelly flatus and diarrhea, although both can usually be mitigated through diet, including avoiding simple carbohydrates. .

How long will I need to recover from a duodenal switch?

We perform the duodenal switch laparoscopically and most patients can return home two days following surgery, as long as they are able to drink liquids comfortably and stay hydrated.  Patients are encouraged to walk and stay active immediately after surgery and as tolerated.  Depending upon their general health and their job, most patients are ready to go back to work within two weeks after surgery.