Duodenal switch surgery is a complex weight-loss surgery that combines two techniques: sleeve gastrectomy and intestinal bypass.
This procedure helps individuals with severe obesity achieve significant and sustained weight loss by reducing the stomach size and rerouting the intestines.
Duodenal switch surgery is also sometimes known as biliopancreatic diversion with duodenal switch (BPD/DS).
Learn more about duodenal switch surgery, including its definition, candidate criteria, types of surgery, expected weight loss, post-surgery diet and lifestyle, and potential risks and complications.
Bariatric surgeons at WashU Medicine
Our bariatric surgeons are part of a weight loss team committed to helping people take charge of their health. We see patients at convenient locations in St. Louis, and we work with nutritionists, psychologists, and others to provide the care you need in a nationally accredited program.
What is duodenal switch surgery?
Duodenal switch surgery combines two procedures:
- Sleeve gastrectomy: Removes about 70-80% of the stomach, leaving a smaller, banana-shaped stomach that restricts food intake.
- Intestinal bypass: Reroutes a significant portion of the small intestine, creating two separate pathways and one common channel. This reduces nutrient absorption and caloric intake.
Learn more about sleeve gastrectomy>>
Types of duodenal switch surgery
Open surgery
- Procedure: A large incision is made in the abdomen to access the stomach and intestines.
- Recovery: Longer recovery time, more pain, and a higher risk of complications compared to minimally invasive methods.
Laparoscopic surgery
- Procedure: Several small incisions are made, and a laparoscope (a small camera) is used to guide the surgery.
- Benefits: Less postoperative pain, shorter hospital stay, quicker recovery, and lower risk of infection.
Robotic surgery
- Procedure: Similar to laparoscopic surgery but performed with robotic arms controlled by the surgeon, who sits at a console in the operating room with the patient. The surgical robot can offer higher precision than laparoscopic surgery in many cases.
- Benefits: Greater precision and flexibility, potentially enhanced recovery times, and reduced risk of complications.
Who is a candidate for duodenal switch surgery?
Body mass index (BMI)
- Severe obesity: Ideal candidates generally have a BMI of 50 or higher.
- Obesity-related health conditions: Candidates may also qualify with a BMI of 40 or higher if they have obesity-related health conditions such as type 2 diabetes, hypertension, or sleep apnea.
Learn more about obesity>>
Additional criteria
- Failed weight loss efforts: Individuals who have tried and failed to lose weight through diet, exercise, and possibly medications.
- Commitment: Candidates must be committed to making significant lifestyle changes, including dietary adjustments and regular follow-ups.
- Overall health: Candidates should be in suitable health to withstand surgery and recovery.
- Age considerations: Typically, adults are considered, though the procedure may be considered for younger patients under specific circumstances.
Expected weight loss
Patients can expect to lose 70-80% of their excess body weight within the first 18-24 months after surgery. Weight loss continues as patients adhere to dietary guidelines and incorporate regular physical activity.
Post-surgery diet and lifestyle
After surgery, you will have to make adjustments to your eating habits and lifestyle. Some changes are for a short time right after surgery, while others are lifestyle changes that you will need to continue for the rest of your life after surgery. Below are some common recommendations your doctor might provide. Be sure to follow any instructions as provided by your health care team.
Immediate post-surgery diet
- Phase 1: Clear liquids for the first few days to prevent dehydration and facilitate healing.
- Phase 2: Gradual introduction of pureed foods, protein shakes, and specific nutrient supplements.
- Phase 3: Soft foods after about 3-4 weeks as the stomach begins to tolerate more textures.
- Phase 4: Introduction of solid foods, usually after around 2 months, in smaller portions to match the smaller stomach size.
Dietary guidelines
- High-protein diet: Emphasize protein to aid healing and maintain muscle mass.
- Hydration: Drink plenty of fluids but avoid drinking 30 minutes before and after meals to prevent overfilling the stomach pouch.
- Vitamins and supplements: Regular intake of vitamins and minerals such as Vitamin B12, iron, calcium, and a daily multivitamin to prevent deficiencies.
- Eating habits: Smaller, frequent meals, chewing food thoroughly, and avoiding high-sugar, high-fat foods to prevent malabsorption-related issues.
Read more: What does a day of eating look like after bariatric surgery?
Long-term dietary and lifestyle changes
Incorporate regular exercise into daily routines to maintain weight loss and overall health.
Continue focusing on a balanced and healthy diet, emphasizing nutrient-rich foods.
Avoid high-calorie, high-fat, and high-sugar foods and beverages.
Follow-up care
- Regular check-ups: Scheduled follow-up visits to monitor progress, nutritional status, and address potential complications.
- Support groups: Participation in support groups for emotional support and practical advice.
Potential risks and complications
Common risks
- Infection: Risk of infection at the surgical site.
- Bleeding: Minimal bleeding at the incision sites.
Specific complications
- Nutritional deficiencies: Higher risk of deficiencies requiring lifelong supplementation.
- Bowel obstruction: Risk of intestinal blockages due to the rerouting of the intestines.
- Diarrhea and malabsorption: Frequent loose stools and malnutrition due to reduced nutrient absorption.
- Dumping syndrome: Rapid emptying of stomach contents causing nausea, vomiting, and diarrhea, typically when high-sugar foods are consumed.
Rare complications
- Blood clots: Risk of developing blood clots in the legs or lungs.
- Adverse reactions to anesthesia: Rare complications related to anesthesia.
Duodenal switch surgery is a significant procedure that can provide substantial weight loss and health improvements for individuals with severe obesity. Understanding the criteria for candidacy, expected outcomes, dietary guidelines, and the importance of post-surgery care is crucial for long-term success. If you are considering duodenal switch surgery, consult with a health care professional to explore this option and determine the best approach for your specific situation.
