What is Duodenal Switch Surgery?
This procedure could be classified as a combination of a Gastric Bypass and Gastric Sleeve surgery with a twist. It is one of the most difficult and complex procedures to perform, but it’s also associated with some of the best results.
The full name of this surgery is Biliopancreatic Diversion with Duodenal Switch (BPD with DS). This type of duodenal surgery changes the normal process of digestion by making the stomach smaller and allowing food to bypass part of the small intestine so that you absorb fewer calories.
You will feel full more quickly than when your stomach was its original size, which reduces the amount of food consumed and thus the calorie intake. Bypassing part of the intestine also means that you will absorb fewer calories. This leads to weight loss. Duodenal switch surgeries are very effective, where most patients lose 75% to 80% of their excess weight and maintain their new weight.
THE PROCEDURE
In a Biliopancreatic Diversion with Duodenal Switch (BPD with DS) a large portion of the stomach is laparoscopically removed to create a cylinder-shaped pouch connecting the esophagus to the top of the small intestine.
An incision is made at the top of the small intestine, but the surgeon leaves part of the duodenum (the top part of the small intestine where most chemical digestion occurs) attached to the stomach.
The surgeon then makes another incision on the small intestine several feet up from the end where it meets the large intestine/colon. The part that is still attached to the large intestine is then connected to the duodenum.
The loose part of the small intestine (the part that was not just attached to the stomach) is then attached to the small intestine, allowing the digestive juices it creates to mix with the food coming from the stomach in approximately the last 15 - 20% of the small intestine.
Since the stomach is shrunk and only a small portion of the intestine has a chance to digest food before the food enters the colon, this procedure is both restrictive and malabsorptive.
The Duodenal Switch Surgery Advantages
People who have had the Duodenal Switch eat much more normally than those who have had other weight loss operations (Laparoscopic Adjustable Gastric Band or Roux-en-Y Gastric Bypass). In fact it is entirely normal for these people to be able to eat a small steak, chicken, salad, or pasta without difficulty where it is a rare person that can do this with the other weight loss operations.
PREPARATION FOR SURGERY
Before traveling to Cyprus, as part of your Duodenal Switch Surgery preparation you will complete a detailed bariatric specific questionnaire, which will allow our doctors to determine your eligibility for Duodenal Switch Surgery. If you are not ready to make lifestyle changes, you will not be considered eligible for the procedure.
To help you adjust to your new lifestyle, we advise you to empty your home of all edible “temptations”, creating a suitable environment for your return, post operatively.
Ten days prior to your arrival in Cyprus, you will receive all the necessary pre operative instructions, to prepare yourself both physically and mentally for your chosen procedure.
After hospital admission, you will receive psychological advice. This will help you adhere to a healthier lifestyle. Without changing your lifestyle, the surgery will not be a success. You will also receive nutritional counseling before (and after) your surgery, by our specialists.
RECOVERY AFTER SURGERY
Most people typically stay in the hospital for 4 days or less after duodenal switch surgery, followed by a stay in a nearby hotel for 4-7 days. Your surgeon will approve your release once you can do the following:
You will remain on liquid or pureed food for several weeks after the surgery. Even after that time, you will feel full very quickly, sometimes only being able to take a few bites of solid food. This is because the new stomach pouch initially only holds a tablespoonful of food. The pouch eventually expands. However, it will hold no more than about one cup of thoroughly chewed food.
Once your diet begins to consist of more solid food, remember to chew each bite very slowly and thoroughly. You will be instructed on eating small meals frequently throughout the day, rather than large meals that your stomach cannot accommodate.
Exercise and the support of others are extremely important to help you lose weight and maintain that loss following Duodenal Switch Surgery. You can generally resume exercise 6 weeks after the duodenal switch operation. Even sooner than that, you will be able to take short walks at a comfortable pace, with the approval and guidance of your doctor. Exercise improves your metabolism, while both exercise and attending a group support can boost your self-esteem and help you stay motivated.
LIFE AFTER SURGERY
Following your recovery diet you will slowly begin to introduce new foods in increasing quantities until about 6 months after surgery when your new bariatric diet will be in full swing.
Assuming you follow the diet and exercise guidelines of our surgical team, all indications are that weight loss and health improvement following Duodenal Switch surgery may be permanent. The Duodenal Switch has an initial 12 to 18 month “honeymoon period” following surgery. During this time, patients usually experience a rapid and significant amount of weight loss. The "extended honeymoon period" with the DS can last three to five years - during which time patients will typically not experience weight regain.
All weight loss surgery however, requires a complete change in diet for your procedure to continue to be effective and Duodenal Switch is no different. Some patients are likely to experience weight regain as a result of your stomach stretching over time if the diet and exercise guidelines are not followed.
Post-Surgery Nutrition
After surgery, you will need a new nutrition plan. Our surgeon and/or dietitian can help you learn about and get used to the changes in lifestyle and eating habits you need to make. It is very important to follow the eating and drinking instructions beginning immediately after the operation.
In the first few weeks after your surgery, you will be on a liquid diet since only thin liquids will be tolerated by your stomach at that time. As you heal, you will gradually progress to pureed foods (three to four weeks post-op) and then soft foods (five weeks post-op). Finally, you will be able to eat solid foods.
When you are at the stage to eat solid foods without problems, you will need to pay close attention to your diet. It is recommended that you eat only three small meals a day and make sure that these meals contain adequate nutrients. Foods that have a concentrated supply of calories with little nutritional value, such as milkshakes, syrups, jam, and pastries, should be avoided as much as possible.
As mentioned above, due to the extent of malabsorption after surgery you will need to take 10 to 15 pills per day for the rest of your life. If you stop taking any prescribed vitamins, you will be twice as likely to develop vitamin deficiency. To the average person, not getting enough vitamins does not sound like a big deal. But when you change the architecture of your digestive system to the extent of the Duodenal Switch, it can become a life-threatening problem. Routine blood tests and follow ups with ensure your body is getting enough supplements.
Exercise Plan
Exercise is very important and incorporating regular physical activity into your daily routine is as important as following your nutrition plan.
Often Weight Loss Surgery patients have been inactive due to decreased activity tolerance, psychological constraints and in some cases, physical disabilities. After Duodenal Switch aerobic activities, particularly walking and gentle swimming are generally best tolerated. Your surgeon will advise you on which activity is right for you.
The weight loss results of Duodenal Switch surgery are generally very good. In the first year following surgery, percent of excess weight lost following Duodenal Switch surgery is between 48% and 65%. Over the long-term, patients lose as much as 75% of their excess weight. Often, the greatest rate of weight loss occurs in the very beginning (that is, just following the surgery when you are still on a liquid diet).