Gastric Reduction Duodenal Switch

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What is gastric reduction duodenal switch surgery?

Gastric reduction duodenal switch is a type of bariatric surgery (weight loss surgery). It can help obese people achieve significant weight loss and improve—or even cure—obesity-related conditions.

Bariatric surgeries have two main approaches:

  • Restrictive procedures reduce the stomach’s size, which limits the amount of food you can eat. Gastric banding is an example.

  • Combination malabsorptive and restrictive procedures divert food past the first part of the small intestine in addition to reducing stomach size. Gastric bypass—the gold standard of bariatric surgery—is an example.

Gastric reduction duodenal switch is a combination procedure. It involves removing a significant portion of the stomach to create a tubular pouch. It also bypasses most of the small intestine.

In general, this complex procedure results in greater weight loss than other types of bariatric surgery. People typically maintain at least 60 to 70% weight loss five years afterwards. It is also the most effective bariatric procedure for resolving diabetes. However, it is a more complex procedure than other bariatric surgeries. It carries more risk and a higher rate of complications, including death.

Other names for this procedure include biliopancreatic diversion with duodenal switch (BPD/DS) gastric bypass and duodenal switch surgery.

Why is gastric reduction duodenal switch performed?

To qualify for bariatric surgery, you must first try other weight loss strategies. This includes diet, exercise, behavioral modification, and medical weight loss (using medication). If these approaches do not help you, your doctor may recommend surgery. You must also meet the following criteria:

  • BMI (body mass index) of 40 kg/m2 or greater

  • BMI of 35 kg/m2 or greater with obesity-related health problems

Your doctor will also require you to demonstrate you are ready to lose weight, improve your health, and make lifelong commitments to living differently. This includes making permanent diet, exercise and behavior changes. You will also need to accept a lifelong need to limit food portions, change food choices, and take vitamin supplements.

Your doctor may specifically recommend gastric reduction duodenal switch if you need to lose more weight than other bariatric procedures can provide. Duodenal switch can result in very large amounts of weight loss, up to 70% of excess weight.

People who have this procedure are also more likely to maintain the weight loss long-term compared to other bariatric procedures. It severely limits the amount of fat your body can absorb. Also, eating fatty foods will cause significant discomfort, which discourages you from choosing high-fat foods. Duodenal switch also controls type 2 diabetes long-term better than other types of bariatric surgeries.

Who performs gastric reduction duodenal switch?

Bariatric surgeons and general surgeons perform bariatric surgeries, including gastric reduction duodenal switch. Bariatric surgeons are often general surgeons who specialize in bariatrics. Bariatrics is the field of medicine that deals with the causes, prevention and treatment of obesity.

How is gastric reduction duodenal switch performed?

Gastric reduction duodenal switch will take place in a hospital using a general anesthetic. The surgery can be either a traditional open surgery or a minimally invasive laparoscopic procedure. Open surgery requires a large incision in your abdomen. A laparoscopic procedure uses instruments your doctor inserts through several smaller cuts. The minimally invasive approach typically results in less pain, lower risk of complications, a shorter hospital stay, and a shorter recovery period.

The surgery has three parts in this order:

  • Sleeve gastrectomy, which removes most of the stomach—about 80%. The surgeon forms a tubular pouch with the remaining stomach.

  • Duodenal switch, which involves detaching the bottom of the stomach pouch from the upper part (duodenum) of the small intestine and reattaching it to the last portion of the small intestine. This bypasses about 75% of the small intestine and reduces the amount of calories your body can absorb from food.

  • Biliopancreatic diversion, which involves taking the previously detached section of small intestine—the part that the surgeon separated from the stomach pouch—and reattaching it to the bottom section of small intestine. This section of the small intestine is where the common bile duct empties during digestion. The diversion creates a way for bile and pancreatic enzymes to mix with food, but also further limits the number of calories absorbed.

What to expect the day of your gastric reduction duodenal switch

The day of your surgery, you will meet with the preoperative nurse and surgeon to go over your medical history again, ensure you followed preop instructions, and answer questions. You’ll also meet with the anesthesiologist about your anesthesia. You’ll receive a sedative and a team member will take you to the operative suite. Here, the team will start your anesthesia. You won’t remember anything else until you wake up in the recovery room. A nurse will be in the room or nearby monitoring your vital signs.

What are the risks and potential complications of gastric reduction duodenal switch?

With any type of surgery, there will be risks and the possibility of developing complications. While they are not common, complications can be serious and even life threatening. Complications can occur during the surgery itself or afterwards during your recovery.

General risks of surgery

The general risks of surgery include:

  • Anesthesia reaction, such as breathing problems

  • Bleeding, which can be life threatening

  • Blood clot, such as a deep vein thrombosis

  • Infection

Potential complications of gastric reduction duodenal switch

In most cases and in the hands of highly skilled surgeon, this procedure is successful. However, potential complications include:  

  • Bowel obstruction due to hernia

  • Damage to organs or blood vessels

  • Dehydration

  • Dumping syndrome, which occurs when food moves too quickly from the stomach into the small intestine

  • Gallstones

  • Internal hernias, which can lead to bowel blockages that can be life threatening

  • Leakage of digestive juices and intestinal contents at the connection sites

  • Malnutrition

  • Peritonitis, which is inflammation and infection of the lining of the abdominal cavity

Reducing your risk of complications

You can reduce your risk of certain complications by:

  • Calling your doctor immediately if you have unusual or unexpected symptoms after surgery, such as extreme fatigue, lethargy, or increase in pain

  • Following your surgeon’s instructions on activity and diet restrictions and recommendations before and after surgery

  • Informing your doctor if there is any possibility of pregnancy

  • Taking your medications exactly as directed, and telling all members of your care team if you have drug allergies

How do I prepare for gastric reduction duodenal switch?

You can prepare for gastric reduction duodenal switch by:

  • Creating a list of your current medical conditions, medications, and drug allergies. This will help you answer your doctor’s questions about your medical history and medications you take, including prescriptions, over-the-counter drugs, supplements, and vitamins.

  • Following a healthy diet and exercise plan. Ask to work with a dietitian and physical trainer if you need help in this area.

  • Getting preoperative testing as directed. For major surgery, this may include imaging tests, heart tests, and blood work.

  • Not eating or drinking before surgery. Your surgeon may postpone surgery if you eat or drink too close to the start of surgery because you can choke on stomach contents when you are under anesthesia.

  • Stopping smoking as soon as possible. If you smoke, quitting for a few days can be beneficial and help the healing process.

  • Taking or stopping medications according to your doctor’s instructions. Ask for this in writing, and make sure you understand the directions for taking your specific medications and supplements.

Questions to ask your doctor

Questions you may want to ask include:

  • Why are you recommending this complex type of bariatric surgery for me? How do the outcomes compare with other types of bariatric surgery?

  • How many of these procedures have you performed? How often do you see complications? Do you have outcomes data to share with me?

  • How long does duodenal switch surgery take? When can I go home?

  • What restrictions will I have after surgery? What kind of assistance will I need at home?

  • When can I return to work and other activities?

  • Will I need physical therapy, and how many treatments are typically necessary?

  • How will you manage my pain?

  • What changes, if any, to my medication plan do I need to make?

  • When should I follow up with you?

  • How should I contact you after hours if I have a problem?

What can I expect after gastric reduction duodenal switch?

Knowing what to expect makes it easier to plan and prepare for a successful recovery.

How long will it take to recover?

After surgery, you will spend several days in the hospital. It’s common to stay for about five days. Your stay may be shorter with laparoscopic surgery. You will start on a liquid diet in the hospital. It can take up to 12 weeks to fully transition from liquids to soft foods and finally to solid foods.

Your age, health, and the type of surgery (open or laparoscopic duodenal switch) can influence your recovery time. It will probably be several weeks before you start to feel like yourself again. Physical therapy for building strength and stamina can help you recover and minimize pain. Working with a physical therapist before surgery can also help speed your recovery. Full recovery can take a few months.

Will I feel pain?

You will have pain after a major bariatric surgery. It’s important to properly manage your pain because staying comfortable lets you complete physical therapy and other rehabilitation activities necessary for smooth healing. Tell your doctor if your pain gets worse or changes in any way—it could be a sign of a complication.

When should I call my doctor?

For questions between appointments, call your doctor’s office during regular business hours. Your doctor will tell you how to get in touch after hours with urgent concerns. Call doctor right away or seek immediate medical care if you have:

  • Confusion or changes in level of alertness

  • Chest pain or sensations of pressure or tightness

  • Difficulty breathing including shortness of breath or wheezing

  • Drainage of pus, redness or swelling around your incision

  • Fever. It’s common to have a fever right after surgery. Your doctor will give you instructions about when to call for a fever.

  • Inability to urinate or move your bowels

  • Leg pain, redness or swelling, which could mean you have a blood clot

  • Unexpected bleeding

How might gastric reduction duodenal switch affect my everyday life?

Your everyday life will be very different following gastric reduction duodenal switch.

Diet

Your diet will be one of the most drastic changes. It can take up to three months to tolerate solid food. You will also need to change how you eat because your stomach will be substantially smaller. This will limit the amount of food and calories you can eat. You will also feel fuller sooner, so you will need to eat smaller, more frequent meals. Limiting fatty foods will improve your comfort after this surgery. Eating high-fat foods can cause stomach cramping and loose stools.

Dehydration

Dehydration is a concern after any type of bariatric surgery. In fact, it’s the most common reason for readmission to the hospital after weight loss surgery. It can be a challenge to take in enough fluids to avoid this problem. You also need fluids to help your body burn stored fat. Carry water with you at all times and remind yourself to take sips often. Try to drink most of your fluid goal between meals to avoid taking up room for food. A member of your care team, such as a dietitian, will tell you how much water to drink per day and how to adjust this amount depending on your activity level and environment (such as being in hot weather).

Malnutrition

Malnutrition is another major concern, especially after gastric reduction duodenal switch. This surgery significantly reduces your ability to absorb vitamins and minerals. Long-term problems can develop from chronic malnutrition. This includes anemia, osteoporosis, kidney stones, severe vitamin deficiencies, and problems from lack of protein. You will work with a dietitian to ensure you are getting adequate nutrients. This will involve lifelong vitamin supplementation starting within a couple of weeks of surgery.

Emotional and social aspects

Finally, some people struggle with body image and personal and social relationships after bariatric surgery. The surgery and the weight loss it causes can trigger changes in the way you see yourself—and how others see you. This can have unexpected effects on relationship dynamics. Emotions during this time can make it difficult to stick with diet and exercise habits. Your bariatric care team will include mental health providers who can help you navigate these issues.

Life expectancy

Despite these challenges, the benefits of surgery are usually worth it. Research shows that morbidly obese people who have weight loss surgery live longer than those who do not. You will be less likely to die from obesity-related problems, such as type 2 diabetes and heart disease. In fact, many of these conditions resolve or improve following gastric reduction duodenal switch.

You will also enjoy a better quality of life. Researchers have found bariatric surgery patients have improved mobility, self-esteem, sexuality, and work and social relationships. They also have less unemployment, disability, anxiety and depression. If you’re considering surgery, talk with your doctor about your options. Together, you can make a plan to get you to your goals.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Jun 23
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