Duodenal switch surgery is a highly effective weight loss procedure and highly effective in type 2 diabetes resolution. If you are thinking of having duodenal switch surgery, you must be aware of duodenal switch complications. As bariatric procedures become more common for weight loss and management of obesity-related diseases, we are learning more about the long-term results from these patients.

What Is Duodenal Switch Surgery?

Also known as biliopancreatic diversion with duodenal switch or BPD/DS, this bariatric procedure is a complex, two-step surgery that leads to weight loss. The procedure limits your ability to absorb calories, vitamins, and minerals. Because of the severely restricted ability to absorb nutrients from food, this procedure can lead to higher weight loss results than gastric sleeve and gastric bypass. However, it can also lead to life-threatening nutritional deficiencies.

The first step of duodenal switch surgery is essentially a gastric sleeve procedure. In this step, about 70% of the stomach is removed with a stapling instrument, leaving the stomach as a banana-shaped tube. This remaining tube connects from the esophagus to the duodenum, which is the first part of the small intestine. The goal of this step in the procedure is to limit the amount of food your stomach can hold at one time. Therefore, you will feel full very quickly, eat less food, and absorb fewer calories.

The second step in BPD/DS is to bypass the majority of the small intestine by connecting the duodenum to the end of the small intestine. The small intestine is the main place where nutrients are absorbed in the digestive tract. By disconnecting the gastrointestinal tract from the majority of this organ, nutrient absorption is limited. Roughly three-fourths of the small intestine is bypassed. Because the small intestine in an adult is usually between 20 to 25 feet in length, that is a lot of organs to bypass.

As the majority of the small intestine is bypassed, food is not able to mix with the bile and digestive juices (i.e., pancreatic enzymes) until it reaches the bottom end of the revised small intestine. Bile and digestive juices are primarily responsible for the breakdown and absorption of proteins and fats from food. Therefore, your body will only gain a limited amount of calories from food. Finally, because much of the stomach is removed and the small intestine is bypassed, your gut hormones, insulin sensitivity will be affected.

Are You A Candidate For Duodenal Switch Surgery?

Biliopancreatic diversion with duodenal switch is performed on people who are morbidly obese and who have obesity-related health issues. Qualifications for bariatric surgery include:

• BMI (Body Mass Index) higher than or equal to 40 or 100 pounds overweight
• BMI higher than or equal to 35 with at least one obesity-related disease, including:
  -High Blood Pressure
  -Sleep Apnea
  -Type 2 Diabetes
  -High Cholesterol
  -Stroke
  -Infertility

People typically do not qualify for surgery until they have first tried losing weight through lifestyle changes such as exercise and diet. Similarly, duodenal switch surgery is not appropriate for every person who is severely overweight. You also take into consideration the duodenal switch complications before you make the final decision to undergo surgery. Your bariatric surgeon will guide you in the best weight loss surgery procedure to meet your specific goals.

Finally, people considering duodenal switch surgery must be committed to making permanent, lifelong changes. These changes include behavior modification, monitoring nutrition, lifestyle changes, and managing other medical conditions carefully.

What Are Short Term Duodenal Switch Complications

Short-term duodenal switch complications for duodenal switch surgery are primarily those that are common after any surgical procedure on the abdomen using anesthesia. Your surgeon may perform the surgery through a traditional large opening in your stomach or by minimally invasive technique (laparoscopic or robotic surgery). A conventional opening along the abdomen will have longer recovery time with greater risks. Because duodenal switch surgery is more complex, your hospital stay will likely be more extended, as well as your recovery. The following is a list of short-term duodenal switch complications:

• Lung problems or breathing issues
• Infection
• Excessive bleeding
• Leaking gastrointestinal fluid outside of the digestive tract
• Blood clots
• Adverse reactions to anesthesia

Short-term duodenal switch complications usually develop within a few days following surgery. Therefore, you will likely be in the hospital where a team of health care providers will be watching for these complications. Furthermore, your health care team should educate you on what short-term duodenal switch complications to watch for after you are discharged from the hospital.

What About Long-Term Duodenal Switch Complications?

Biliopancreatic diversion with duodenal switch complications is similar to those of other bariatric procedures. However, the risk of severe nutrient deficiencies is much greater. The following is a list of long-term duodenal switch complications that may occur over time:

• Vitamin and Mineral defficiencies
• Protein defficiency
• Bowel obstruction
• Gallstones
• Malnutrition
• Diarrhea
• Vomiting

People who undergo bariatric surgery must adhere to a personalized supplement regimen in order to get all of their essential nutrients, such as calcium, iron and vitamins. However, people who have duodenal switch surgery, are more likely to develop vitamin (A,D,E,K), mineral and protein defficiencies because of the loss of surface area in the small intestine for absorption. Therefore, following an appropriate diet and the supplement guidelines set by your bariatric surgeon and nutritionist is especially critical for duodenal switch patients.

While studies have determined that duodenal switch surgery leads to the most significant amount of weight loss, some research has indicated that duodenal switch patients are more likely to experience gastrointestinal, surgical, and nutritional complications. This is compared to other bariatric procedures, including gastric bypass, gastric sleeve, and lap band.

What Are The Advantages Of Duodenal Switch Surgery?

The American Society for Metabolic and Bariatric Surgery has identified five distinct advantages of duodenal switch surgery.

1. Greater weight loss than gastric bypass, gastric sleeve, and adjustable gastric band. For example, at a five-year follow-up, patients have lost 60-70% of their excess weight.
2. Patients can eventually eat almost normal-sized meals.
3. Reduces absorption of fat from the diet by at least 70%.
4. Changes in gut hormones decrease hunger cues and make you feel full more quickly.
5. Duodenal switch surgery is the most effective bariatric surgery against type 2 diabetes.

What Are The Disadvantages of Duodenal Switch Surgery?

1. There is a higher risk for complications and death with biliopancreatic duodenal switch surgery as opposed to gastric bypass, gastric sleeve, and adjustable lap band surgeries.
2. Patients typically have longer hospital stays for recovery compared to patients who undergo gastric sleeve or adjustable gastric band procedures.
3. Greater potential for long term protein, vitamin, and mineral deficiencies.
4. Compliance in follow-up care, diet, supplement regimes, and lifestyle changes are critical for success. If patients do not follow the guidelines recommended for them, they may suffer from severe nutritional deficiencies.

Interested In Weight Loss Surgery? Here Are Your Next Steps

If you find that you have tried, and failed, to lose weight through diet, exercise, lifestyle, and behavior changes, weight loss surgery may be an option for you. Meet with a bariatric surgery specialist to weigh your options for weight loss. Your doctor will review your medical history and evaluate whether or not you are a candidate for weight loss surgery.

It is important to remember that surgery does carry both short-term and long-term complications. However, the risks of long term effects of excess weight can be far worse for your health than the risks associated with surgery. There are various weight-loss surgeries that your doctor should inform you about, and you should be aware of all the risks related to those procedures.

Finally, your weight loss journey does not end as you exit the hospital doors. People who choose to undergo weight loss surgery must be committed to making lifelong changes to ensure the weight stays off and obesity-related diseases do not return. Weight loss surgery can be the first step on a lifelong journey dedicated to a healthier you.