Duodenal Switch.

The duodenal switch surgery for weight loss combines the restrictive as well the malabsorptive approach to reduce weight in obesity. Primarily though, the malabsorptive approach is important here to aid in weight loss. It is also known as Biliopancreatic diversion with duodenal switch or Gastric reduction duodenal switch.

In general, interest in duodenal switch is gathering momentum judging from the fact that about 20,000 duodenal switch surgeries are performed in the U.S. annually.

Duodenal Switch Procedure.

In this bariatric surgery, the restrictive approach involves removing about 70% to 85% of the stomach. The resection of the stomach is on a vertical plane so that the greater curvature of the stomach is left out of the path of food. The stomach capacity is reduced to about 6 ounces only.

The malabsorptive approach involves creating two channels in the small intestine. One pathway carries food from the stomach to the distal end of the small intestines and the other pathway carries the bile from the liver to that part of the small intestine where the first pathway meets it.

The common channel into which both these pathways empty is about 75 to 150 cms long where the bile mixes with the food before entering the large intestine. Due to this quick passage of food into the distal part of the small intestine, time and area for absorption of food is much reduced leading to absorption of only 20% of the fats or calories in the food. The figure below illustrates this anastomosis.

Picture of the duodenal switch.

Biliopancreatic Diversion.

As mentioned above, the duodenal switch is a modification of another weight loss surgery called the Biliopancreatic diversion.  Therefore a liitle write up on this procedure may be useful. This is a more radical bariatric surgery than the gastric bypass.

Here about 70% of the stomach is surgically removed and an even greater portion of the intestine is bypassed. The stomach portion that remains is directly connected to the distal part of the intestine, thus preventing the calories  from being absorbed. This also results in preventing the nutrients from being absorbed.

This surgery gives a faster and much higher loss of excess weight than the gastric bypass. Results show up to about 75% to 80%  loss of excess weight. The upper stomach pouch is larger than in the gastric bypass enabling you to eat more. However, it is much less preferred than the gastric bypass due to the high risk of nutritional deficiency setting in.

Biliopancreatic diversion with a duodenal switch is a less drastic modification, in which a larger portion of the  stomach is left intact and less of the intestine is bypassed. The duodenum is left attached. Chances of risks of biliopancreatic diversion are reduced in this version of the surgery.

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