Duodenal Switch

Duodenal switch, also known as vertical gastrectomy with duodenal switch, or biliopancreatic diversion with duodenal switch, or DS or BPD-DS, is a complicated weight loss surgery.

It involves resection of the greater curvature of the stomach, leaving in place the pylorus and a little of the duodenum, which are anastomosed to the ileum. The rest of the duodenum and jejunum simply empty their secretions into the distal ileum through a new anastamosis.

Duodenal switch combines restrictive and malabsorptive techniques to achieve and maintain the excess weight loss.

The restrictive component involves reducing the size of the stomach. The stomach is divided vertically and more than 85 percent of the stomach is removed. The stomach that remains is shaped like a banana and is about 100 to 150 milliliters or 6 ounces.

The duodenal switch also keeps a small part of the duodenum in the digestive system. The duodenum is the first part of the small intestine. It is located between the stomach and the jejunum, or the middle part of the small intestine.

Food consumed mixes with stomach acid, and then moves down into the duodenum, where they mix with bile from the gall bladder and digestive juices from the pancreas.
Malabsorptive surgery restricts the amount of calories and nutrients the body absorbs. In this surgery small intestine is rearranged to separate the flow of food from the flow of bile and pancreatic juices. The food and digestive juices interact only in the last 18 to 24 inches of the intestine, allowing for malabsorption.

Unlike the restrictive part of the surgery, the intestinal bypass part of the duodenal switch is partially reversible if the patient experiences malabsorptive complications.

After duodenal switch (DS), the patient consumes less food than normal, but it is still more than with other weight loss surgeries. Even this amount of food cannot be digested as normal, so a large amount of food passes through the shortened intestines undigested.
The duodenal switch can also be performed laparoscopically, which means that the surgeon will make small incisions rather than one large incision. The surgeon will insert a laparoscope (viewing tube with a small camera) and other tiny insert instruments into these small incisions to perform the duodenal switch procedure.

People with a body mass index (BMI) greater than 40 are suitable for the duodenal switch. People with lower BMIs, but with obesity-related illnesses such as diabetes may also be apt candidates for this surgery. The duodenal switch can be effective for people with very high BMIs of greater than 55.

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