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Duodenal Switch Procedures

Duodenal switch procedures lead to weight loss in three ways: reducing the volume of food that can be consumed by reducing the stomach size; limiting the amount of food the body can absorb by rerouting the intestines and suppressing the appetite by reducing the body's ability to produce ghrelin---the hormone that stimulates hunger. The body's ghrelin producing tissue is located in the stomach lining, making its quantity directly proportional to the stomach's size.

  1. Stomach

    • During a duodenal switch, approximately 70 percent of the stomach is removed, leaving your stomach banana shaped and initially about three to five ounces in weight. The size will increase over the nine to 12 months after surgery, eventually returning to approximately two-thirds of its original size. This part of the duodenal switch is not reversible.

    Intestines

    • To keep food from the stomach separate from the digestive juices and not mixed together until they meet toward the end of the small intestine, the intestines are rerouted so the alimentary limb carries the food and the biliopancreatic limb carries the bile and digestive juices. By keeping the food and digestive juices separated, fats and complex carbohydrates are not fully absorbed. This component of the duodenal switch procedure is fully reversible.

    Appendix and Gallbladder

    • Whether or not to remove the appendix and gallbladder during the duodenal switch procedure is at the surgeon's discretion; however, according to a 1995 study, which followed gastric-bypass-induced rapid weight loss patients for six months, 32 percent of the patients experienced the formation of gallstones within six months. When the gallbladder is not removed, medication is often prescribed to help reduce the probability of gallstones. In addition, the appendix may be removed to avoid any confusion of possible future abdominal symptoms with appendicitis.

    Staged Duodenal Switch

    • A duodenal switch may be performed in two stages if a surgeon deems that age or body mass index make it risky for the patient to undergo the whole procedure at once. In such a scenario, the restrictive component is performed first. Then, after the patient has lost some weight and any other health issues have been addressed, the intestinal rerouting is performed.

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