The duodenal switch is a weight loss procedure which consists of a restrictive and malabsorptive diet. This is one of the most complicated weight loss surgeries. The procedure keeps a small part of the small intestine known as the duodenum. It also leaves a larger portion of the stomach intact including the pyloric valve compared to another procedure known as the biliopancreatic diversion. About 20,000 people in the United States undergo this procedure annually.
The malabsorptive component of the procedure involves separating the blood flow from the bile and pancreatic juices so that the food and digestive enzymes only interact in the last 18 to 24 inches of the intestine. It is this rerouting of the intestine which produces the malabsorption. The patient will consume less food than that consumed prior to the surgery. Some of the food will pass through the intestine undigested.
The procedure can be performed through a laparotomy (large abdominal incision) or through a laparoscope (several small incisions on the abdomen).
A BMI greater than 40 qualifies you for this procedure. BMIs less than 40 can still qualify with certain related conditions attributed to obesity like diabetes. The duodenal switch is a complex surgery, and only you and your doctor can ultimately decide whether this is the right surgery for you or not. Remember that any surgery carries risks such as infection, hemorrhage, injury to another organ system, and death. Particular risks associated with this surgery include leakage from the stitches in the bowel and inability to keep fluids ingested due to swelling in the gastrointestinal (GI) tract. The swelling in the GI tract will subside, but the patient may require hospitalization for hydration while the swelling goes away.
You will have to undergo a preoperative protocol. One of the steps in the protocol is to speak with a dietician about the diet that you will follow prior and after the surgery. These diet changes involve a life long commitment. An evaluation by a mental health professional will be performed. Your doctor will most likely recommend an upper endoscopy to make sure that you do not have stomach conditions like ulcers. Depending on your medical condition and age, your provider may order other tests such as an EKG, blood work, sleep study, and X-rays among others. Finally, you will have a preoperative physical exam where your physician will go over your history and perform a physical exam. At this time, be sure to inform your physician about any medications that you are taking including over the counter supplements and herbs. Some herbs and supplements will impact your body adversely like prolonging your bleeding time.
You will be asked to make other lifestyle changes besides diet. This includes quitting smoking if you are a smoker. We all know that smoking increases your chances of developing some types of lung cancer. In addition, there are other potential lung problems like chronic obstructive pulmonary disease (COPD). You will also be asked to stop consuming alcohol prior to the surgery. Losing some weight will help your postoperative recovery.
The surgery will last three to four hours if complications are not encountered. You will be restricted to drinking fluids postoperatively followed by a pureed diet. Solid foods will then be reintroduced into your diet. There will be postoperative pain which will be controlled with different forms of pain killers.
The major weight loss will occur over 12 to 18 months after the surgery. A patient can expect to lose 70% of their body weight during this time. The patient will have to take minerals and vitamins daily as well due to the malabsorption caused by the surgery. Bowel habits will change following the procedure. Ingesting fatty foods will produce diarrhea and gas.
Other potential postoperative changes include osteoporosis (thin bones), chronic diarrhea, vitamin deficiencies, and chronic diarrhea. Bad smelling stools may also occur.
The cost for this procedure is about $20,000. Some insurances pay for this procedure.
Weight loss surgery is reserved for those people who are morbidly obese and cannot lose the weight. It is also done on people who need to lose weight quickly due to a medical condition(s).
Consider your options carefully before undergoing any form of surgery. Wishing you success in your weight loss and management, Pablo.