Looking for one of the most successful weight loss surgeries? Learn about the Laparoscopic Duodenal Switch.
Patients who are morbidly obese need options for their weight loss. At Alabama Surgical Associates, we offer a series of minimally invasive laparoscopic bariatric surgeries that will take the weight off and start you on the road to a healthy future. The most successful of our gastric surgical options, especially for diabetic patients, is the laparoscopic duodenal switch surgery. This operation combines two areas of surgery in a single procedure, with patients losing 70 to 80% of their excess weight over a two-year period, up to 90% in five years. If you are interested in Laparoscopic Duodenal Switch Surgery, call the Alabama Surgical Associates today.
What is laparoscopic duodenal switch surgery?
In a laparoscopic duodenal switch, your surgeon reduces the size of the stomach as in gastric sleeve surgery. However, they also dramatically shorten the small intestine to roughly one-quarter of its former length. This bypassing of much of the small intestine results in a significant decrease in the absorption of calories and nutrients, and especially fat, enabling the patient to lose the dangerous excess weight.
A laparoscopic duodenal switch (also known as a biliopancreatic diversion with duodenal switch) is a procedure with two components. First, as in a sleeve gastrectomy, roughly 80% of the original stomach is trimmed away to create a tubular stomach pouch shaped like a banana. Next, a large portion of the small intestine is bypassed.
Dr. Foreman and Dr. Doucette use laparoscopic methods to make the procedure minimally invasive.
Who is the best candidate for a laparoscopic duodenal switch?
As with any type of weight-loss surgery, a laparoscopic duodenal switch should only be thought of as a last resort. The problem is that when a person becomes morbidly obese, the excess weight is very difficult to lose through non-surgical weight-loss programs. Studies show that less than 5% or those participating in non-surgical weight loss programs lose and keep off a significant amount of weight. Plus, when a person’s weight is constantly rising and then falling and rising again, this adds to the health risks already inherent with being obese.
To qualify for a laparoscopic duodenal switch with the Alabama Surgical Associates team, a patient generally needs to be at least 100 pounds over his or her ideal weight and have a Body Mass Index (BMI) of 40 or above. Patients with a BMI of 35 with weight-related medical problems such as high blood pressure, diabetes, coronary hearth disease, or sleep apnea also qualify for this type of gastric surgery.
Why does laparoscopic duodenal switch work?
Laparoscopic duodenal switch surgery allows the patient to lose vast amounts of weight for a variety of reasons. First, by reducing the size of the stomach up to 80 percent, it can only hold from 100 to 150 milliliters, compared to 1 to 1.5 liters in a normal stomach. This obviously reduces calorie intake. By removing the majority of the stomach, various hunger-triggering gut hormones are also removed. This makes the person feel satiated sooner and helps with blood sugar control.
The second area of weight loss comes from bypassing so much of the small intestine. This is where a laparoscopic duodenal switch differs from procedures that focus on the stomach size. The objective is to reduce the amount of time the body has to capture calories from food in the small intestine and to selectively limit the absorption of fat. After laparoscopic duodenal switch surgery, patients only absorb approximately 20% of the fat they take in.
What are the risks of this surgery?
Risks associated with weight loss surgery at Alabama Surgical Associates are very low. Mortality rates are 0.3%, very low. These are the three most common complications, but they are very rare and usually caught while the patient is still in the hospital:
- Staple line leaks — 2%
- Bleeding — 1%
- Stenosis/strictures — <1%
What are the side effects?
Gastroesophageal reflux disease is experienced by 20% of patients in their first year after surgery, but this drops dramatically, down to 3% thereafter. The patient may develop intolerance to certain foods that may cause nausea, vomiting, and indigestion, but changes in diet mitigate these issues. About half of patients develop gallstones as a result of rapid weight loss, but we may opt to remove the gall bladder with the surgery to eliminate this problem. Issues with changes in bowel movements, excessive flatulence, and diarrhea can usually be improved through changes in diet.
What are the advantages of laparoscopic duodenal switch surgery?
- Laparoscopic duodenal switch surgery results in greater weight loss than other procedures with patients losing up to 70-80% of their excess weight within the first two years, up to 90% within five years.
- It allows patients to eventually eat near “normal” meals.
- It reduces the absorption of fat by 70% or more.
- It leads to favorable changes in gut hormones, reducing hunger, improving satiety, and controlling blood sugar.
- It is the most effective procedure for addressing diabetes, with studies showing up to a 98% cure rate for Type 2 diabetes.
- It is very effective on hyperlipidermia, sleep apnea, and hypertension.
- It doesn’t involve foreign objects as with gastric band surgery.
What are the disadvantages of laparoscopic duodenal switch surgery?
- This has a somewhat higher complication rate and risk of mortality (but that pales when compared to the mortality problems arising from morbid obesity).
- This is a non-reversible procedure.
- It can lead to nutritional deficiencies.
- It demands strict adherence to dietary and vitamin supplementation guidelines for the remainder of the patient’s life.
How is a laparoscopic duodenal switch performed?
At Alabama Surgical Associates, we perform duodenal switch surgery through laparoscopy, rather than open surgery. Dr. Foreman or Dr. Doucette usually make five small incisions and insert a trocar into each. Trocars allow for the insertion of the surgical instruments and the laparoscope (video camera).
The first part of the procedure is basically the same as gastric sleeve surgery. The stomach is reduced by roughly 80 percent to about the size of a banana. Staples are used to secure the new backside of the stomach.
Next, the duodenum (the first portion of the small intestine) is divided just past the outlet of the stomach. This preserves the pyloric valve where most chemical digestion occurs. The end of the small intestine is then located and about three meters is measured, cut, and attached to the remaining duodenum. Now when the patient eats, the food goes through the newly shrunken, banana-sized stomach and then empties directly into the last segment of the small intestine, bypassing about three-fourths of it.
The bypassed small intestine is reconnected to the last portion of the small intestine, and it will now carry necessary bile and pancreatic enzymes from the liver down to where it will mix with the food to help digestion before it enters the large intestine.
What will my recovery entail?
After your laparoscopic duodenal switch surgery, you’ll stay two to three days in the hospital. Pain is very manageable. You can return to work in two weeks and can expect full recovery within four to six weeks. Full exercise and any heavy lifting will likely need to wait for two months.
What will my diet be like after my procedure?
Every patient responds in his or her own way after laparoscopic duodenal switch surgery. But there are some general guidelines:
- Focus on eating your proteins first, in solid form. You need 80 grams of protein to stay healthy, so you don’t want to fill up on other food first.
- Once healed, don’t opt for liquid protein, as you’ll feel hungry sooner and this can lead to gaining weight again.
- Try to get most of your calories from solid foods, as they will keep your hunger sated longer.
- Don’t drink anything for 30 minutes before, during, or 30 minutes after eating, as liquids will tell your body you’re full before you’ve consumed enough calories.
- Chew meat thoroughly, or cut it up into very small pieces.
- Eliminate carbonated drinks, high-calorie nutritional supplements, milk shakes, high-fat and high-fiber foods.
- Limit alcohol.
- Eliminate desserts or foods with sugar listed as one of the first three ingredients.
Avoiding vitamin deficiencies
Due to the extent of malabsorption after duodenal switch surgery, you will need to take 10 to 15 pills per day for the rest of your life. This is because your body now has far less small intestine to take in all the vitamins and minerals from your food. While this makes you absorb far less fat and calories, it also can lead to vitamin deficiencies. This, however, is totally manageable as long as you are diligent with taking your supplements every day.
Trust your laparoscopic duodenal switch surgery to the skilled, board-certified surgeons at Alabama Surgical Associates (ASA) in Huntsville, AL.