Duodenal Switch

This operation enables patients to eat a near normal meal by preserving 20% of the non-stretchable inner portion of the stomach. The operation works primarily by decreasing calorie absorption by bypassing roughly two-thirds to three-fourths of the upper small intestinal length.  Patients in general do not have the “Dumping syndrome” when they consume sugars because the stomach valve (pylorus) that regulates the exit of food from the stomach is preserved in this operation.  Because intestines are sewn to the duodenum there is a very low incidence of ulcers.

Technical Details

The outer stretchable 80% of the stomach is removed, leaving a tube like stomach with roughly 150ml (5-6 oz) capacity so patients generally feel full after eating a 4-6 oz solid food.  The duodenum, which is the first section of the small intestine is divided and connected to the last 10-12 feet of intestine.  The top half of the intestine carries just the digestive (bile and pancreatic juices) juices and is called the Bilio-Pancreatic Limb (BPL) of the small intestine. This is reconnected to the food stream 3.5 -7 feet (40-80 inches) from the colon (or large intestine). Absorption of nutrients and calories is determined by the length of this last segment of intestine where the food and digestive juices mix and is referred to as the Common Channel (“CC”).  A long CC decreases the risk for nutritional problems. A short CC decreases the risk for weight regain by decreasing the calorie absorption.



Results:

Patients lose roughly 75-80% of excess weight on the average.

	Resolution of all co-morbidities especially diabetes, hypertension and elevated blood lipids is excellent.
	This operation has very good long-term weight loss and weight maintenance.
	Compliance with recommended supplements & nutritional surveillance with labs are critical.
	Decreased absorption of fats & carbohydrates may result in loose stools, bloating and body odor, but in most patients this seems to improve with time as the intestines adapt