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The duodenal switch is the most drastic of all forms of bariatric surgery. It is often done in the most obese patients as the second operation in a two-stage procedure. The first stage is a sleeve gastrectomy.

Who is a duodenal switch suitable for?

If you have a BMI of 65 or over, your obesity makes all types of surgery risky and you will need to have a sleeve gastrectomy and reduce your excess weight by 30 -50% before the duodenal switch can be done.

What does a duodenal switch involve?

The duodenal switch is a modified form of gastric bypass, but it is more drastic in terms of the amount of small intestine that it bypasses:

  • This is a major malabsorption procedure: the bypass is performed at the level of the duodenum not at the level of the stomach. The result is that only around 75 cm of your small intestine, about one sixth of the entire length, is available to digest and absorb nutrients, including vitamins and minerals.
  • Our bariatric consultants need to ensure that you understand the scope of the surgery, exactly what a duodenal switch will involve, and the impact it will have on your life in the future.
  • You will lose weight but you will need to take vitamin, mineral and protein supplements for the rest of your life to avoid developing malnutrition.
  • You will also need constant follow-up for the rest of your life: you will need to come back to see your consultant at regular intervals to make sure you are not developing complications.

What results can I expect after a duodenal switch?

Weight loss is sustained and rapid, with 80% of the excess weight lost at 2 years after surgery. The results are more dramatic than with a gastric bypass or a sleeve gastrectomy alone.  This is a successful treatment for exceptionally morbidly obese patients but it is not to be undertaken lightly.

What problems might I experience with a duodenal switch?

The complications are similar to those that can occur after a gastric bypass:

  • Leakage can develop at the junctions created in the small intestine. This occurs, on average, in one in 50 operations.
  • Internal hernias can develop: these are rare but each patient should be monitored to detect them.
  • Nutritional deficiencies, including mineral, vitamin and protein deficiency can develop more frequently if patients do not follow dietary advice.
  • Dumping syndrome, as occurs after a gastric bypass.

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