Duodenal Switch Surgery with Gastric Sleeve

Understanding Laparoscopic Duodenal Switch

Laparoscopic Duodenal Switch (BPD-DS or DS) is a complex weight loss surgery that involves multiple elements. The first is removal of a large part of the stomach, which promotes weight loss because you become full after just a small amount of food. The second element reroutes the food, bypassing the small intestine where digestion normally occurs. The procedure also alters the way bile and digestive juices break down food. This promotes weight loss by reducing the number of calories that can be absorbed.

Combining laparoscopic bypass of a portion of the intestine with a laparoscopic sleeve gastrectomy, DS surgery represents a powerful combination of “malbabsorptive” and “restrictive” weight loss. The result is the best and most durable weight loss of any of the major bariatric procedures.

Because the process involves malabsorption, there are possible complications related to insufficient vitamin and mineral intake and absorption, but these are usually controllable with oral supplementation. With proper maintenance and follow-up, the Duodenal Switch is a safe and very effective bariatric operation.

Before the procedure

• Stop smoking and begin eating 5-6 small meals per day.
• Consider joining a Wellstar support group for bariatric patients.
• Your medical history will be reviewed. Medical tests may include a urinalysis, glucose test for diabetes, thyroid analysis, chest X-ray, electrocardiogram and psychiatric evaluation. You may also have an upper GI or upper endoscopy test, lung function test and a gallbladder ultrasound.
• Your doctor will talk with you about other relevant medical issues.
• Begin an exercise program to increase your fitness and stamina.
• You will receive counseling on nutrition and fitness to help you modify your habits and maximize post-surgery results.
• Tell your doctor about all medications or supplements you take. You may need to discontinue those that can increase bleeding.

During the procedure

• You will be given an anesthetic to put you to sleep for the surgery.
• Your Wellstar surgeon will make 7 small incisions in your belly. A tiny video camera (laparoscope) and thin surgical instruments will be inserted through the incisions.
• While viewing our belly on a video screen, the surgeon will remove the left side of your stomach, leaving a much smaller “sleeve-shaped” stomach.
• The intestine will be divided and a small section will be used to create a bypass from the small intestine to a point near the end of the intestinal tract.
• The bypass permits food to be rerouted through the small intestine. Weight loss occurs because the pouch is small and because the body absorbs fewer calories due to the bypass.
• The procedure takes about 3.5 to 4 hours, depending on a patient’s previous operations.

After the procedure

• You will be monitored in a recovery room for an appropriate time before being moved to a hospital room.
• You will remain in the hospital for 2-3 nights and will be able to return to work and normal activities after about two weeks.
• A nurse or therapist will help you get up and walk soon after your surgery to keep your blood moving and improve healing.
• You may have a catheter in your bladder to remove urine.
• You may require supplemental oxygen for a day or two.
• You may take pain medication as needed.
• You will wear special stockings that help prevent blood clots.
• You will not be able to eat immediately after surgery, but will soon be able to have liquids, then pureed and soft foods. You will find that you become full after a small meal.
• The DS is not a quick fix for weight loss. Your doctor will talk with you about ongoing diet and exercise to maximize your results.
• You will see your Wellstar bariatric surgeon regularly to monitor your progress and address any possible complications. Blood work will be very important at certain intervals to make sure that your nutritional health remains intact.
• You will need to take extra vitamins and supplements to stay healthy.