Duodenal Switch....?

[MeganES]

I guess I'm ignorant cause I hadn't even heard of that surgery until just now! I'm going for my first consultation with my surgeon on Thursday and have been dead-set on the sleeve. I've done a bit of reading on the DS in the last 1 1/2 hours or so but I'm still pretty unsure of any pros/cons between the VSG and the DS. It seems like the major + to the DS is it has more sufficient long-term studies and the weight tends to stay off. Any opinions on the matter?

[TheJennC]

When I went for my first initial information session, the surgeon mentioned duodenal switch, but only to say that they're not the "preferred" method of treatment anymore. I don't really remember why, but I think there were many more complications and nutrition issues...

[Finallyanewme]

All I know is duodenal switch is usually not covered by insurance.

[SoNotABarbie]

From what I got from my doctor The DS is kind of like having the bypass after you've had the sleeve . And he told me to think about it after I had the sleeve. I don't want anything like that. Where I could have malabsorption problems like people with the bypass do. I will have the sleeve for the rest of my life. As long as I treat my body right and eat right I will continue to lose weight.

[incredibleshrnkngshirly]

My sister in law had this by pass surgery. She has to go to the potty about fifteen minutes after she eats...every time! I was scared of it but she lost all her weight too....seems to be keeping it off....

[JustWantToBeHealthyAgain]

The DS causes MASSIVE, MASSIVE weight loss and as far as I know, restricting the stomach is not part of the procedure. A HUGE part of the small intestines is completely bypassed.

The reason why it's not "preferred" anymore is because of the complications. Absorption issues, horrible dumping issues, food intolerances, liver problems, etc. and many more are associated with DS.

I think it can work for some people, maybe people who weigh 500+ and are really in danger of dying soon because of their obesity. But for me? No, I don't think it's right at all. I couldn't stand the dumping and malabsorptive issues.

[niamh]

This is my lay person's understanding. Sleeve Gastrectomy was actually historically being performed as the first stage of two part surgery for people who were too obese to risk doing the whole surgery at once. The second stage was the Duodenal Switch which is a bypass procedure which would then be performed after people had lost enough weight to have the subsequent surgery safetly. When they found that many people had adequate response just to the Sleeve alone without requiring the further procedure, surgeons started offering the sleeve as a stand alone procedure.

So, as I understand it, DS remains an option for people who've had the sleeve if they don't manage to get adequate weight loss with the sleeve. Whether or not it would be covered by your insurance is another thing altogether. For the most part though, it seems people don't require it - and most people's preference is not to have it as we chose not to have a bypass because we didn't want that level of re-organising the gastrointestinal system.

[JustWantToBeHealthyAgain]

^ Exactly. I chose the sleeve over the bypass because I didn't want the issues that come with bypassing parts of the intestines.

[bergamini]

The Duodenal Switch is basically the VSG / Sleeve coupled with a malabsorption adjustment to the small intestines more invasive than the malabsorption Gastric Bypass/Roux En Y offers. It is the king of all WLS and I can't imagine a doctor in the US who would perform it on someone weighing ~ 250#. It's very effective and very permanent, but so is the sleeve or Roux En Y for that matter. Obesity Help has more information on it but the few reviews I read were basically like yeah, this thing works and it works for good but for the first few months you spend an hour or more per day on the toilet and you have to be VERY diligent about getting vitamins, nutrients, etc., into your system because you can get malnourished or out of balance quickly. It is definitely the right choice for some super fluffy people but I would say that at your weight, it's not even an option.

[Steve Webb]

Most of the time the DS surgery is for Patients that are extremely obese, loke 50 bmi that sort of thing. That is what I have learned on variuos sites. It is usually the surgery that is done on them.

[Wolfy]

I know it's an old thread, but I wanted to answer to some of the questions after my research on this a few months ago. Duodenal Switch definitely does involve a stomach restrictive portion. DS is basically a combination of a gastric sleeve and an intestinal malabsorbive portion. In fact, the standalone gastric sleeve procedure actually came out of surgical DS procedures done in two parts, with the sleeving done first, then after a period of time, the malabsorption portion. When doctors noted that a lot of weight loss was occuring with just the sleeve portion, it began to be offered as a standalone option and eventually became the popular offering that it is today.

The usual gastric sleeve portion of a DS only removes around 60% to 70% of the stomach, whereas a standalone gastric sleeve often removes a bit more (though it seems to vary by physician and patient). However, the malabsorptive portion of the surgery creates a dynamic causing much more weight loss than gastric sleeve alone. The small intestines are not removed as someone mentioned. Rather, they are rerouted into three pathways: one digestive and one biliopacreatic, that feeds into a final common pathway. The digestive pathway is very short; it begins from the stomach, and is what delivers food to the common pathway. The biliopancreatic pathway is much longer; it carries bile from the liver to the common pathway.

By shortening the path that food normally travels, less of the food is absorbed, particularly the fat. This leads to much more weight loss, and of course, the side effect of having to go to the bathroom more quickly after eating and having more malodorous excrements. However, unlike the classic Gastric Bypass procedure, DS patients almost never experience the "dumping syndrome" and other side effects common with the previous method. Also, since no small intestines are removed, the malabsorptive part of DS is entirely reversible (though obviously, same as gastric sleeve, the stomach restriction portion is not). Finally, it has a much higher rate of ending certain co-morbidities, particularly diabetes, for which it is has almost a 100% resolution rate. It has a bigger rate for resolution of most other common co-moribidities as well.

Medical standards state that DS is recommendable when you have a BMI of at least 40, but lately doctors have avoided doing DS without a much higher BMI (or a combination of a lower BMI and several comoribidities). I couldn't find any doctors in my part of the country that even do DS. Nonetheless, I seriously considered it, and I would have picked the DS and went out of State for a doctor if I had been past the 400 lb. mark. However, I was about 50 lbs. shy of that, so I felt that the side effects were too great to consider it right away. However, the nice thing about gastric sleeve is that it is the first part of DS, so if gastric sleeve does not produce the effects you want after a considerable period of time, DS could be a next step (whereas all other options are closed off due to the modifications to the stomach). And again, the malabsorptive part is fully reversible, so if later on you decide you don't want the intestinal modifications, you can have them undone.

EDIT: I had to edit this because I saw that some people have actually been converted from gastric sleeve to gastric bypass, which I thought was not possible. In any case, I think it would be undesirable to go that route in my case. If I felt that I needed the malaborptive portion, I don't think I would go from sleeve to bypass. I'd do DS instead. There are simply less side-effects, and I like the reversibility of the latter.

[KristinaMD]

Hi All,

This is my first post here. I have had the duodenal switch procedure. Actually, the full name is a biliopancreatic diversion with duodenal switch. I am probably in the wrong place for what I am looking for, which is advice on nutritional deficiencies years after the procedure.

If anyone knows a doctor who can advise with experience and authority on this subject, please let me know.

I have had a lot of medical problems and though I do have some documented deficiencies, such as Fe, vitamin D, and copper, what could I be deficient in that I wouldn't even think about checking? Like copper, for example. I just found out about that one.

For those who are deciding about which surgery to have, I chose this route because I wanted to avoid some of the problems associated with the gastric bypass, such as the dumping syndrome. Also, there is a high rate of failure for that procedure.

At the time I had my procedure, there weren't many people doing simply the gastric sleeve portion of the "duodenal switch". That is, however, what I would have chosen, if it had been possible for me to go ahead with the duodenal switch portion of the procedure if the sleeve portion of the procedure was not enough. However, my insurance wouldn't pay for a second procedure, so that really wasn't an option for me.

My insurance was one of the few that paid for the duodenal switch procedure at that time. I weighed 290 pounds and I rapidly lost weight and got to down to 130 pounds, which is probably the lowest I weighed in high school. Back then, I varied between 132-138.

Due to a medical issue, I gained weight steadily until I got up to 290. I felt that even if I resolved the medical issue, I would never be able to diet that much weight off.

I now weigh 140, having just gained 10 pounds. I had been down to 130 again. But anywhere around here is fine with me. I am just concerned about nutritional issues.

I am also considering having a partial reversal of the duodenal switch portion of the surgery so that I would have less malabsorption. My understanding is that I now absorb 50% of the protein that I eat, 30% of the fat, and 100% of the carbohydrates.

It is kind of nice to be able to eat anything that I want to. For those who might be considering the procedure, there is only one other issue, which is rather odiferous BMs.

[KristinaMD]

I just want to say Hi because I see you are from Madison, WI. I am from a tiny town about 100 miles from Madison, though I currently live in Dallas. I just joined this group as I came across it and I am looking for info on nutrition post-duodenal switch. I don't think I chose the right group for this question, but like I say, I just came across is.

Hope you are doing well

Kris