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Duodenal Switch

It is considered the most powerful bariatric procedure designed to date. In essence, it works in a similar way to gastric bypass, although because the length of the common channel is much shorter the level of absorption is superlative. This of course results in greater weight loss and a pronounced metabolic effect. However, patients who undergo a Duodenal "Switch" frequently have several evacuations a day. In addition to this, patients must be highly disciplined with vitamin supplementation and their diet to avoid significant nutritional deficiencies. This operation  in general, is reserved for patients with a very significant degree of obesity and is usually carried out at two different surgical times 

The operation is carried out as follows:

  • The operation begins with the creation of a “gastric sleeve”.

  • Subsequently, the division and reconfiguration of the intestine is carried out in the same way as is done with gastric bypass.

  • Unlike the "bypass" the length of the common canal (the portion of the intestine in which food mixes with digestive enzymes) is about 1.5 meters.

  • A connection is made between the first portion of the intestine (duodenum), which is immediately at the end of the “sleeve”.

  • The permeability and integrity of the connections are verified.

What are the benefits associated with the Duodenal Switch?

  • You can expect to lose around 95% of excess weight.

  • It is the operation with a greater “anti-diabetic” effect, as well as the effect on most of the rest of the comorbidities.

  • 95% of patients report a significant improvement in their quality of life.

  • Potential improvement in terms of fertility.

  • Years of life are gained (89% reduction in mortality at 5 years, between 8 and 13 years of gain in years of life).

  • Significantly reduces cardiovascular risk (heart attacks and other diseases).

  • Usually, there is an improvement or resolution of depression and other psychosocial aspects, such as self-esteem, changes in self-perception of body image, etc.

In what way does this operation act on obesity and its associated diseases?

  • By restrictive route: by reducing the capacity of the stomach, the amount of food that can be consumed is significantly reduced, so that the patient who undergoes this operation can only consume very small portions of food, reaching a sensation of full satiety very quickly.

  • By the malabsorptive route: by reconfiguring the intestinal anatomy, the foods that are usually unfolded and processed in an intact stomach and the first portion of the intestine, do not have contact with the enzymes produced by these organs until they have reached a very distal portion of the digestive system and therefore the nutrients and calories of what is consumed cannot be absorbed and used in their entirety, since the digestive process is shortened.

  • By hormonal route: the stomach and intestine are complex organs that carry out different functions. Among them is the ability to release hormones that regulate various metabolic and digestive aspects. By creating the gastric "sleeve" most of the stomach is partially excluded from its digestive function. Consequently, a hormone; ghrelin, which is produced mainly in this region, significantly decreases its concentrations. This hormone is one of those responsible of generating the sensation of appetite. In this way, the patient not only cannot consume large portions, but also does not feel the desire to do so, which greatly facilitates weight loss. Other hormones such as PYY, CKK, GIP, GLP-1, leptin, adiponectin, among others, also see their participation modified due to intestinal reconfiguration. Some of these substances are responsible for the early and radical improvement seen in diabetes after undergoing a gastric bypass.

  • Other mechanisms: there are other ways by which the post-operative Duodenal Switch patient loses weight and the diseases associated with it improve. These include the change in food preferences, the suppression of appetite via the central nervous system, the change in the intestinal bacterial flora, among many others.

What to expect from the procedure and hospital stay?

  • The surgery is performed laparoscopically and lasts an average of 2 to 3 hours.

  • Postoperative pain is generally not significant and is adequately controlled with commonly used pain relievers.

  • It is started with oral fluids the day after surgery.

  • The total hospital stay varies between 2 and 3 days.

  • The patient can ambulate from the day of surgery.

  • It is usually possible to return to daily activities within the first two weeks of the procedure.