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Duodenal Switch - All you need to know

Updated January 25, 2019

What is duodenal switch?

slim belly with measuring tapeThe duodenal switch surgery is also called a biliopancreatic diversion with duodenal switch (BPD-DS) or gastric reduction duodenal switch (GRDS). This type of procedure is a weight loss surgery very complicated, restrictive and is composed of malabsorptive aspects.  The restrictive aspect of the procedure contains removing more or less 70% of the stomach and a great part of the duodenum.

The malabsorptive part of the procedure reroutes a large portion of the small intestine where two pathways are made and also one common channel. The food is taken from the stomach by the shorter of the pathways (called the digestive loop) to the stomach. The common channel is a part of a small intestine and it is usually about 75-150c cm long. In it, the contents of the digestive path are blended with the aid of the bile from the biliopancreatic loop just before reaching the large intestine. The main aim of this arrangement is to restrict the time of the body to receive calories from food in the small intestine and gradually limit the absorption of fat. As a consequence, after the procedure, only about 20% of the fat consumed is absorbed by the patients.

Why duodenal switch is a good solution for me?

One of the main benefits of the affordable duodenal switch procedure is that your stomach is still able to digest food as usual following the surgery. Anyone who had Lap-Band or Roux-en-Y Gastric Bypass performed are obliged to follow strict diet till the rest of their lives due to the fact that these types of surgeries affect significantly the digestive capacity.

Next benefit of the duodenal switch abroad is that it leaves the pyloric valve, in other words, a sphincter-like muscle which divides the stomach from the duodenum, untouched. Therefore, it reduces adverse effects typical to bariatric surgeries, which are as follow:

  • dumping syndrome
  • blockages of stomach and intestines
  • ulceration

Moreover, another advantage of the duodenal switch is that it creates a possibility for quick, significant and long-lasting weight loss. It also may also enhance or even tackle a number of diseases related to obesity like heart disease or diabetes.  Those who suffer from diabetes and underwent a gastric surgery may observe that insulin needs considerably re diminished straight after the surgery.

Who is a good candidate for a duodenal switch

After the consultation with the surgeon you both arrived at the decision that weight loss surgery would a good option for you, the next step is to decide on the technique which will suit you best as it is a personalized decision.

If your BMI is 40 or more, a duodenal switch may be a good option for you. Those with lower BMIs yet suffering from obesity-related issues like diabetes may also be qualified for the surgery. A BMI is measured by taking into account height and weight to measure body fatness, a BMI of 30 or more is said to designate obesity.

The surgery is an effective option for those who have BMI more than 55. However, a study observed that the duodenal switch was responsible for more weight loss in comparison to Roux-en-Y gastric bypass in those who had at least BMI of 50.

In conclusion, duodenal switch is a complex procedure with some risks of possible complications and may not be a good choice for those who suffer from heart issues and sleep apnea, therefore consult your surgeon and determine if the surgery is an option for you

Prices of duodenal switch

The first thing you should do is to contact your insurer and ask if the company is able to cover the duodenal switch costs in order to receive pre-certification. It is of great importance to bear in mind that some of the bariatric surgery insurance companies are not eager to cover the costs of duodenal switch. However, on average the cost of the surgery is about 14 000/ 15 000 GBP. Therefore, a great majority of patients travel abroad to get the cheap duodenal switch done. For instance, the cost of the surgery in Mexico is about 442 GBP, in Poland 4000 GBP and Turkey 5375 GBP.

Before duodenal switch surgery

What is necessary to take into consideration before deciding on Biliopancreatic Diversion With Duodenal Switch.

Due to the fact that any bariatric surgery is a complex issue which has numerous aspects to consider. Surgeons are not only obliged to provide all information regarding available procedures but also look holistically at a patient’s health and take into account all necessary criteria. The main requirement for a duodenal switch is to hand in copies of a patient’s medical records with all the results of the evaluation, a medical clearance from a physician and a psychologist.  Patients should be examined by a psychologist as the obesity-related issue may stem from problems like stress or binge eating, thus the procedure would not be a good solution.

Patients should also be informed or they should look for information regarding the risks and complications connected with the disease, potential results and a patient’s devotion before and after the procedure.  Not only gathering information about the surgery is one of the most important aspects prior to the surgery but also a commitment to leading a healthy lifestyle which is necessary after the surgery for the results to be satisfactory. The treatment does not end in the surgery itself. A patient should be aware that sticking to the surgeon’s recommendations, healthy diet and regular exercising which will guarantee weight loss. Before taking any further steps, a patient and the surgeon ought to take into account the level of commitment to the surgery.

Sometimes preparing for a duodenal switch like losing weight prior to the surgery is required due to some reasons. Firstly, stick to the treatment plan, even incorporating lifestyle changes before the biliopancreatic surgery which will definitely have long-lasting results. Moreover, introducing new habits prior to the surgery may speed up the changes and aid weight loss following the surgery. Moreover, there is a requirement in some insurance company which states that patients should lose some weight till they undergo the surgery in order to cover the costs of the procedure.

Due to the fact some patients who are qualified for the duodenal switch surgery are frequently obese, in some instances, the procedure is divided into two separate stages namely undergoing gastric sleeve first a few weeks before the final surgery. People involved in the surgery process, which also includes dietician will provide the exact details about the surgery and guidelines regarding behavioral changes occurring before the surgery which may even last months or even a year.  There are no fixed guidelines and the recommendations take into account age, weight and any other co-morbidity

How is duodenal switch done

The surgery is performed under general anesthesia and a patient is in a split-legs position. A 10-mm optic trocar is put two hands spans under the xiphoid process. Also, two 12 mm ports are inserted at the same position on both flanks. There are also three 5 mm ports put on the left upper quadrant, another on the left flank and the last one on the epigastrium for liver retraction.

Firstly, the surgery begins with the duodenal dissection. With the aid of a clip, the pylorus is identified and peritoneum of the duodenum is opened both in inferior and superior borders. A window is prepared and a Penrose drain is applied for a transaction.

A patient has his head up and the surgeon is operating between the patient’s legs. On the right upper quadrant the alimentary limb is positioned and then an end-to-side anastomosis is done with the use of the OrVil and a circular stapler.

The results of the duodenal switch

In all cases regarding the gastric surgeries, a patient is obliged to follow a restrictive diet and incorporate exercises into the daily routine in order to achieve the most desirable results. For instance, it is recommended to exercise at least three or four times weekly, preferably 30-45 minutes. Moreover, it is important to be aware of what and how much you are consuming as even though with gastric surgeries the stomach may be stretched when eating too quickly

Those who struggle with significant overweight and are dreaming of losing it, the duodenal switch might be a solution. Nevertheless, it is vital to discuss all available options with the surgeon to determine the right course of treatment.

Recovery and diet following the duodenal switch

Not only after biliopancreatic diversion with a duodenal switch but also after any other bariatric surgery your body needs time to heal properly. Usually, patients require to stay two or three days in the hospital and during this time the surgeons will evaluate if the digestive system functions properly. A few days after the surgery you may have abdominal pain yet it is frequent. Generally, patients should stay at least two weeks at home before returning to work and also should stick to a restrictive diet in order for a stomach to heal properly.

Following the surgery, the stomach may only contain a small amount of soft food and liquids, therefore, gradually during the first-month patients are getting used to solid foods according to their surgeon’s advice. Also, patients should see regularly the surgeon usually every three months during the first year and twice a year after that. Moreover, it is advisable to join a support group. The main benefit of the surgery is the fact that patients feel full faster than normal, however, it is important to pay attention to symptoms like diarrhea, nausea, fainting which may indicate side effects of dumping syndrome or malnutrition.

Pills after a duodenal switch surgery

After very first weeks following the procedure, it is forbidden to swallow pills or any capsules due to the risk of pills or capsules getting stuck. The solution for this is to crush pills or open capsules into food or liquids. You may swallow pills after the first week provided that they are less than a size of the little finger. If not, you need to divide your pills and capsules and mix with the food or beverages or you may go on with liquid medication for up to two weeks until you are able to consume soft solid food.

Vitamins/ minerals

After you leave hospital you will have multi-vitamins prescribed that are rich in A, D, E, K and they are listed below:

  1. Bariatric Advantage High ADEK Multivitamin (with minerals)- these tablets are chewable, you should take them three times a day
  2. Celebrate Multi‐ADEK – also chewable tablets, you should take three times a day

In order to increase the absorption of vitamins and minerals please find some tips below:

  1. Do not try to take supplements on an empty stomach as it may prevent from nausea and vomiting
  2. you should take supplements with plain water. Some caffeinated beverages for example tea or coffee may disrupt the absorption of certain vitamins and minerals. Moreover, other beverages may contribute to the occurrence of undesired interactions with the nutrients found in supplements.
  3. it is not recommended to take more than 500-600 mg of calcium as the greater amount will not be absorbed at one time
  4. As calcium may dwindle the absorption of thyroid hormones, therefore, it is recommended to wait at least two hours before taking the thyroid hormone pills
  5. There should be at least one hour break between taking your supplements and prescribed medications due to the fact that they may minimize the efficacy of each other

If you are considering a duodenal switch in Poland for weight loss and you want to have cheap and done safely, you need definitely consider Poland as one of the destinations. With highly experienced surgeons and newly equipped hospital, your stay will be comfortable.  If you would like to know more information about the procedure, and why Bariatric Surgery abroad may be a good solution for you, do not hesitate but contact Beauty Poland- our customer advisor will be glad to help you with. Like in any other weight-loss surgeries, preparation for weight loss surgery is of great importance in order to achieve the most desirable results. Therefore prior knowledge of the procedure and following the recommendation is vital.

Source:

  1. www.en.wikipedia.org/wiki/Duodenal_switch
  2. www.plasticsurgeons.com/article/weight-loss-surgery/duodenal-switch/advantages-and-disadvantages-of-duodenal-switch
  3. www.yourbariatricsurgeryguide.com/duodenal-switch
  4. www.findclinic.net/bariatric-surgery/uk/london/warren-street/duodenal-switch?cc=ae
  5. www.treatmentabroad.com/costs/obesity-surgery/duodenal-switch
  6. www.obesitynewstoday.com/preparation-biliopancreatic-diversion-duodenal-switch
  7. www.aischannel.com/society/biliopancreatic-diversion-with-duodenal-switch-step-by-step
  8. www.phenq.com/blog/duodenal-switch-surgery/
  9. www.obesitynewstoday.com/biliopancreatic-diversion-with-duodenal-switch-recovery/
  10. www.columbiasurgery.org/sites/default/files/obesity_postop_diet_duodenal.pdf

Justyna Zastapilo

Justyna is a very open person and likes to talk to people. That's why she decided to become a patient adviser. She has comprehensive knowledge about medical procedures performed abroad.
+44 748 315 53 08

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