Duodenal Switch Forum (DS)

Duodenal Switch Frequently Asked Questions

Q. How is the duodenal switch similar to the gastric bypass?  How is it different? 

A. Like the gastric bypass, the duodenal switch causes restriction (reduction in the amount of food you can eat) as well as malabsorption (reduction in the percentage of calories that get absorbed).  However, the duodenal switch is a much more malabsorptive operation.  This results in greater disruption to your bowel habits and more side effects than you might see with the gastric bypass.  It is important to remember that the duodenal switch is the most major of all the weight loss operations.  It is also irreversible.

Q. I?ve heard that duodenal switch is like a ?magic bullet? for the treatment of obesity. Is this true?

A. The duodenal switch is a very effective treatment for obesity.  However, it should not be considered a "magic bullet".  Rather, the duodenal switch is part of a thorough weight management program that needs to include diet, exercise and other lifestyle changes.

Q. Why should I consider the duodenal switch?

A. The duodenal switch has certain advantages. Because the stomach is larger, it allows you to eat larger portions than you can with gastric bypass or gastric banding procedures such as LAP-BAND.  Because of the substantial amount of malabsorption it causes, the long-term weight loss may be better than other weight loss surgeries.  However, because it is a larger operation, the side effects and risks may be more substantial.  If you are considering this operation, it is important to discuss the risks and benefits in depth with your surgeon.

Q. Am I a candidate for duodenal switch?

A. If you have a body mass index greater than 40 and are between the ages of 18 and 65, you may be a candidate for duodenal switch.

Q. What is the difference between the duodenal switch and the BPD-DS?

A. These are different words for the same operation.  The biliopancreatic diversion may also be performed without a duodenal switch.  However, when the operation is performed this way, there is a higher risk of dumping syndrome and marginal ulcer formation.

Q. How long is the recovery time for duodenal switch?

A. Every person's recovery is different.  Most people require about 3 to 4 weeks for recovery from their surgery. Even if the operation is performed laparoscopically, with small incisions on the outside, the operation is a big one on the inside.

Q. How long does it take to lose weight after my surgery?

A. Most of the weight loss occurs during the first 12 to 18 months after your duodenal switch.

Q. Will I gain my weight back after surgery?

A. Because of the malabsorption caused by the duodenal switch, this operation tends to have the best long-lasting weight loss of any surgery.

Q. Will I have to avoid certain foods after my duodenal switch?

A. Fatty foods tend to cause diarrhea after duodenal switch surgery. Also, some very starchy foods, like pasta, will result in gassiness. It is difficult to make specific recommendations because each person responds differently to various foods.

Q. What are the risks of the duodenal switch?

A. The short-term surgical risks of duodenal switch are similar to those of gastric bypass. These include the risk of bleeding, infection and leakage of gastrointestinal contents.  These complications may require a return to the operating room for repair.  Additionally, because of the amount of malabsorption it causes, the duodenal switch may result in more long term nutritional complications than other procedures.  For this reason it is necessary to have lifelong nutritional follow-up after duodenal switch.

Q. Is it true that the weight loss with duodenal switch is better than any other bariatric operation?

A. Typically, patients lose about 60-80% of their excess body weight after duodenal switch. This compares to 50-75% for the gastric bypass and 40-60% for the LAP-BAND®. 

Q. Is there a weight limit for duodenal switch surgery? What about for laparoscopic duodenal switch surgery?

A. First, it is necessary to calculate your body mass index, or BMI. There is a BMI calculator located on the home page of this duodenal switch forum.

There is a definite lower limit for for weight loss surgery. Your BMI usually needs to be 40 or higher for you to benefit from weight loss surgery (and for your insurance company to approve it). If you have major health problems directly caused by your obesity, also known as ?comorbidities,? then you may be a candidate for weight loss surgery with a BMI as low as 35. At many programs, including the Mount Sinai Program for Surgical Weight Loss, you will only be considered a candidate for the duodenal switch if your BMI is above 40.

There is no absolute upper limit for open or laparoscopic weight loss surgery. However, if your BMI is greater than 60, you may not be an ideal candidate for the laparoscopic approach -- you may require either an open surgery or a 2-stage laparoscopic procedure (where the surgery is performed in two separate laparoscopic procedures.)

Depending on your BMI, your general health status, and whether you have had prior abdominal surgery, your surgeon may decide that your surgery will be safer to perform open rather than laparoscopically. This can only be established after an in-person evaluation by your surgeon.

Q. Do previous abdominal operations make me a poor candidate for laparoscopic duodenal switch surgery?

A. After any abdominal operation you will probably develop some adhesions, or scars inside your abdomen. This may make your laparoscopic operation somewhat more technically difficult to perform, and it will probably take more time. Also, the risk of conversion to an open procedure is increased. However, assuming that your surgeon is well-trained in laparoscopic techniques, you definitely remain a candidate for laparoscopic weight loss surgery.

 Q. (For women) I want to get pregnant soon after my duodenal switch surgery. Will my surgery have any effect on pregnancy?

A. It is very important that you do not get pregnant during the 18-month period following your operation. During this time you will lose a substantial amount of weight. If you were to get pregnant during this period, your fetus could suffer from abnormal development due to malnutrition.

Because of this issue, you must be on a reliable method of birth control if you are sexually active during this time!

Interestingly, weight loss surgery can help you to have a healthy pregnancy (after the maximal weight loss occurs). Many women who were unable to conceive prior to their operation, are able to do so after their weight loss! Plus, with the significant improvement in preoperative health problems like diabetes, your chance of a healthy pregnancy is improved.

However, it is critically important to make sure that your nutritional status is optimized before considering getting pregnant. The duodenal switch is a highly malabsorptive operation that may result in numerous nutritional deficiencies. Please contact your surgeon to find out more of this critical information before considering pregnancy.

Q. What is the minimum age for duodenal switch surgery? What is the maximum age?

A. Lower age limit:

Most bariatric programs will not perform duodenal switch surgery on patients under the age of 18. Some programs do perform weight loss surgery on adolescents but only the less major operations: Lap-Band or gastric bypass.

Upper age limit:

While there is no absolute upper age limit for duodenal switch surgery, most programs are very reluctant to operate on patients over 65 years of age

If you are between 18 and 65 and are physically able to withstand an operation and you fulfill the other criteria for surgery, you may be a candidate for the duodenal switch.

Q. Will duodenal switch surgery be the cure for my depression?

A. Many of our patients have experienced some degree of depression before their surgery, and have sought treatment with psychotherapy or anti-depressant medication. Some feel depressed because they are overweight. Some feel that they are overweight because they are depressed. Many feel that the best way to treat their depression is to treat their obesity.

Weight loss surgery can help to break the ?vicious circle? in which obesity causes depression and vice versa. However, it is important to remember that weight loss surgery is NOT primarily a treatment for depression! Remember, there are plenty of depressed thin people too!

Major weight loss can bring about many emotional shifts! Many patients who were depressed before surgery find that their mood improves significantly after surgery. As they lose weight, their self-esteem and self-respect increase considerably. This can lead to a significant improvement in personal relationships, work relationships, and overall happiness.

On the flip side, some patients find that weight loss brings with it many new emotional stresses. Heavy friends, or an overweight spouse, may be jealous of your weight loss. Your boss may expect more from you at work as you start to look more physically fit. You may feel more sexual as you lose weight. Needless to say, each of these issues carries with it a whole slew of emotional implications. The bottom line is this: it is impossible to predict whether weight loss will improve your depression. This is one of the reasons we have all our patients see our team's psychiatrist before the operation! It is important to go into this type of surgery with realistic expectations.

Next: >> Back to the Duodenal Switch forum home or visit the message board and learn more!

This information has been provided courtesy of the Mount Sinai Program for Surgical Weight Loss. Please visit them at http://www.SurgicallySlim.com.