Duodenal Switch Surgery in Tijuana, Mexico

INTRODUCTION

Duodenal Switch Surgery

Duodenal switch is not a very commonly done procedure for most bariatric surgeons. It’s also known as a biliopancreatic diversion with duodenal switch (BPD-DS) and is reserved only for those who need bariatric surgery the most.

How Duodenal Switch Surgery Works

Duodenal switch packs a one-two punch against obesity. It does so by preventing weight gain through two surgical components: a restrictive component and a malabsorptive one.

The restrictive component involves reducing the size of the stomach. About 85 percent of the stomach is removed, reducing the stomach to the shape of a banana with a volume of about 100 to 150 milliliters or 6 ounces.

Duodenal switch surgery is a variation of another procedure, called biliopancreatic diversion. However, the duodenal switch leaves a larger portion of the stomach intact, including the pyloric valve, which regulates the release of stomach contents into the small intestine.

As the name suggests, the duodenal switch also keeps a small part of the duodenum (the first part of the small intestine) in the digestive system. Foods mix with stomach acid, then move down into the duodenum, where they mix with bile from the gallbladder and digestive juices from the pancreas.

Unlike the restrictive part of the surgery, the intestinal bypass part of the duodenal switch is partially reversible if you are one of the people who experience malabsorptive complications.

With the duodenal switch, patients consume less food than before. However, the remaining stomach can handle more food than typical Roux-en-Y gastric bypass patients. Much of this food gets passed through the small intestine undigested, preventing the absorption of calories (specifically fat).

The duodenal switch can also be performed laparoscopically, meaning that your surgeon makes small incisions as opposed to one large incision and uses a small camera attached to a catheter tube to perform the operation. Laparoscopic procedures tend to have lower infection rates and quicker recovery times.

Who Is A Good Candidate For Duodenal Switch?

Duodenal switch surgery is not usually the first choice for people looking to have weight loss surgery. Most weight loss surgery patients opt for the gastric sleeve or gastric bypass instead. However, there are situations where a duodenal switch procedure is preferred.

Patients with BMIs over 50 may find that the duodenal switch is a preferable alternative to gastric bypass or gastric sleeve surgery. While patients with BMIs over 40 qualify for the procedure, these patients generally choose gastric bypass or gastric sleeve because of their relatively fewer risks compared to duodenal switch.

That said, this complex surgery can produce more complications and may not be the right choice for certain high risk individuals, including those with heart problems. Talk to your surgeon to determine if the duodenal switch is right for you.

Pre-Surgery Considerations for the Duodenal Switch

Whether you choose duodenal switch surgery in Tijuana or any other kind of weight loss surgery, you’re making a lifelong commitment to your health. This means sticking with the dietary and lifestyle changes necessary to succeed. Weight loss surgery is NOT “the easy way out”; you still have to eat fewer calories. However, weight loss surgery can make this a lot easier for certain individuals.

After you’ve seen a surgeon and have decided to go through with the procedure, evaluations are taken to make sure that you’re OK to have surgery. These include:

– Meeting with a registered dietician to discuss your dietary changes and your new lifestyle after surgery.

– A comprehensive evaluation (psych eval) by a mental health professional.

– You may need an upper endoscopy exam to make sure no polyps, tumors, ulcers or ulcer-causing bacteria are present.

– Additional preoperative evaluations may be necessary for the heart and lungs.

We also require that patients commit to certain lifestyle changes before surgery in order to reduce the risk of complications. These include:

– Quitting smoking for at least six to eight weeks before and after weight loss surgery. Smoking can increase the risk of complications, such as blood clots and pneumonia.

– Not drinking alcohol for at least 48 hours before weight loss surgery.

– Losing 5 to 10 percent of excess body weight. According to a study in Archives of Surgery, people who lose some weight before surgery have shorter hospital stays and quicker weight loss after surgery.

What To Expect After Duodenal Switch Surgery

Recovering from duodenal switch surgery in Mexico is similar to recovering from other weight loss surgeries. Immediately after surgery, you will be prescribed some painkillers and some instructions for caring for your incision wounds. Your hospital stay is expected to be a day, however you may need to stay longer in case of any complications.

You’ll be put on a post-op diet lasting between 4 to 6 weeks, with a reintroduction phase at the end.

Your first few days after surgery, you’ll only consume clear fluids. Next, you’ll move onto consuming pureed foods for about a week. Then, you’ll be able to eat softer solid foods for several weeks. Once your doctor gives you the OK, you can start reintroducing solid foods.

Most weight loss happens within the first 12 to 18 months after surgery. Plateaus during this period are normal and to be expected. Weight loss expectations generally hover around 70% of your pre-op weight, resulting in a decrease of about 35% of your BMI. This is greater than other surgeries, where 50-60% are much more likely.

However, the duodenal switch does not come without risks. Duodenal switch patients are more likely to experience problems absorbing key nutrients such as vitamin A, vitamin D, and calcium. For this reason, multivitamins are required to prevent malnutrition. You may also need potassium and iron supplements.

It’s highly unlikely that you will regain all of the weight you lose after surgery, but this requires that you stick with the nutritional guidelines set by your surgeon. Failure to do so may result in malnutrition, stomach pain, and unpleasant bowel changes.

Risks of Duodenal Switch Surgery

All surgeries have a risk of blood clots, excessive bleeding, infection, and death.

The long-term risks of duodenal switch include:

The short-term risks of duodenal switch include:

Advantages of Duodenal Switch Surgery

Although the duodenal switch procedure is associated with a variety of risks, here are some advantages to the procedure: