Duodenal Switch

The BilioPancreatic Diversion with Duodenal Switch (often referred to just as the “Duodenal Switch.”)  is the most effective weight loss surgery available.  It also has the highest rate of complications, and long term vitamin deficiencies.  I do not offer the Duodenal Switch to my patients and refer those who are interested in the surgery to one of the very few surgeons who perform it.  This surgery is usually done through a large incision (open), rather than through several small incisions (laparoscopically) as the other bariatric procedures are.

The serious complication rate after Duodenal Switch is 3-4 times higher than after gastric bypass.  Even more concerning is the remarkably high rate of vitamin deficiencies.  Most patients require between $100-$200 per month of vitamin supplements after the procedure that aren’t covered by insurance and are critical to maintaining good health.  Although the downsides of this surgery are significant, so are the upsides.  The Duodenal Switch represents the best treatment for Diabetes and is able to get nearly all diabetic patients off insulin after the surgery.  It also offers the most profound weight loss.  Most patients are able drop nearly all of their excess weight without making significant changes to their diet.  However, nearly every meal results in a trip to the bathroom, particularly if the food has a high fat content.

Although some aspects of the surgery seem too good to be true, I have cared for many patients who struggle with the chronic health conditions that their surgically induced malnutrition has created.  These patients are often much thinner, but rarely are much healthier.  While the surgery may be the best option for a small group of patients, particularly those with a very high BMI (>60) or severe diabetes, it should be chosen with great caution and understanding of the risks and nutritional consequences.  I believe that a gastric bypass or sleeve gastrectomy procedure, paired with significant improvement in your diet and exercise program can bring about results that are nearly as good as with the Duodenal Switch, with a fraction of the difficulties.

 My practice is almost exactly 50% Sleeve Gastrectomy and 50% Gastric Bypass.  I am not a zealot or firm believer that one operation is superior to the other.  They are both excellent operations that are more similar than different in their outcomes and patient experiences.  I let my patients make their own choice about which surgery to perform, but always offer my advice on which I think would represent the best choice for them.

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