Confusion Regarding Duodenal Switch

They are still performing THAT operation?
Why doesn't everyone know about Duodenal Switch?

There is a lot of confusion regarding Duodenal Switch. When patients tell their doctor they want to have the Duodenal Switch procedure, many PCPs have never heard of it and assume it is an older procedure that is no longer performed. "THAT operation" sometimes refers to the Jejunoileal Bypass (JIB) or the Biliopancreatic Diversion (BPD) stand alone procedure. The JIB was the first malabsorption procedure developed and you can read more about it in our section on the History of Duodenal Switch. Many doctors are not aware of the Duodenal Switch procedure and how it reduced or resolved some of the complications that could occur following the JIB or BPD procedures.

Diana C. summarizes the confusion regarding Duodenal Switch.

When the DS was introduced, it was an improvement over the Biliopancreatic Diversion procedure, or BPD - unfortunately, this led to the procedure being called the BPD/DS, which is a misnomer. While the intestinal part of the BPD is essentially the same as the DS, the stomach part is VERY different. The problems with the BPD are much more like a distal RNY than the currently practiced DS, as the BPD involves removing much of the lower part of the stomach, including the parts that absorb vitamin B12 and iron, and the pyloric valve, and BPD issues include potentially serious malnutrition issues. What insurance companies often do is to cite papers discussing the very real problems with the BPD (which is rarely performed anymore) against the DS, which is quite inappropriate. In addition, they completely ignore the growing body of scientific evidence that is approaching 20 years of study on the DS and the wonderful results that have been established.

What the experts say...

Gary J. Anthone, MD, FACS, "The Duodenal Switch Operation for Morbid Obesity", Aug 2005, pg 829-830. [9]

The duodenal switch operation includes a restrictive and malabsorptive component. This has resulted in conflicting opinions regarding the side effects of the malabsorptive component; some investigators believe that severe metabolic and nutritional complications are frequent after the operation. This likely is due to a presumed similarity of the currently performed malabsorptive operations (ie. biliopancreatic diversion and duodenal switch) to the old and now-discredited jejunoileal bypass (JIB). Unlike the jejunoileal bypass, the duodenal switch does not have a blind enteric limb.

Gary J. Anthone, MD, FACS, "The Duodenal Switch Operation for Morbid Obesity", Aug 2005, pg 820-821. [9]

Despite favorable reports on the use of the duodenal switch procedure for the treatment of morbid obesity, it has been slow to gain widespread popularity. There are three reasons for the: (1) there is a perception that its malabsorptive component may be associated with metabolic complications, protein calorie malnutrition, or other nutrient deficiencies; (2) the procedure is longer and more technically demanding than other bariatric operations; and (3) the procedure is difficult to perform laparoscopically.