Performing Duodenal Switch

Why don't all bariatric surgeons perform Duodenal Switch?
Is Duodenal Switch a more complicated procedure than Gastric Bypass?

Duodenal Switch (DS) is a more complicated procedure to learn and to perform properly, as the tissue of the duodenum is harder to stitch. As a result, DS is a more complicated surgery to perform then Roux-en-Y Gastric Bypass (RYGBP) and Adjustable Gastric Banding. Ensure you have a very experienced surgeon to perform this procedure. Some surgeons prefer to perform the quicker Adjustable Gastric Banding (like LAP-BAND®) or RYGBP procedures. Be assured, performing Duodenal Switch demonstrates a great deal of dedication from your surgeon.

It is in the patient's best interest to continue to receive follow-up care from their Duodenal Switch surgeon to ensure proper health is maintained. Some surgeon's do not perform Duodenal Switch due to the extensive follow-up care.

What the experts say...

A. Baltasar, MD, "Duodenal Switch: an Effective Therapy for Morbid Obesity--Intermediate Results", Feb 2001, pg 4. [5]

The BPD-DS operation is a "complex" operation with at least 4 suture-lines. The duodenal-jejunal is the most complex anastomosis.

DS usage continues to expand, based on patient demand and growing awareness of the advantages of established hybrid procedures. Currently RYGBP is the most widely used bariatric operation in the U.S.A.; however, the number of centers offering the DS is growing rapidly. The ASBS 2002 Membership Roster listed approximately 50 surgeons who offer the DS. The ASBS 2003 Membership Roster listed 104 surgeons offering the DS. Most bariatric surgeons already have substantial experience with RYGBP before beginning to perform DS, and the fact that the already large number of ASBS members offering DS doubled last year reflects widening recognition and acceptance of the superior weight loss and decreased morbidity of DS.

Vivek N. Prachand, MD, "Duodenal Switch Provides Superior Weight Loss in the Super-Obese (BMI > 50 kg/m2) Compared With Gastric Bypass", Oct 2006, pg 612. [70]

The greater technical complexity (particularly when performed laparoscopically) and perceived perioperative and nutritional risks of DS in compared to RYBGP, however, have limited the widespread adaptation of DS among bariatric surgeons.