Duodenal Switch Risks and Complications

Potential Duodenal Switch risks and complications are listed below. Keep in mind all surgical procedures involve a degree of risk however this must be balanced against the significant risks associated with severe obesity without surgical intervention.

Possible Duodenal Switch Risks and Complications

Intra-Operative

• Bleeding
  
• Blood Transfusion
  
• Injury to Liver, Spleen, Esophagus, Large Bowel

Immediate Post-Operative

• Bleeding
  
• Deep-Vein Thrombosis (blood clot)
  
• Pulmonary Emboli (blood clot traveling to the lungs)
  
• Infection
  
• Abscess
  
• Bowel Obstruction
  
• Perforation involving small bowel, Duodenum, Stomach (leak)
  
• Pancreatitis
  
• Pneumonia

Long Term

• Hernia
  
• Bowel Obstruction
  
• Excessive Weight Loss
  
• Anemia
  
• Osteopenia/Osteoporosis
  
• Kidney Stones
  
• Malodorous bowel motions and flatus (stinky bowel movements and gas)
  
• Diarrhea

More on Malnutrition

More on Gas and Diarrhea

Following Duodenal Switch, many patients experience excess gas if they eat too many carbohydrates or specific kinds of carbohydrates. Many will also experience diarrhea if they eat too many fats. In most cases patients have control over when and if this occurs because it can be controlled through diet. Patients have reported a varying degree of how much smellier their gas and bowel movements are post-op compared to pre-op and to control malodorous or loose stools patients are encouraged to frequently ingest yogurt and probiotics. [2] When necessary some are prescribed metronidazole (Flagyl). [2]

81.3% of Duodenal Switch patients experience normal gastric emptying according to Martínez et al. [36]

Anthone [9] reported the average number of bowel movements per day for 43 pre-op patients was 1.9, 421 patients six months post-op was 2.7, 316 patients twelve months post-op was 2.6 and 113 patients > thirty six months post-op was 2.8.

In a study by Wasserberg et al. [19] they found that although Duodenal Switch is often associated with more bowel episodes than gastric bypass, the difference is not statistically significant. Bowel habits are similar in patients who achieve 50% estimated body weight loss with duodenal switch surgery or gastric bypass.

In the Marceau et al. 15 year study Duodenal Switch: Long-Term Results [2] they say "The negative side-effects with DS were not benign. The unpleasant odor of stool and gas and the frequent abdominal bloating were the price to pay for these patients and it was a major preoccupation for many of them. However 95% of patients declared themselves satisfied despite this handicap and no one has required reversal of the procedure for this reason." (1428) In the same way that RNY patients accept "dumping", DS patients accept stronger odor of gas and stool.

Statistics on Possible Risks and Complications

Marceau et al [2] reported that over 15 years of follow-up...

• Revision for protein malabsorption or diarrhea was required in 9 cases (0.7%). Of those nine, six had their alimentary and common channel lengthened and in 3 the diversion was reversed.

• Kidney stone incidence increased from 6.3% prevalence before surgery to 14.8% during 15 years of follow-up. This is not different than the reported 16% during 11 years of follow-up after long Roux-en-Y gastric bypass. [16], [18]

• Bowel obstruction in 6% of patients which required a laparotomy for intestinal obstruction during the 15 years of observation.

• Incisional hernia was repaired in 13% of patients and is within expected outcomes after major abdominal surgery.

Hess et al. [1] reported the following major complications after DS in the first 1,300 patients (42% of patients with a BMI > 50)...

• Gastric leaks 0.7%
  
• Mortality 0.57%
  
• Reversal 0.61%
  
• Revisions 3.7% (22 were for excess weight loss and protein deficiency and 2 were for frequent diarrhea. In these cases the common channel and alimentary limb were lengthened. 7 revisions were for inadequate weight loss and the common channel was shortened.