Performing Duodenal Switch
Why don't more bariatric (doctors specializing/treating obesity) surgeons offer the Duodenal Switch procedure? Where is the answer to this question?
Is Duodenal Switch a more complicated procedure than Gastric Bypass, and other weight loss operations?
Duodenal Switch (DS) is a complex procedure to learn and perform safely. Duodenal Switch involves division of the duodenum (part of small intestine) as it wraps around a number of organs and structures in a very densely packed area. The head of the pancreas, common bile duct (carries bile to duodenum), and other vital structures are in very close proximity of the duodenum where it needs to be divided. There is potential injury to these adjacent organs. Just as important, if not more so than the technical considerations, are the follow-up requirements. Patients considering DS, should commit themselves to a proactive supplement regiment with the help of a surgeon who appreciates the gravity of nutritional, mineral and vitamin deficiencies after DS. Ensure you have a very experienced surgeon to perform this procedure who not only has the technical capabilities, but also the structured follow-up.
It is in the patient's best interest to continue receiving follow-up care from their Duodenal Switch surgeon to ensure proper health is maintained. Note that some surgeons 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. 
The BPD-DS operation is a "complex" operation with at least 4 suture-lines. The duodenal-jejunal is the most complex anastomosis.
Robert A. Rabkin, MD, FACS, "The Duodenal Switch as an Increasing and Highly Effective Operation for Morbid Obesity", Jun 2004, pg 863. 
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. 
DS usage continues to expand, based on patient demand and growing awareness of the advantages of this established hybrid procedure. Even more so as the high rate of failed Gastric Bypass, Gastric Banding and, to some degree, Sleeve Gastrectomy is becoming more aware.Click here to read about the first DS patient.