Duodenal Switch

Biliopancreatic Diversion with Duodenal Switch (BPD) is a bariatric surgery that is both restrictive and malabsorptive, which means that it reduces a patient’s capacity for food and also changes the way that calories and nutrients are absorbed by the body. This surgery has been shown to be effective for patients with severe morbid obesity.

The Benefits of Duodenal Switch*

  • Biliopancreatic Diversion with Duodenal Switch resolves 99.1% of hyperlipidemia
  • Over 85% resolution rate of type 2 diabetes (T2DM)
  • Studies show excellent results in reversal rates of other obesity-related diseases such as Type 2 diabetes, sleep apnea, hypertension, high cholesterol, and high blood pressure
  • Patients typically lose 80-100% of excess weight within one year of surgery.

How Does Duodenal Switch Work?

In most cases, the Duodenal Switch procedure can be done laparoscopically to minimize scarring and improve recovery time. A portion of the stomach is removed and this creates a smaller capacity for food, reducing the amount that a patient can eat in one sitting. The first portion of the small intestine, called the duodenum, is divided and redirected, circumventing pancreatic and bile drainage. Then, the lower small bowel is connected to the duodenum to allow for food to pass through where the digestive juices don’t mix with it until it is almost to the colon. This step changes the way the body digests food so that fewer calories are absorbed.

Duodenal Switch Animation

Ask the Doctors- When can I resume activity?

apostrophe icon I have lost 205 lbs since my Duodenal Switch procedure. I feel AWESOME and am more active with my kids!
Ryan

Does Insurance Cover Duodenal Switch (BPD)?

You may have health insurance coverage for weight loss surgery such as Duodenal Switch, but bariatric coverage can vary from plan to plan and can be difficult to navigate. Contact TLC for a free insurance check and let our experts help you determine if your insurance plan will cover Duodenal Switch surgery.

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What if My Insurance Plan Doesn’t Cover Duodenal Switch (BPD)?

Some insurance plans do not offer bariatric coverage, or the requirements to cover weight loss surgery are so strict that patients prefer to self-pay. We want everyone to get the care they deserve, so we partner with medical financing lenders to offer payment plans and financing options for self-pay patients.

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Loop Duodenal Switch

If you are interested in losing weight using the Duodenal Switch (DS), you may be a candidate for the Loop Duodenal Switch also known as the Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy (SADI-S). The SADI-S is a variation of the Duodenal Switch procedure which requires just one anastomosis (intestinal connection) and may have favorable outcomes for some patients. Due to the single anastomosis, the SADI-S decreases the chance of complications that are increased with two anastomoses, such as a leak from the connection, not healing. In addition, it requires less operative time and reduces the risk of prolonged surgery-related complications.

Like the DS, the SADI-S is both restrictive and malabsorptive, meaning the size of the stomach is reduced and there is less absorption of calories. Weight loss is achieved by diminished appetite and capacity for food as well as reduced calorie absorption due to a reduction of the small intestine. In the Loop Duodenal Switch procedure, the small intestine retains more of its length in order to maximize the absorption of nutrients. Typically, there are fewer vitamin deficiency issues and diarrhea with this procedure when compared to a standard duodenal switch.

Benefits of Loop Duodenal Switch*

  • Lower risk of vitamin deficiencies compared with traditional Duodenal Switch
  • Studies show more than 90% of the patients experienced complete remission of Type 2 diabetes
  • Studies show hypertension was controlled in 98% of the patients and the remission rate was 58%

Duodenal Switch

Diagram depicting Duodenal Switch procedure

Loop Duodenal Switch (SADI-S)

Diagram depicting SADI-S procedure

Procedure Duodenal Switch Loop Duodenal Switch (SADI-S)
Bariatric Effect Malabsorbative & Restrictive Malabsorbative & Restrictive
Description
  • Reduces the size of the stomach by 2/3
  • 2X anastomosis for rerouting the bowel.
  • Reduces the size of the stomach by 2/3
  • 1X anastomosis for rerouting the bowel.
Purpose Decreases volume of food intake, reduces the calories and nutrients absorbed by the body Decreases volume of food intake, reduces the calories and nutrients absorbed by the body
Advantages
  • Improved glucose control
  • Less hungry
  • Reduced urge to eat
  • Fewer calories absorbed
  • Most weight lost in the first year
  • Achieves long-term weight loss
  • Improved glucose control
  • Less hungry
  • Reduced urge to eat
  • Fewer calories absorbed
  • Most weight lost in the first year
  • Achieves long-term weight loss
  • One fewer anastomosis or mesenteric window
  • Lower rate of complications
  • Lower instance of GI side-effects
Disadvantages
  • Some foods may not digest properly
  • May cause discomfort
  • Dumping syndrome can occur due to poor eating
  • Stomach can stretch due to excess food intake
  • Patients are required to take vitamins supplements in perpetuity
  • Patients required to supplement essential nutrients not absorbed through food intake
  • Two anastomoses
  • Longer surgery
  • Higher incidence of vitamin deficiency
  • Higher incidence of diarrhea
  • Some foods may not digest properly
  • May cause discomfort
  • Dumping syndrome can occur due to poor eating
  • Stomach can stretch due to excess food intake
  • Patients are required to take vitamins supplements in perpetuity
  • Patients required to supplement essential nutrients not absorbed through food intake
  • Newer procedure, so long term outcomes are not yet known
Complications
  • Abdominal pain
  • Acid reflux
  • Insufficient absorption of nutrients
  • Leakage
  • Malnutrition
  • Vitamin deficiency
  • Nutrient deficiency
  • Novel procedure with less clinical data
  • Leakage
  • Malnutrition
Recovery 1-2 days 1-2 days
Time Off Work 1-2 weeks 1-2 weeks
Complete Recovery 4-6 weeks 4-6 weeks
Excess Body Weight Loss 80-100% 80-100%

Patients Traveling from Out-Of-Town to TLC

For out-of-town patients, we offer some helpful tools and information to help you take the first step on the journey to a healthier life! By offering telemedicine appointments, virtual nutrition classes, and online support, it’s never been easier or more convenient to begin the process. All paperwork can be filled out online and follow-up appointments can be done over-the-phone. Contact us to get started.

Am I a Candidate for Duodenal Switch?

Duodenal Switch is a surgical option for patients with severe morbid obesity. As with any surgery, there are risks and medical factors to consider. However, the effectiveness of Duodenal Switch to improve and cure critical obesity-related conditions is an important advantage to patients suffering from obesity. Patients report a vast improvement to their quality of life after BPD. As with all weight loss surgeries, patients must be prepared to follow all dietary instructions and devote energy to living a healthier lifestyle.

Tips to Help Avoid Weight Gain After Surgery

Duodenal Switch surgery is a great procedure to help patients shed excess weight, in order to start living a more confident, healthy, and active life. After the surgery is complete, your journey is not over. Committing to your overall health and weight-loss goals will be ongoing and our team will continue to be your biggest supporter. Below is a list of our tips to help you keep the weight off:

  • Get creative with your diet and utilize nutritious ingredients.
  • Check out our blog for recipe ideas!
  • Exercise daily.
  • Make sure you have a positive support system.
  • Check-in with your physician or dietitian if you need support or guidance.
  • Keep in touch by following us on Instagram! We update our feed with healthy recipes, exercise tips, and inspiration as often as we can.

Pre-Surgery: Liquid Diet


2 Weeks Before Surgery

 

Protein Supplements (3 to 5 servings daily, 60-150 grams of protein daily)
Choose supplements with >20g of protein, <10 grams of fat, <10 grams of sugar, <250 calories per serving

  • Ready to Drink options: Premier Protein, Muscle Milk, Unjury, Iconic
  • Protein Powder options (mixed with ice, water/low fat milk/unsweetened nut milk, no fruit/vegetables): Bariatric Advantage High Protein Meal Replacement, Isopure, Orgain
  • Avoid: smoothies, food

Clear Liquids (+64oz daily)
Choose products with <50calories, <10g sugar per 8oz serving

  • Water with lemon, Crystal Light, G2/GZero, Proper, MiO
  • Decaf tea/coffee, herbal tea with sugar substitute
  • Sugar free gelatin/ice pops
  • Broth (store bought, homemade)
  • Avoid: any carbonated beverages, fruit/vegetable juice, soup

Post-Surgery Diet

Day 1-2 
+48-64oz Clear Liquids

  • Sip on clear liquids (same clear liquid options as pre-op): Crystal Light, G2, GZero, Mio, sugar free gelatin/ice pops, broth
  • Do not drink: carbonated beverages, caffeine, protein shakes
  • Avoid: drinking through straws, vitamins and do not eat any food.

Day 3-14 (2 weeks)
Full/Thick Liquids

  • Start slowly taking Bariatric vitamins
  • +48-64oz clear liquids
  • +40-60 grams of protein from 1-3 Protein Supplements (Ready to Drink, or protein shakes made with protein powder and water/low fat milk/unsweetened nut milk)
  • Smooth (strained) and thick, low fat soups (no rice/noodles, meats, vegetable pieces)
  • Smooth, low fat, low sugar Greek yogurt
  • Smooth, sugar free pudding

Day 15-28 (weeks 3 and 4)
Pureed Foods

  • +48-64oz clear liquids
  • +40-60 grams of protein from 1 – 3 servings of Protein Supplements (Ready to Drink, or protein shakes made with protein powder and water/low fat milk/unsweetened nut milk)
  • Protein foods: Mashed scrambled eggs, mashed white fish/tuna, finely minced ground turkey, cottage cheese
  • High fiber foods: Mashed beans, mashed fruits (bananas, raspberries, pears, etc), mashed vegetables (carrots, peas, cauliflower, avocado, etc.)
  • Plain, instant hot cereals

Weeks 5 and 6
Chopped Soft Solid Foods

  • +48-64oz clear liquids
  • +40-60 grams of protein from 1 – 3 servings of Protein Supplements (Ready to Drink, or protein shakes made with protein powder and water/low fat milk/unsweetened nut milk)
  • Protein foods: soft, tender meats (skinless, dark meat chicken, pot roast/roast beef, baked fish), eggs, low fat cheese, low fat deli slices
  • High fiber foods: beans, soft cooked vegetables, peeled fruits, high fiber crackers/breakfast cereals
  • Avoid bread, pasta, rice and tortillas for 6 months after surgery.

Week 7 and beyond
Chopped Solid Foods (Maintenance Phase)

  • +48-64oz clear liquids
  • +60-80 grams of protein from 1 – 3 servings of Protein Supplements (Ready to Drink, or protein shakes made with protein powder and water/low fat milk/unsweetened nut milk)
  • Protein foods: chopped meats, eggs, low fat cheese, deli meats
  • High fiber foods: beans, chopped and shredded raw/cooked vegetables, chopped fruits with skin-on, high fiber crackers/breakfast cereals

Am I a Candidate for Duodenal Switch?*

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*Duodenal Switch is a surgical option for patients with severe morbid obesity. As with any surgery, there are risks and medical factors to consider. However, the effectiveness of Duodenal Switch to improve critical obesity related conditions is an important advantage to patients suffering with obesity. Patients report a vast improvement to their quality of life after BPD.

*As with all weight loss surgeries, patients must be prepared to follow all dietary instructions and devote energy to living a healthier lifestyle. Specifically, with the Duodenal Switch procedure, it is crucial that patients are diligent with their follow-up care and take nutritional supplements.

Learn More About Duodenal Switch

The team at Texas Laparoscopic Consultants is committed to improving the lives of patients. Our renowned surgeons can discuss all available options to find the weight loss procedure that is right for you. Contact us today to learn more.

The TLC Surgery Doctors have either authored or reviewed and approved this content.

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