The Medical Minute: When duodenal switch may be the best weight loss option

A less-common form of bariatric surgery can help the heaviest patients reach an ideal weight, but it's not for everyone.

Biliopancreatic diversion with duodenal switch – or “duodenal switch” for short – isn't a new procedure. A father-son team came up with it in 1984. But only a few surgeons in each state are performing the technically difficult operation laparoscopically.

Dr. Ann Rogers, director of Penn State Hershey Surgical Weight Loss, performs the procedure.

The two most common forms of bariatric surgery in use at Penn State Hershey are gastric bypass and vertical sleeve gastrectomy.

In the bypass, surgeons divide and reconnect portions of the stomach and small intestines to make a smaller stomach pouch and shorter path for absorbing food. The sleeve removes much of the stomach, leaving only a vertical, sleeve-shaped portion. Both procedures typically result in patients losing a third of their starting body weight.

The duodenal switch combines a bit of both to seriously limit the body's ability to absorb calories, but also vitamins and minerals in food. Patients typically lose more weight with the procedure, and faster. Most of the weight loss occurs within the first year or 18 months after surgery, and almost all patients can expect to get to an ideal body weight.

“If someone comes in weighing 300 pounds and we can get them down to 200 with one of our more common operations, that is often good enough,” Rogers said. “But if someone comes in weighing 600 pounds and they get down to 400, they are still morbidly obese. The duodenal switch is the only operation we have where we are likely to help them get to an ideal body weight.”

That's why the duodenal switch can be a better option for the heaviest patients – or those who have had a sleeve gastrectomy and need to lose additional weight.

Along with the potential for more benefits comes the potential for more complications, though, unless patients follow a strict post-operative regimen.

After undergoing the duodenal switch, patients must be willing to follow a much more rigorous diet and take nutritional supplements. They also need routine blood testing and frequent follow-up with their doctor.

“That's hard for a lot of people,” Rogers said. “You have to be good as gold with this procedure in order to be successful.”

Those who don't follow the program can experience unpleasant side effects such as chronic diarrhea, or more serious health complications and malnutrition. Rogers said she doesn't recommend the operation for patients who have gluten intolerance, Crohn's disease or advanced liver disease.

“This is something we have in our toolbox for patients in special cases,” she said. “But I don't put it out there for everyone. The patient has to ask me for this and convince me it is going to be a good choice for them.”

If you have questions about surgical weight loss options, join us for a web chat on Friday, Oct. 2 from 1 to 2 p.m. Log-on to abc27.com/chat to submit questions and participate in the web chat.

The Medical Minute is a weekly health news feature produced by Penn State Milton S. Hershey Medical Center. Articles feature the expertise of Penn State Hershey faculty physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

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