To compare DS/BPD to other surgeries, one must fully understand the surgical procedure first. With duodenal switch surgery, nearly 70% of the stomach is removed, and the digestive tract is altered. Two separate pathways are created to the Common Channel (CC), a portion of the small intestine that connects to the large intestine.
- The Digestive Loop (DL) is the pathway that takes food from the stomach to the CC.
- The Biliopancreatic Loop (BL) carries bile and juices from the liver to CC to be combined with food to digest.
Here, we compare DS to gastric sleeve. RNY gastric bypass, gastric banding, and SADi-S.
Benefits/Advantages of Duodenal Switch
Compared to gastric sleeve
Gastric sleeve and duodenal switch produce substantial and sustainable weight loss. Both procedures resect the stomach to create restriction, 85% and 70%, respectively. In both procedures, the pyloric valve stays intact.
Duodenal switch is more aggressive as it creates the malabsorption component to absorb less fat and calories. Duodenal switch patients enjoy a higher weight reduction that lasts longer. They also have higher remission rates for diabetes type 2, etc.
Compared to gastric bypass
Both gastric bypass and duodenal switch use a combination of restriction and malabsorption methods to produce a high level of weight reduction. However, duodenal switch sees much higher weight loss rates, almost 50% more than gastric bypass after one-year and two-year post-op benchmarks. In a 10-year period, gastric bypass patients see 25% overall weight loss, while duodenal switch patients see 60-70% in eight years.
According to various studies, the surgery has a 98% or higher cure rate for Type 2 diabetes. This occurs almost immediately following surgery due to the metabolic effect from the switch of the intestine and its tract. The surgery also cures 92% of sleep apnea patients. Unlike Roux-en-y gastric bypass patients, DS patients do not experience dumping syndrome symptoms because of the preservation of the pyloric valve between the stomach and small intestine.
U.S. News Health found that the duodenal switch is more successful at maintaining weight loss than gastric bypass surgery. Because of the preservation of the pyloric valve, many complications associated with gastric bypass surgery are avoided. Also, the malabsorptive component of the surgery is fully reversible, unlike other surgeries that are permanent.
Compared to SADi-S (BPD/DS vs. SADi-S)
Single-anastomosis duodenoileal bypass with Sleeve gastrectomy (SADi-S) is a less complex version of BPD/DS with less operative time, morbidity, and mortality. Both procedures result in significant initial and long-term weight loss, as well as resolution of comorbidities.
SADi-S is a less aggressive operation and is reserved for patients with lower BMI (50).
Conventional DS operation may result in a slightly higher excess weight reduction as their underlying mechanisms for weight loss are somewhat different. Regarding variations in glucose, glucagon, insulin, and C-peptide levels, DS/BPD presents lower limits.
Advantages
The duodenal switch is the mother of all bariatric surgeries and has the most definitive results. Compared to gastric sleeve, gastric bypass, and other bariatric surgeries, a post-op diet for duodenal switch patients is more normal and tolerated.
Disadvantages
While risks early on are higher with duodenal switch than any other weight loss surgery, the complication rate is low compared to those initial risks. Also, the duodenal switch surgery takes, on average, 20 minutes longer to perform and is associated with a longer hospital stay (3-5 days versus 2-3). Duodenal switch patients also typically undergo open surgery associated with a longer recovery time, while gastric bypass and sleeve patients have laparoscopic surgery.
Also, because of rapid weight loss, many patients experience gallstone post-op. Because of this increased risk, many surgeons suggest removing the gallbladder during surgery as a preventative measure, which further extends the recovery process.
Duodenal switch patients also have a higher occurrence of diarrhea or loss, frequent bowel movements after surgery, as well as foul-smelling gas, and frequent flatulence. Both of these things can be resolved with a low-carb diet.
While the restrictive portion of the surgery isn’t reversible, some duodenal switch patients see expansion in their stomach area over time. This causes a reversal from stretching to occur, which may increase GERD symptoms in the future. This is seen only in duodenal switch surgery patients.
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