The duodenal switch or biliopancreatic diversion with duodenal switch, consists of the combination of two techniques: the gastric sleeve or tube, and the biliopancreatic bypass.

The gastric sleeve or tube provides the restrictive component (the size of the stomach is reduced and, with it, the amount of food that the patient can ingest), while the biliopancreatic bypass provides the malabsorptive component (the effective length is reduced of the intestine and, with it, the absorption of nutrients).

The restrictive component (sleeve or gastric tube) consists of a reduction of the stomach in which the pylorus (valve that regulates stomach emptying) is preserved.

On the other hand, the malabsorptive component (biliopancreatic bypass) consists of dividing the small intestine into two segments of different sizes that join in a common channel. The digestive segment is responsible for carrying food from the stomach to the common channel, while the biliopancreatic segment transports bile and pancreatic juice to the common channel. Thus, total digestion is carried out in the common channel which, because it is shorter, allows patients to absorb only 30% of fats and 80% of carbohydrates.

When is duodenal switch indicated?

The duodenal switch is indicated in the following cases:

• Patients with a Body Mass Index (BMI) greater than 40.
• Patients with a lower BMI who present comorbidities (obesity-related diseases) such as:
  • Type 2 diabetes mellitus (high blood sugar)
  • Arterial hypertension (high blood pressure)
  • Dyslipidemias (high cholesterol and triglycerides)
  • Coronary artery disease (heart disease)
  • Sleep apnea (snoring when sleeping)
  • Osteoarthritis (problems with the joints, ankles, knee and spine)

Expected results

The percentage of excess weight loss can be greater than 85% at two years. The greatest decrease occurs in the first months after the intervention, and then decreases progressively, until reaching the so-called “ideal weight”.

Advantages of the duodenal switch

• It is the technique that achieves the greatest weight reduction, greater than 85% of excess weight
• Removing the greater curvature of the stomach eliminates the production of the hormone ghrelin, which controls hunger.
• It maintains the pylorus and, therefore, the natural functioning of the stomach, avoiding rapid emptying which is one of the causes of the dumping phenomenon.
• Disappearance or clear improvement of diseases associated with obesity (hypertension, diabetes, arthropathies, sleep apnea, etc….)
• Allows a good quality of life.

Disadvantages of the duodenal switch

• This is a more complex technique to perform laparoscopically, so it is less used by most bariatric surgeons.
• Since this technique has a malabsorptive component, certain vitamins (A, D, E, K, ) and minerals (mainly iron and calcium) may be poorly absorbed, causing patients to have to take supplements for some reason. time of your life, as well as regular check-up blood tests.
• Dumping: Dumping syndrome is one of the most frequent causes of morbidity after gastric surgery. The syndrome is characterized by gastrointestinal and motor symptoms. Gastrointestinal symptoms include a feeling of fullness, cramps,nausea, vomiting and explosive diarrhea. Vasomotors include sweating, restlessness, weakness, flushing, palpitations, and an intense desire to stretch. The manifestations vary from one subject to another, however the simultaneous presence of both symptoms, gastrointestinal and vasomotor, is frequent. The presence of these symptoms leads the patient to voluntarily reduce their intake, and as a consequence, the patient becomes malnourished and loses weight.
• Formation of gallstones. Sometimes the gallbladder is removed during obesity surgery to avoid this possibility.

Intervention, postoperative and follow-up

The duration of the intervention is variable, depending on the characteristics of each patient. It can go from an hour and a half to three hours. The patient spends the first hours in the resuscitation unit or ICU, moving to her room afterwards.</ P>

Twenty-four hours after the intervention, a radiological control is performed, before restarting the progressive oral diet according to the bariatric surgery protocol.

Discharge occurs after 3 days. With strict observations.

After 8 days the patient can return to their usual activity, as long as they do not make physical efforts. After a month you can make physical efforts and play sports.

The diet is carried out in phases that go from liquids, blenders and soft drinks, to a varied diet but always in smaller amounts. Carbonated beverages should be avoided, and chew slowly.

It is prescribed in the first month, in addition to the gastric protector, a multivitamin, a protein supplement and, for 3 weeks.

In this technique, which has a greater malabsorption aspect, the need for more continuous supplements of fat-soluble vitamins and minerals is more common.

Monthly check-ups and follow-ups during the first six months and then annually, with the pertinent analytical studies.

Observations

Using this technique, not a single centimeter of the small intestine is removed, so the malabsorptive component of the duodenal switch is reversible.