The duodenal switch (DS) procedure involves a sleeve gastrectomy in combination with surgical bypass of the majority of the small intestine.
The duodenal switch causes marked malabsorption of fat and to a lesser extent carbohydrate. Consequently patients cannot absorb the fat-soluble vitamins (A, D, E and K) and need high dose supplements for life, including vitamins A and D, calcium and multivitamin / mineral supplements.
The duodenal switch is an operation that should be used with great caution in designated centres of expertise. Even though we at Phoenix Irish Health have a great deal of experience with this operation it still accounts for just 2% of our total workload.
A major concern after such an extensive intestinal bypass is the potential for protein energy malnutrition. Unlike older malabsorptive procedures, the duodenal switch does allow a degree of protein absorption, however strict compliance with a high protein (>100g/day) diet is essential if protein deficiency is to be avoided. Vigilant post-operative follow-up and regular blood tests (including vitamin A and D3 levels) are mandatory.
The duodenal switch has the lowest incidence of weight regain of all bariatric operations, the best results in the heaviest patients (BMI >60), the best excess weight loss (about 90%) and the best diabetes resolution (more than 90%). But all of this success comes at a price. Duodenal switch operations should only be performed on patients who are incredibly well motivated and will commit to regular, on-going follow-up.