Duodenal switch Overview

Duodenal switch, which can also be called biliopancreatic diversion with duodenal switch, is a surgery for obesity that ensures the best long-term success in the excess weight loss when compared to other weight loss operations. However, duodenal switch surgery is not as popular as other weight loss operations. This is caused by the fact that duodenal switch bariatric surgery is a longer and more complex procedure than a gastric bypass or a gastric band.

Doctors may recommend the biliopancreatic diversion with duodenal switch (bpd/ds) to:

• people who suffer from morbid obesity and have a body mass index (BMI) of 50 and more
• people with a BMI of 35-40 and more with the developed type 2 diabetes and other obesity-related medical conditions such as sleep apnea, non-alcoholic fatty liver disease, heart disease, high blood pressure, lung disease, or high level of cholesterol.

So what actually is duodenal switch?

DS switch is a combination of a gastric sleeve and gastric bypass surgery as it involves both restrictive and malabsorptive aspects:

1. the restrictive aspect of the duodenal switch procedure:

• during the bariatric surgery, the patient’s stomach size is reduced by approximately 70-80 percent along the greater curvature.
• the most of the duodenum, which is the first part of the small intestine, is also removed but the normal connection between the stomach and the remaining part of the first intestine is preserved.
• the amount of food that the patient can eat during one meal is limited, which lowers appetite and helps to feel satisfied by consuming smaller portions of food.

2. malabsorptive aspect of the duodenal switch procedure:

• malabsorption of calories is created when the consumed food gets through the stomach to its normal entry into the intestine and then, it is re-routed and reconnected farther down the intestine.
• digestive juices and bile cannot start processing the food when it gets down the intestine, resulting in the less caloric absorption and the desired weight loss effect.

How does duodenal switch work?

Biliopancreatic diversion with duodenal switch is a combined malabsorptive and restrictive weight loss surgery. This means that thanks to this bariatric surgery, the amount of food that can be consumed is decreased by reducing the size of the stomach as well as the number of calories that can be absorbed by the small intestine is decreased by reducing the length of the intestine that comes into contact with the consumed food.

The specifics of the surgery depend on the patient’s individual situation and the surgeon’s practice in the hospital. BPD/DS is usually performed as a single surgery, however, in some circumstances, usually, when the patient is extremely overweight, the procedure may be performed as two separate operations – sleeve gastrectomy is done first followed by the small intestine bypass once the patient’s significant weight loss can be observed, which is usually about 12-18 month after the first operation.

Generally, there are two different ways of performing the gastric duodenal switch:

• a traditional surgery that involves open incisions in the abdomen
• a laparoscopic duodenal switch, where the multiple small incisions in the patient’s abdomen are made to insert the surgical instruments and a special camera Laparoscopic duodenal switch can help patients recover more quickly and reduces the risk for complications, such as infections.

The reason for creating the bypass is to reduce the amount of time the food is processed in the small intestine. The body has less time to absorb nutrients and calories, especially fat. After the biliopancreatic diversion with duodenal switch, the patient’s body can absorb only approximately 20 percent of the fat they consume.

It is very important to remember that the pre-surgery period is crucial for all types of bariatric procedures and the surgeons and medical staff in every clinic provide patients with pre-surgery instructions and DS switch requirements to follow. They also prepare a list of all necessary things that the patient should have in the hospital, such as documents, clothing, cosmetics, etc. The patient can also be asked to begin the pre-op diet at least 2 weeks prior to surgery to start the weight loss process.

The duodenal switch procedure is performed in the clinic or a surgery centre using general anaesthesia.

How is duodenal switch surgery done?

There are two methods – DS switch surgeons can conduct a stomach operation using a laparoscopic technique or a traditional operation. However, laparoscopy is preferred both by the surgeons and the patients as the risk of the postoperative complications is much lower. The laparoscopic duodenal switch means that in order to avoid open, more invasive surgery, the surgeons make small incisions in the patient’s abdomen to insert small instruments into the abdominal cavity. They are guided by a special video camera and a surgical telescope.

How long does a duodenal switch take?

The procedure may take a few hours and there are two steps of the surgery:

• sleeve gastrectomy which takes from 45 to 60 minutes
• laparoscopic duodenal switch which takes longer to complete, approximately between 90 and 120 minutes.

After the surgery, the patient can be discharged home after 2 or 3 days stay in the hospital after the procedure, however in the case when the patient’s BMI is very high (more than 40) or he/she has some other serious obesity-related health problems, the stay in the hospital can be prolonged to make sure that no complications occur.

How is a duodenal switch performed?

Patients are always curious about what happens during a duodenal switch surgery because it means a major change in their bodies. The laparoscopic duodenal switch bariatric surgery is a complex procedure that consists of two basic steps.

1. Firstly a gastric sleeve surgery is performed. After making the incisions, a large part of the stomach pouch (up to 80 percent) is removed with a stapling instrument and a remaining part from the top to the bottom of the stomach is formed into a narrow sleeve or tube that can store less amount of food, which helps patients to feel full more quickly after a meal. The pyloric valve is left intact to make sure that the food is released to the restricted part of the small intestine (duodenum) in a normal way.
2. The second step of the gastric reduction duodenal switch involves the small intestine being rerouted to significantly reduce the absorption of calories. One cut is performed through the upper part of the small intestine, below the duodenum, and the second one farther down near the end of the small intestine. In this way, the first section of the small intestine is divided and connected to the last 250 – 400 cm of the small intestine to create a shorter separate pathway for food which is called alimentary limb or AL. In this channel, only the absorption of calories from simple carbohydrates can occur. The remaining much longer top half of the small intestine, the biliopancreatic limb, carries only digestive juices (bile and pancreatic juice). The two pathways meet at the end to create a 100 – 300 cm long common channel leading to the colon (large intestine). In the common channel, the food and digestive juices mix, the food can be fully processed and the absorption of nutrients and calories from complex carbohydrates and fats can take place.

At the end of the surgery, the surgeon needs to check that there are no areas of leaking and then the instruments are withdrawn and the incisions closed using the absorbable sutures and the sterile tape.

Usually, the patient is required to stay in the hospital for around 2- 3 days, and for the first 2 or 3 weeks after the surgery, the patient should not go back to work and everyday responsibilities and take extra care of yourself

Once the patient is awakened from the general anaesthesia, he/she may feel dizzy and sore, but the pain control medications will surely help to get relieved from the pain. The pain is manageable and can be compared to the pain after other laparoscopic procedures. The medical staff usually encourage the patient to stand up and move as soon as possible to speed up the healing process and reduce the risk of blood clots. After 2 or 3 days in the hospital, the patient is usually discharged home but it is important to remember that for the first 2 or 3 weeks after the surgery, patients should not go back to work and everyday responsibilities. 

The full duodenal switch recovery time is about 4 to 6 weeks. This means that their family and work-life will be affected by their absence (child or pet care, work requirements, etc.). That is why they should also remember that it is important to ask a close person to help and assist during the recovery time, especially right after the procedure. It is common and completely understandable that patients feel weak and tired after being discharged from the hospital because their body gets used to smaller amounts of food, but their physical condition gets better day by day.

The smaller stomach may be sensitive at first, so the doctor usually prescribes pain and digestion medications. Patients start on a liquid diet and then slowly move on to solid food. The patient should also go back to, or start, regular physical activity, and exercise to speed up the recovery process.

Experts agree that the results of a duodenal switch surgery are excellent, much better than in the case of other weight loss operations such as gastric bypass.

To prevent vitamin deficiency after the surgery, there may be a need to take minerals and other nutritional supplements for the rest of the patient’s life

Usually, patients lose approximately 70 to 80 percent of the excess weight in two years after the stomach surgery for weight loss. However, patients who choose this type of bariatric surgery are more likely to have nutritional deficiencies than with other types of weight loss operations. 

Fortunately, it is possible to prevent malnutrition after the DS switch by taking duodenal switch vitamins, minerals, and other nutritional supplements but it is likely to be necessary for the rest of the patient’s life. The amount of duodenal switch vitamins that should be taken by the patient depends on the level of malabsorption after the duodenal switch, but it usually means taking 10 to 15 pills per day.

If the person stops taking the prescribed vitamins, he/she will be twice as likely to develop a vitamin deficiency which can become a life-threatening problem. The patients should remember that they cannot take any vitamins or other supplements without consulting their doctor. 

Usually, the list of the prescribed supplements includes multi-vitamin and mineral supplements with additional calcium, iron, probiotics with the beneficial intestinal tract bacteria, fat-soluble vitamins in a dry form (A, D, E and K), additional copper and zinc.

A lot of patients ask what to expect after duodenal switch surgery in the long-term perspective. Most patients who decide to undergo this type of weight loss surgery report lasting results and success in excess weight loss.

The major advantages of the life after the duodenal switch:

• the lifestyle changes are not as radical as they are usually with other types of bariatric surgery
• the body is not able to digest all the food that the patient consumes, but the portions of food that can be eaten are substantially larger when compared to other bariatric post-op diets
• the possibility of eating larger meals and still being able to maintain the sustained weight loss increases the patient’s satisfaction and encourages the prospective patients to undergo this type of weight loss surgery
• duodenal switch preserves the outlet muscle called the pylorus that controls the function of stomach emptying, so the risk of a “dumping” syndrome is very low
• patients observe a significant improvement in the treatment of obesity-related health problems such as type 2 diabetes (90 percent chance of resolution), hypertension (approximately 75 percent chance of resolution), obstructive sleep apnea, liver disease, asthma or high level of cholesterol
• patients no longer experience the inconveniences of being overweight such as difficulties in breathing, back or legs pain
• the change in the lifestyle after the DS switch means an improvement in the patient’s psychological health and social life.
• people after duodenal switch are no longer prone to obesity discrimination, they are treated with more respect which re-builds their self-confidence.

The patients should not forget that the restrictive diet should be accompanied by regular physical activity and exercise, at least 2 to 3 hours per week. This leads not only to the sustained weight loss, but also a better physical condition improvement.

Duodenal switch post op diet

Patients often wonder what to eat after duodenal switch surgery. They do not have to worry, because the doctors will make sure that the post duodenal switch diet is adjusted to the individual needs of the patient:

• immediately after the biliopancreatic diversion with duodenal switch, the patient can drink liquids but no solid food is allowed because the stomach and intestines begin to heal
• after the surgery, a special diet plan needs to be followed to make sure that the transition from liquids to puréed and solid food does not happen too fast and the patient’s body is able to tolerate these kinds of food
• the duodenal switch diet after surgery is quite restrictive but you will be allowed to eat larger portions of food than in the case of other weight-loss operations.
• there are specified limits on how much and what a person can eat and drink.
• the doctors always recommend the appropriate duodenal switch vitamins and mineral supplements to prevent micronutrient deficiency.
• the transition to the long-term duodenal switch diet takes up to 4 weeks, depending on the patient’s healing process and the surgeon’s recommendations.

The good news is that the restrictive diet may not be as hard to keep as people imagine. The patients usually permanently feel less hungry than before the surgery. The feeling of hunger is caused by the hormone called ghrelin which gets into the bloodstream when the stomach is empty and causes the brain to generate hunger impulses. After the meal, the level of ghrelin drops and then slowly rises until the person eats another meal. The smaller stomach after duodenal switch means the smaller amount of ghrelin that is secreted into the blood. Less ghrelin in the system means that the patient feels less hungry and keeping up a post duodenal switch diet is no longer a challenge.

Usually, the weight loss after duodenal surgery is around 70 to 80 percent of the excess weight in two years, but the patient needs to be careful about nutritional and vitamin deficiencies as this happens very often after this weight loss surgery

The long-term success of the duodenal switch surgery is the highest seen in the field of weight loss surgery. It has been proved by the study conducted at Madigan Army Medical Center, Fort Lewis, Washington, that compared patients who had a duodenal switch surgery with those who had gastric bypass surgery. It appears that patients after the DS switch had more successful sustained weight loss. Two years after the weight loss surgery, the DS patients maintained the average weight loss at the level of 79 percent whereas patients after the gastric bypass surgery only 67 percent. During the same study, it was observed that 20 percent of gastric bypass patients who had their follow-ups after 1 and 2 years since the surgery, failed to lose half of their excess body mass index, while DS switch surgery patients had only 9 percent failure after year 1 and 6 percent failure after year 2.

With the DS switch, the patients are expected to lose approximately 70 to even 100 percent of the excess body weight within the first 2 years after the surgery. As it is true in the case of other bariatric surgeries, medical consultations and follow-ups are necessary to ensure long-term success.

The major factors that contribute to the high effectiveness of the weight loss surgery duodenal switch include:

• reduction of the caloric intake
• decreased absorption from food
• lowering the level of ghrelin, the hunger hormone
• reducing the body’s need to store energy in the form of fat
• the increased insulin sensitivity that contributes to resolving the type 2 diabetes.

Like after every surgery there are some risks and complications that may occur some of them are vomiting and nausea, breathing problems, or vitamin deficiency

All weight loss operations involve a degree of risk, however, the risks associated with severe obesity are much more dangerous for people’s health. Duodenal switch is a technologically advanced laparoscopic procedure which means that the risk of complications is lower than in the case of traditional open surgery. However, patients should be aware that their weight before the surgery and the so-called comorbidities have a strong impact on the duodenal switch complications they may experience.

In the article “Duodenal switch: long-term results” published by NCBI (National Center for Biotechnology Information), which summarizes 15 years of the surgical experience with duodenal switch, we may find information that the survival rate after biliopancreatic diversion with the duodenal switch was 92 percent and the risk of death (Excess Hazard Ratio – EHR) was 1.2, which is that of the general population.

However, there are duodenal switch problems and complications that patients should be aware of.

The most common short-term biliopancreatic diversion with duodenal switch complications reported by patients include:

• vomiting and nausea which can last for about a week after the surgery.
• possibility of wound infections
• mild excessive internal bleeding and leaks
• breathing problems

Other duodenal switch side effects are similar to any abdominal surgery and are usually related to the adverse reactions to general anaesthesia.

Long-term duodenal switch problems may include:

• a small risk of the so-called “dumping syndrome” – patients who experience this complication suffer from diarrhoea, nausea,
• cramping, sweating, or vomiting after eating too large portions of food containing sugar of carbohydrates
• vitamin deficiency
• malnutrition

Vitamin deficiency

It is one of the most serious problems as, due to the DS switch procedure, the absorption of vitamins (especially the fat-soluble vitamins A, D, E and K) and minerals (iron, calcium and protein) is smaller than before the operation. That is why the vitamin levels after the surgery must be controlled regularly. 

Also, there is approximately 10 percent risk of severe malnutrition, especially in the case when patients do not take the recommended daily amount of proteins. In such cases, it might be necessary to reverse the bypass element of the duodenal switch surgery. That is why it is so important to participate in the long-term follow-up programme to monitor the patient’s health after the surgery.

Other issues that patients may experience after any weight loss surgery include digestion problems:

• about 1 in every 5 duodenal switch patients experience gastroesophageal reflux disease (GERD) in the first 12 months after the surgery. Fortunately, after 3 years, the percentage of patients experiencing GERD drops to around 3 percent.
• patients are likely to experience more frequent and loose bowel movements (2 or 3 per day)
• the decreased absorption of food after the DS switch may cause increased flatulence and foul-smelling stools, diarrhoea or loose stools and indigestion.

The major reason behind the digestion problems is the fact that the body no longer absorbs all the fat that is consumed. Also, the complex carbohydrates may not be processed in the small intestine and proceed to the large intestine, where the carbs are metabolised by bacteria causing flatulence. Therefore, it is important to keep a well-balanced low-fat and high-protein restrictive diet that helps to prevent these problems.

Sagging skin

It is another problem that may have a negative impact on the patient’s quality of life after surgery and weight loss. Skin usually loses its flexibility after years of being stretched out to accommodate the excess weight and after losing weight the extra skin can be considered not only unattractive but can also cause physical problems such as skin rashes and infections. For some patients, body-contouring undergarments may help, but sometimes a plastic surgery after weight loss is needed.

Weight regain

It is one of the most feared duodenal switch surgery complications, however, the good news is that this is much less of an issue after DS switch than after other types of bariatric surgeries. There are three major aspects that contribute to sustained weight loss without weight regain:

• Restriction – the size of the stomach is reduced by approximately 70 percent and is able to store less amount of food
• Malabsorption – duodenal switch has a much smaller degree of the calorie absorption than other bariatric procedures
• Reduced hunger – secreting of the hunger hormone ghrelin is decreased thanks to the smaller stomach, which results in reducing the patient’s appetite

When searching for different gastric surgery types, patients may often find information that gastric sleeve or gastric bypass are the best methods, probably because they are the most popular bariatric surgery procedures types and biliopancreatic diversion with duodenal switch (bpd/ds) is relatively new. However, as it was already presented in the previous parts of the article, the weight regain in the case of a duodenal switch procedure is much lower when compared to other methods.

The most popular types of gastric surgery that can be alternatives to duodenal switch surgery are gastric sleeve and  gastric bypass.

Duodenal switch vs gastric sleeve

Gastric sleeve, also called sleeve gastrectomy, is a popular bariatric surgery that involves removing 70-80% of the stomach. During this procedure, a small sleeve-shaped pouch is created and the other part of the stomach is permanently removed. Weight loss surgery duodenal switch is a newer procedure than gastric sleeve surgery. It has become an option for people who are not satisfied with the effects of the gastric sleeve operation because it provides the highest average expected weight loss available and the best remission of comorbidities. It is considered the best option for severely obese patients that require immediate weight loss.

Both procedures work on the same principle – restriction, but, in the case of DS switch, the malabsorptive function is even more important. Unlike the duodenal switch, the gastric sleeve does not involve the manipulation of the intestine and altering the natural path of digestion. Also, gastric sleeve patients need to take less vitamin and mineral supplements, because the risk of deficiencies and the related complications is much lower.

Another duodenal switch vs gastric sleeve difference can be observed in the length of the surgery. Gastric sleeve is a much simpler operation to perform and it usually lasts about 1,5h, whereas the duodenal switch operation may last 3 to 4 hours as it involves two steps – sleeve gastrectomy followed by duodenal switch. Also, the cost of duodenal switch is higher than that of the gastric sleeve, which is understandable since the sleeve gastrectomy is a part of the more complex duodenal switch procedure.

Duodenal switch vs. gastric bypass

Gastric bypass (also called Roux-en-Y Gastric Bypass) can be described as creating a new, tiny stomach pouch that can store the only 30ml of food. During the procedure, the surgeon transects the stomach to divide it into a small upper pouch and the larger lower pouch, which is excluded from digestive processes and then connects them to the small intestine. Also, the portion of the small intestine is bypassed.

How is duodenal switch different from gastric bypass?

Duodenal switch is a newer procedure than the gastric bypass and is usually recommended for morbidly obese patients whose BMI is highest than 50. Both procedures have restrictive and malabsorptive functions (to a greater extent in the case of DS switch).

Another duodenal switch vs gastric bypass difference is the fact that gastric bypass involves creating a new, smaller stomach whereas in the DS switch surgery, the stomach’s size is reduced. Also, the time of the operation and the period of recovery are longer in the case of the duodenal switch surgery.

All bariatric surgeries are quite expensive. The cost of duodenal switch is higher when compared to other less complex and invasive methods such as sleeve gastrectomy or gastric bypass. In the case of duodenal switch UK, patients have three options available; they can apply for surgery on the NHS, they can choose a private clinic, or they can try medical tourism and find this type of surgery available in the hospital abroad.

Duodenal switch surgery on NHS

The NHS covers the cost of the duodenal switch surgery if the patient meets specific requirements:

• the patient needs to apply for the surgery
• he/she is studied by a number of specialists who decide if it is safe and beneficial for the individual to undergo this type of bariatric surgery
• to be considered for the surgery, the patient’s BMI should be 40 or above
• if the person suffers from obesity-related medical conditions that can be improved by the DS switch, such as type 2 diabetes, the body mass index can be lower, above 35
• people with BMI above 50 have the best chance for the NHS refund because  the duodenal switch is the most successful in the cases of the morbid obesity
• the candidate needs to prove that he/she attempted all the possible methods of losing weight without any success and is determined to completely change the lifestyle.

The duodenal switch cost in private clinics varies across the UK and the patient needs to conduct thorough research before he/she chooses the best clinic with the most attractive offer. There are hospitals that offer the procedure at around 10 000 GBP but in other clinics, the cost reaches even 13 500 GBP. Prices vary due to the different types of support and aftercare a person receives after the procedure. However, most clinics offer free consultations to the candidates.

Medical tourism in Europe gives patients many options for bariatric surgery abroad. The clinics offer high-quality treatments at great prices

Sometimes the cost of bariatric surgery in the UK is so high that people cannot afford it in their country. Patients often decide to choose weight loss surgery abroad, because the popularity of the DS switch method made it available at lower cost outside the UK. Although bariatric surgery abroad requires much more research than applying for surgery on the NHS, the possibility of saving a few thousand pounds is very appealing. Patients in the US must cope with a similar situation. There, the average cost of the duodenal switch surgery varies between 23 000 USD and 34 000 USD. That is why many people decide to use the benefits of medical tourism.

Most clinics abroad strictly follow the international guidance regarding patient assessment for the duodenal switch (BMI values, comorbidities, good attitude for surgery, etc.) to ensure the safety and effectiveness of the procedure. It is also a common practice to organize a medical consultation in the UK to make sure that the candidate qualifies for the procedure.

Medical tourism in Europe gives patients a great variety when it comes to the choice of destinations and available bariatric procedures. However, when comparing costs of the duodenal switch surgery in different countries, patients need to be aware that although the majority of clinics offer the whole packages, sometimes the given cost refers only to the price for the surgery. It may happen that services such as travel costs, stay in the clinic, consultations before the surgery, medications, anaesthesia, meetings with a dietician and psychologist need to be paid separately, which significantly increases the overall cost of the duodenal switch procedure. However, usually, even if the travel costs and the price of accommodation need to be paid separately, the cost of weight loss surgery abroad is still cheaper than in the UK.

Affordable bariatric surgeries are available in the majority of European countries, the leading regions being Poland and Turkey.

The most important advantages of duodenal switch abroad:

• medical services in these countries are cheap, but it does not mean that they are not the best quality.
• the patient risks absolutely nothing while the financial benefits are worth the effort
• travel costs are not as high as they used to be in the past.
• patients can choose from a variety of budget flight connections, getting to the destination place is fast and convenient
• patients should not worry about the language barrier as the medical staff speak English and other languages
• the clinics usually run their websites in English, so it is easy to get all the information about equipment, sanitary conditions,
• medical staff and organisation of the clinic
• the surgeons are qualified and licensed to perform weight loss operations
• there is a wide choice of accredited medical agencies offering weight loss procedures abroad. Usually, these organisations offer full all-inclusive packages with surgery, flights, stay in the hotel and the hospital post operation consultations and other aspects of the trip included
• the term medical tourism means that the patient will have a great chance to visit another country, plan some sightseeing, or other favorite activities during the stay
• patients can get secured for their medical trip, which makes their travel and stay abroad much safer. Clinic Hunter & AXA Partners have created a special medical travel shield dedicated solely to medical tourists.

Duodenal switch in Poland

Poland is considered to be one of the top European destinations for different medical and dental procedures. It is no wonder that the phrase “weight loss surgery Poland” is so popular among the candidates for duodenal switch surgery in Poland. The most important reason is the fact that Poland offers cheap prices for top quality, well-equipped clinics with experienced bariatric surgeons and qualified medical staff in the biggest cities including Warsaw, Cracow, Gdansk and Wroclaw. People in the UK and other European countries know that they can find convenient direct economy and business class flight connections to these destinations from most major European cities. The flight is short and lasts about 2 hours. Also, there is a great choice of medical agencies that can help potential patients find a suitable, preferably all-inclusive package at the price starting from 4000 GBP.

Turkey is a very popular destination among bariatric patients

Duodenal switch in Turkey

Weight loss surgery in Turkey is a very good option for people who want to combine surgery with a visit to an interesting multicultural country. The most popular clinics offering duodenal switch can be found in Istanbul, Antalya, and Alanya. Another key factor attracting potential patients is the low cost of bariatric procedures. Weight loss surgery cost Turkey varies from 2700 GBP to even 6700 GBP depending on the package and the clinic. The network of medical agencies that can help patients find the best destination and offer is also well-developed.

Duodenal switch before and after pictures of our patients are the best proof of the effectiveness of biliopancreatic diversion with duodenal switch surgery.

The laparoscopic duodenal switch surgery also called biliopancreatic diversion with duodenal switch (bpd/ds), is an innovative and effective method in the field of weight loss surgeries. This type of bariatric surgery is considered complex and quite invasive because the parts of the stomach are permanently removed and the small intestine is rearranged. However, this type of weight loss surgery is considered the most effective when it comes to sustained weight loss without regaining and reducing the obesity-related medical conditions such as type-2 diabetes or hypertension. The weight loss after the duodenal switch is the greatest when compared to other procedures. Patients are expected to lose approximately 70 to 100 percent of the excess body weight within the first year after the surgery. The procedure is recommended to people with morbid obesity whose BMI is 40 and more or for those who have lower BMI but suffer from the so-called comorbidities.

The procedure is complex and consists of two steps:

• during the first one, sleeve gastrectomy, the size of the stomach is reduced by 70 to 80 percent in order to store less amount of the consumed food.
• the second step of the gastric reduction duodenal switch involves rerouting of the small intestine and forming two limbs: a short, alimentary limb for food and the long biliopancreatic limb that carries only digestive juices. Both limbs meet at the end to form a common channel where the food can be fully processed and calories absorbed by the body.
  In this way, the two major functions – restrictive and malabsorptive are achieved.

Complications after duodenal switch may include digestion problems such as:

• reflux
• frequent bowel movements
• diarrhoea
• foul smelling loose stools
• flatulence

These inconveniences may be reduced by keeping low in fat and high in protein restrictive, well-balanced diet that is adjusted to the individual needs of the patient.

One of the greatest challenges after the procedure may be the necessity to take vitamin, protein, and mineral supplements for the rest of the patient’s life due to the malabsorption. Duodenal switch requires a special post operation diet, which at first is based on fluids only, but in the long-term perspective the DS patients’ diet is considered less restrictive than in the case of other bariatric surgeries. Also, patients are less likely to feel hunger thanks to the reduction in secreting of the hunger hormone, ghrelin, to the blood system.

In order to undergo a biliopancreatic diversion with duodenal switch (bpd/ds) patients can:

• apply to the NHS, fulfil all the requirements and have the procedure refunded by NHS
• choose a private clinic, which can be quite expensive in the UK
• choose a less expensive alternative of weight loss surgery abroad

For European patients, the best bariatric surgery destinations are Poland and Turkey where patients may find offers with the same quality of  bariatric procedures at a price even a few thousand pounds lower.

Undergoing bariatric surgery is a life-changing decision and patients need a good attitude that would help them get through all the complications and downsides to achieve a better quality of life without the excess weight.

https://brisbaneobesityclinic.com.au/procedures/duodenal-switch/

https://www.obesityhelp.com/articles/17-things-you-should-know-about-the-duodenal-switch-ds/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC556277/pdf/11695_2017_Article_2680.pdf

https://www.soard.org/article/S1550-7289(06)00779-9/fulltext

https://pubmed.ncbi.nlm.nih.gov/22987179/

https://jamanetwork.com/journals/jama/article-abstract/199587

https://pubmed.ncbi.nlm.nih.gov/22425057/

https://www.healthcentre.org.uk/weight-loss-surgery/weight-loss-surgery-duodenal-switch-cost.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3938871/

https://www.sciencedaily.com/releases/2012/09/120917161416.htm

https://pubmed.ncbi.nlm.nih.gov/18219767/