Is The Gastric Sleeve With Duodenal Switch A Safe Form Of Bariatric Surgery?

Of the numerous different forms of obesity surgery that are now the vertical sleeve gastrectomy with duodenal switch is probably the most controversial and, although widely performed, there are a lot of bariatric surgeons who will not carry out the procedure as a result of worries about adverse long-term effects on health.

Frequently simply known as a duodenal switch procedure, this particular form of bariatric surgery is essentially a gastric sleeve with an added duodenal switch. This form of surgery is also sometimes called a biliopancreatic diversion with duodenal switch.

The first part of this procedure is a gastric sleeve in which the stomach is divided vertically and about eighty-five percent is permanently removed. The small remaining sleeve shaped stomach keeps the original stomach outlet to the intestines and functions very much as a normal stomach. This first part of the procedure is designed purely to restrict the amount of food which can be consumed and this restrictive surgery is not reversible.

The second phase of the procedure is to make the duodenal switch adding in an element of malabsorption surgery that is largely reversible. In contrast to restrictive surgery that leads to a loss in weight by preventing you from consuming too much food, malabsorption surgery contols the body's power to absorb calories from a meal as it passes through the digestive tract.

During the procedure the intestine is divided and a reasonably small section (usually about 150 cm long) is used to create a bypass from the duodenum, which lies close the outlet of the stomach, to a point close to the end of the intestinal tract thus bypassing the major part of the digestive tract. The result of this duodenal switch is that food that passes through the intestine only mixes with the digestive juices in the short final section of the intestine below the switch thereby giving the digestive juices little time to absorb calories from it into the body.

While the duodenal switch has the advantage of providing weight loss using both restriction and malabsorption, it is the degree to which the malabsorption element predominates when it comes to the duodenal switch which leads to a lot of the controversy surrounding this particular type of surgery. By comparison, the classical Roux-en-Y form of weight loss surgery makes use of a far shorter bypass and the length of intestine over which food mixes with the digestive juices is about five times greater.

The argument that is often used against the duodenal switch is that insufficient absorption takes place so that there is a great risk of protein deficiency, anemia and metabolic bone disease. The vertical sleeve gastrectomy with duodenal switch is also perhaps the most complicated type of weight loss surgery and a lot of surgeons think that it carries an unacceptable level of risk.

Regardless of the risks however the duodenal switch remains an option and can be very effective, especially in those patients with a very high body mass index (BMI).