Duodenal switch

Duodenal switch surgery may be suitable for you if you are morbidly obese (have a BMI of 40 or above). Morbid obesity means you have a high risk of developing certain health conditions because of your weight.

The surgery may also be recommended if you have a BMI of 35 or above and have other weight-related health problems such as high blood pressure or type 2 diabetes.

To be considered for duodenal switch surgery you will need to demonstrate that you have tried other weight-loss methods without success. You will also need to pass a health check to make sure you are fit enough to undergo surgery.

Alternatives to duodenal switch surgery

At Circle Health Group, our expert surgeons offer several surgical procedures to help with weight loss. If duodenal switch surgery isn't suitable for you, talk to one of our consultants to discuss alternative treatments.

Alternative weight-loss surgeries offered by Circle Health Group include:

• Banded gastric band
• Banded sleeve gastrectomy
• Endoluminal sleeve
• Gastric band surgery
• Gastric bypass surgery
• Gastric sleeve (sleeve gastrectomy)
• Roux-en-Y gastric bypass (RYGB) surgery

At your first consultation, you will be seen by a consultant specialising in weight-loss surgery. This is typically a general surgeon or a bariatric surgeon. Your consultant will ask you about your general health and past medical history including any weight-related conditions. They will perform a physical examination.

If duodenal switch surgery is a suitable option for you, your consultant will explain all the implications of the procedure to ensure you fully understand what is involved. This may include:

• What happens during the surgery
• Risks and benefits of surgery
• What to expect during your recovery
• Changes to your diet and lifestyle after the procedure
• A lifetime commitment to follow-up appointments after your surgery

At Circle Health Group, your first appointment is very important as it's where we get to know you, discuss your expectations for treatment and encourage you to ask any questions you may have.

It's very important to us that you are as well-informed and comfortable as possible during your treatment, so please discuss any questions or concerns you may have at your appointment.

Do I need to lose weight before my surgery?

It is often the case that people having weight-loss surgery will need to lose some weight at home before we can book in your operation. Your consultant will let you know if this is the case, and our team will help you achieve the required weight loss.

Your consultant will tell you everything you need to do to prepare for your duodenal switch surgery. If there's anything you're not sure about, or if you have any questions about how to prepare for your surgery, speak to your consultant or call the hospital for advice. Being well-prepared for your surgery will help to ease any anxiety you may have as well as allow your surgery and recovery to go more smoothly.

Before your surgery, tell your consultant about any medical conditions or allergies you have and any medication, including over-the-counter medicines you are taking. Your consultant may tell you to stop taking some medications like blood thinners before your operation. This is to reduce the risk of bleeding during and after your surgery.

Around a week before your operation, you will need to attend a preoperative assessment to check that you are fit for surgery. This will include a blood test, chest X-ray and ECG.

You will not be able to eat or drink anything from midnight on the day of your operation.

What lifestyle changes can I make before my surgery?

Being in optimal health before your surgery can reduce the risk of complications and speed up your recovery.

To make sure you are as healthy as possible before your surgery:

• Eat a healthy, balanced diet with plenty of fruit, vegetables, lean proteins, and whole grains
• If you smoke, you will need to demonstrate that you have stopped at least four weeks before your surgery
• Avoid alcohol for a few days before and after your surgery. Alcohol thins the blood and can increase the risk of bleeding
• Take regular exercise

Duodenal switch surgery is performed under general anaesthetic, which means you'll be asleep for the procedure.

The surgery is normally performed laparoscopically (keyhole surgery) using a flexible camera with a light and specially designed instruments inserted into small incisions (cuts) in your abdomen. In some cases, the operation may be done as open surgery through a single large incision.

Duodenal switch surgery is performed in two stages. The operation normally takes between two and three hours.

Sleeve gastrectomy

During the first stage, known as a sleeve gastrectomy or a gastric sleeve, the capacity of your stomach is reduced by up to 70%. This is usually done using a surgical 'stapler', and your surgeon will leave a banana-shaped tube or 'sleeve' of your stomach for you to use from now on.

Intestinal bypass

The second stage of surgery involves dividing the first part of the small intestine (the duodenum) into two sections.

The last part of the small intestine is then attached to the duodenum, bypassing the middle section, and creating the duodenal 'switch'.

The remaining part of the small intestine is then connected to a point close to where the first part joins the large bowel (colon), allowing bile and digestive enzymes to mix with food before entering the colon. This creates only a small section of bowel where food and digestive enzymes meet, reducing the body's absorption of food.

Intestinal bypass can be performed in one of two ways. The original intestinal bypass surgery, known as biliary pancreatic diversion, bypasses around 80 to 90% of the small intestine. This creates a high risk of malnutrition in patients who have had the procedure, as they may find it difficult to absorb enough nutrients.

A newer approach, known as a modified duodenal switch, bypasses only around 50 to 60% of the small intestine, reducing this risk.

At the end of your operation, you will be taken to the recovery room where your breathing, heart rate and blood pressure will be monitored closely until the anaesthetic has worn off.

Recovery from any type of surgery is different for everyone and depends on factors such as your age, general health and whether or not there were any complications during your surgery or recovery.

Your consultant will be able to give you an estimated recovery timeline based on your individual circumstances.

You may have some post-operative pain when you wake up from your anaesthetic. You will be given regular painkillers to manage this, but please tell a member of the nursing staff if you feel pain.

How many nights will I need to stay in hospital?

You can expect to spend between two and five nights in hospital after your duodenal switch, but this may be longer in some cases.

Will I be able to drive home?

You will not be able to drive yourself home from the hospital after your duodenal switch surgery. Please make arrangements for someone to come and collect you, or we can organise a taxi if you prefer.

How soon can I go back to work?

How soon you can go back to work after your surgery depends on what happened during your procedure, your individual recovery, and the type of job you do. If your job is sedentary, you can expect to return to work after two or three weeks, but you may need longer if your job is active, strenuous or requires heavy lifting.

How soon can I drive?

You can drive when you can safely control your vehicle and perform an emergency stop without pain. This is normally a week or two after your surgery. Check with your consultant and inform your insurance company before driving after your procedure.

When will I be back to normal?

Most people can resume normal activities after around three to four weeks.

Recovery from any surgery is a gradual process that is different for everyone. You can help your recovery to go more smoothly by taking things at your own pace and listening to your body. Follow your consultant's instructions carefully and be sure to keep any follow-up appointments. Call the hospital if you have any questions or concerns.

You may feel more tired than usual for a while after your operation. Build up your activity level slowly and allow yourself time to rest when you need to.

Your consultant will explain all the possible risks and complications before your surgery and discuss the risks of having the surgery over the risks of not losing weight. Please ask as many questions as you need to before your procedure and make sure you are aware of all the potential risks and complications to allow you to make an informed decision.

Possible complications of any surgery include:

• Bleeding
• Infection
• Blood clots
• Adverse reactions to the anaesthetic

Possible complications specific to duodenal switch surgery include:

• Malnutrition - you will need to take nutritional supplements for the rest of your life following duodenal switch surgery and will need regular follow-up appointments to check for nutritional deficiencies
• Diarrhoea - after your surgery, your small intestine won't be able to digest food or extract water as efficiently as before. This can result in loose, smelly or watery stools, passing stools more frequently, and an increase in gas
• Bile reflux - if the pyloric sphincter (a ring of muscle that holds food in the stomach) is damaged during surgery, bile from the gallbladder can pass back into the stomach leading to gastritis (stomach inflammation) and stomach ulcers
• Gallstones - this may be caused by a build-up of cholesterol in your gallbladder due to rapid weight loss
• Bowel obstruction - may be caused by a build-up of scar tissue (adhesions) and may occur weeks or months after surgery
• Dumping syndrome - occurs when food, especially food high in sugar, moves too quickly from the stomach into the intestines causing symptoms like nausea, fast heart rate, abdominal cramps, diarrhoea, and vomiting. It can be unpleasant but is not dangerous
• Hernia - occurs when tissues or organs bulge against a weakness in the abdominal wall

We answer some of your most commonly asked questions about duodenal switch surgery.

Can you have a duodenal switch after a gastric bypass?

If you have had previous weight-loss surgery such as a gastric bypass that hasn't been successful, it may be possible to revise your surgery with a further procedure such as a duodenal switch.

You may consider revision weight-loss surgery if:

• You didn't lose enough weight after your gastric bypass
• You gained back the lost weight
• You had complications such as dumping syndrome, nutritional deficiencies, or bowel issues after your gastric bypass

If you would like to discuss revision weight-loss surgery, make an appointment with one of our expert weight-loss surgery consultants to discuss your options.

Can you gain weight again after a duodenal switch?

It's possible to gain the weight back after any weight-loss surgery, but this is less likely after a duodenal switch than with other types of weight-loss surgery.

At Circle Health Group, we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about duodenal switch surgery, book your appointment online today or call a member of our team directly.

Content reviewed by Circle in-house team in April 2023. Next review due April 2026.

1. BPD/DS Weight-Loss Surgery, John Hopkins
2. The Duodenal Switch Operation for the Treatment of Morbid Obesity, PubMed
3. Duodenal switch, Cleveland Clinic