Why Isn't the Duodenal Switch More Popular?

Question

my bariatric surgeon doesn't perform the duodenal switch and said that only 2-3% of patients get it. but when i read online it said it had fewer complications than bypass. is this true and if so, why do so few patients opt for it?

Jay Roberts, DO, FACOS, FASMBS · Answer

The bottom line is not many surgeons perform the operation so very few surgeons get trained to do it. Most surgeons arent going to recommend an operation that they dont know how to do, even if there is a better option out there. Surgeons do what operations they are taught. Moreover, the lap DS is the most difficult of the weight loss operations to perform and takes more time than a bypass or a sleeve. The lap DS is the last of the weight loss operations to be standardized into a laparoscopic version of the traditional open bpd/ds. I do believe as young bariatric surgeons deal with weight regain after sleeve there will be a big increase in the number of bariatric surgeons who decide to add DS to their practice as conversion to bypass from sleeve yields less than desirable results for weight regain.

Gilberto Ungson, MD · Answer

Hello! 
The Duodenal Switch is a more complex surgery which requires that  surgeons  be trained and specialized in this specific procedure.  If a surgeon is not skilled at this surgery or does not perform it frequently he / her may not recommend it to his/her patients. 
The Duodenal Switch is a very effective surgery but you need to have it done by a surgeon who has ample experience and performs it frequently to reduce your surgery risks and optimize your results. 
The DS has become more popular in the last few years, in our practice over 30 % of all patients we treat have a DS done, which is a great increase from 20 years ago!
More surgeons are now offering it and in addition patients are more informed and committed in working with their surgery to lose weight in a healthy way.  It is important to note that patients need to follow up closely with their surgeons as well as with the interdisciplinary group  to avoid long term complications like malnutrition , abdominal or intestinal discomfort, etc.

Bo Neichoy, MD · Answer

Popularity of the duodenal switch has been suppressed on many fronts.  The ASMBS (the society of weight loss surgeons) is staffed and governed by surgeons that have spent their whole careers doing bypasses and willingness to change what they do is low, despite the tract record of gastric bypasses.  The surgery also involves dissecting anatomy that has important structure close by and many surgeons do not want to take the risk of being in this area.
In the right hands (a surgeon that focuses on duodenal switch) the complication rate is lower than gastric bypasses and the long term complication rate is drastically lower.

Ricardo M. Bonnor, MD, FACS · Answer

The duodenal switch otherwise known as the DS, is an excellent operation in the well selected patient that carries an overall low complication rate. The complication rate in terms of leaks is comparable to that of gastric bypass. Certain patients with severe metabolic syndrome will benefit greatly from this opeation. DS is better at achieving overall weight loss for patients with BMI > than 50 and helping those patients get to a more "normal BMI". Also the DS is more resistant to weight regain which is far more common in gastric bypass patients. DS has potential issues or complicaitons such as protein and vitamin deficiencies. If you are a patient with high triglycerides and insulin dependent diabetes, and a high BMI, a DS procedure may be the right fit for you.

David Buchin, MD · Answer

There are higher complications with the duodenal switch as opposed to a gastric bypass or a laparoscopic sleeve gastrectomy or a lap band. There is a higher risk of leak and a higher mortality with the duodenal switch versus the gastric bypass. Also, there are many more nutritional and vitamin deficiencies with the duodenal switch. Duodenal switch patients have a higher incidence of diarrhea after the procedure, as well.

Pablo Garcia, MD - Account Suspended · Answer

Thanks for asking.Gastric bypass surgery is the most popular weight loss surgery but doesn’t provide the highest expected weight loss. Duodenal Switch provides the highest average expected weight loss available yet and comes with more risks and complications.Hope you find this answer helpful,Regards.

Daniel J. Rosen, MD - Account Suspended · Answer

When is the DS the procedure of choice? For light weight people (bmi under 40) with really bad diabetes (your on insulin shots multiple times a day but your diabetes keeps getting worse). First let's understand what a Duodenal Switch is and why most bariatric surgeons don't perform it often. Rarely is it the go-to procedure of choice, particularly if you have a high bmi. Here's why: Quick FactsA gastrectomy is simply cutting out your stomach. A sleeve gastrectomy means you are cutting out only part of your stomach but leaving a small tube or "sleeve." The duodenal (doo-oh-deen-nul) switch is a sleeve gastrectomy on your stomach with an intestinal rerouting bypass. Why would you want to bypass some of the intestines? In your intestines you have fullness hormones that are released when food hits your intestines. By rerouting the intestines (without removing any portion) you feel fuller faster and longer. RisksIt is not appropriate for most patients simply because there are more risks associated with the procedure. If you have a high BMI it's too risky a procedure. Point blank. The reason most bariatric surgeons do not perform this surgery often is one, they might not be trained in it.Plus, most people will show a lot of improvement with a gastric sleeve or LapBand. There's more risk, because there's more surgery. Additionally, on the post op side, you'll have to be more vigilant about taking your vitamins and minerals to avoid deficiencies. Since most people lose lots of weight with the sleeve, most surgeons would prefer to see how you do with a sleeve first. If for whatever reason, you aren't losing weight, your diabetes is still acting up, and for whatever reason the sleeve alone isn't doing the trick the DS can be added after the sleeve as a second stage procedure.

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