Duodenal Switch Procedure FAQ
Southern Oregon Bariatric Center does not perform the DS. This information is offered for educational purposes.
Why is it necessary to remove part of the stomach in the DS?
What is a common tract and why is it significant?
Will malabsorption cause me to become malnourished?
How much protein will I need each day?
Why is it necessary to remove part of the stomach in the DS?
The idea of partial stomach removal is a stumbling block for some people who are considering the Duodenal Switch procedure. However, it needn’t be as scary as all that. The DS stomach is left essentially as a smaller version of its former self, with all of the functionality of an unoperated stomach—just as nature intended it, only smaller.
The DS procedure’s partial gastrectomy divides the stomach along the greater curvature, and the part that is removed is nothing more than a mass of acid-producing tissue. Removal of that mass of tissue (and thus the acids it would create) eliminates the danger of ulcer formation, which would be difficult to diagnose and treat if that stomach tissue were stapled off or transected and not removed (left “blind”, as in the RNY procedure).
In DS patients, the remaining stomach is very close to “natural”. The pyloric valve continues to function normally, and the lower part of the stomach (the antrum) continues its function to churn food into the proper consistency for nutrient absorption in the gut. The DS stomach will eventually (after 18 months or so) expand to hold a small- to normal-sized meal, with weight loss being maintained by the malabsorption component of the procedure. The DS stomach will never go back to its original size.
What is a common tract and why is it significant?
The common tract (or common channel) is the length at the end of the small intestine in which food and digestive juices are able to mix, after being initially kept separate by the intestinal “rerouting” of the gastric bypass procedure. Keeping food and digestive juices initially separate is what enables your body to absorb fewer calories and fats.
You can visualize the surgically rearranged intestine in the shape of a “Y”: digestive juices travel from the liver and pancreas down one arm of the ”Y”; food travels from the stomach down the other arm of the “Y”. At the bottom of the “Y”, these two paths are joined, allowing food and digestive juices to mix and continue on their path toward the large intestine.
Sugars, protein and nutrients are absorbed to a limited degree in the food tract. Fat absorption occurs only in the common tract. Therefore, the shorter the common tract, the less fat absorption can occur. In general, a shorter common tract means that patients might experience more of the side effects that can affect all distal bypass patients (eg. smelly gas, diarrhea, vitamin deficiencies).
When you are researching your surgeon, it is important to question him as to exactly what measurements and methods he will employ in your surgery, and how these might affect you post-operatively.
Will malabsorption cause me to become malnourished?
You will need to take daily multivitamins in order to maintain your health. You may also need extra calcium and iron. Extra protein is sometimes recommended early on, just after surgery. Your doctor may require occasional bloodwork to make sure that you are maintaining the proper levels of vitamins and minerals. If you follow these simple guidelines, malnourishment is very unlikely to occur.
How much protein will I need each day?
As stated in the explanation of the Gastric Bypass Surgery, recommended daily allowance of protein for the general population is 60 grams. In order for DS patients to absorb an adequate amount of protein in our altered digestive tracts, it is generally recommended that we consume around 90 grams of protein each day. Here again, your surgeon may have specific guidelines that you should follow, and it is important that you follow those instructions.
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