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Weight-loss surgery combining sleeve gastrectomy with intestinal bypass
A duodenal switch combines two procedures, one of which is an operation on your stomach, and the other an operation on your duodenum (the first part of your small intestine):
This type of weight-loss surgery also reduces the hunger hormones that are produced in the stomach and duodenum, which should make you feel less hungry.
Duodenal switch surgery has the highest rate of sustainable weight loss of all weight-loss surgeries, but it also has a higher rate of complications, so it won't be the right choice for everyone. If you would like to know more about the different types of weight-loss treatment we offer, call or book online today to arrange a consultation with a specialist of your choice.
This page explains what duodenal switch surgery is, what happens during the procedure, and what to expect during your recovery.
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.
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:
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:
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.
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.
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:
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.
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.
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.
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.
You can expect to spend between two and five nights in hospital after your duodenal switch, but this may be longer in some cases.
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 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.
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.
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:
Possible complications specific to duodenal switch surgery include:
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:
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.
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.
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.