Laparoscopic/Robotic Duodenal Switch (DS) Surgery

Our team of experts is at the forefront of weight loss surgery. We will work with you to find the best weight loss procedure for your goals and needs. The laparoscopic/robotic DS is one of the surgery options we offer at Brigham and Women’s Hospital. Laparoscopic/robotic techniques use only a few tiny incisions (cuts), unlike traditional open surgery. The laparoscopic/robotic DS is considered a minimally invasive approach. This means it’s safer and you have a faster recovery time than if you had open surgery.

What is DS?

In this procedure, surgeons perform a sleeve gastrectomy (remove the outer portion (also called crescent) of the stomach) so that the new stomach looks like a narrow sleeve. In addition, the upper small intestine gets divided. The lower intestine is divided much further down than the Gastric Bypass, so it is the most malabsorptive procedure. This part gets connected to the stomach. The remaining intestine is connected back to itself to allow enzymes and bile to mix with food, to support digestion. In the DS, one more connection is made than the SADI-S.

How does DS work?

After a DS procedure, there are hormonal changes that will lead you to have less hunger after surgery. After surgery, the stomach is reduced to the size of a banana resulting in a much smaller stomach. Due to the additional changes with the small intestine routing, there is some malabsorption of both macronutrients (calories) and micronutrients (vitamins and minerals) that can occur. As a result of all these changes, weight loss occurs.

What are the expected weight loss outcomes and other health benefits for DS?

After treatment, you can expect to:

• Lose about 40 percent of your pre-surgery weight, usually over the course of one year
• Much better control of blood sugars if you have type 2 diabetes
• Have more energy and move more easily
• Haver fewer weight-related health problems

What are the additional health benefits of DS besides weight loss?

After surgery, improvements to weight-related health conditions are very common. These can include sleep apnea, high blood pressure, and type 2 diabetes among others. In some cases, these conditions may even resolve completely after weight loss surgery.

Am I a candidate for DS?

You need to have a certain body mass index (BMI) to quality for surgery. You may qualify if:

• Your BMI is 50 kg/m² or more. This means you’re about >150 pounds overweight
• Your BMI is 45 kg/m² or more and you also have uncontrolled type 2 diabetes
• You had sleeve gastrectomy previously; you don’t have reflux and your BMI is more than 45 kg/m².

Healthcare professionals use BMI to check your risk for weight-related diseases. BMI is based on a formula that considers your current weight and height. While it’s not a perfect method, it can be a useful health indicator for many people. To find out your BMI, you can use our BMI calculator. Even if you don’t qualify for bariatric surgery, we offer other weight loss options like endoscopic treatments and medically supervised treatments.

How do I improve and optimize my health before DS?

We will work with you to help you make lifestyle changes before surgery. You will have a few consultations with providers leading up to the surgery. These include:

• Consultations with a surgeon and physician assistant who review your medical history and help you decide on the best procedure for you
• Consultation with a psychologist who assesses your weight and emotional history, and helps you develop strategies for weight loss success
• Meetings with a dietitian through a nutrition class, a nutrition assessment and follow-up, to develop a plan that fits your lifestyle

What is recovery like after DS?

The operation takes about 3.5 hours to perform and the hospital stay is 1-2 days. Patients usually return to work in 2-4 weeks. After the surgery, you will also need to take daily vitamin supplements especially fat soluble vitamins (A,D,E, and K). After surgery, you move through a staged eating plan which consists of:

• Clear liquids, such as water and broth for 1 day
• Protein drinks, yogurt, egg whites for 1 week
• By day 7, more smooth textures can be added (cottage cheese, oatmeal, etc.)
• At day 14, soft textures are included (chicken, turkey, fish, beans, etc.)
• At day 35, most foods can be added back in, gradually

Other nutrition considerations:

• Similar to SADI-S, developing diarrhea, steatorrhea, or foul-smelling gas can occur after DS, especially with food choices that are not recommended.
• Daily protein goals will be higher after DS (80-100 grams per day)
• Taking specific types of vitamins lifelong (vitamins with higher amounts of Vitamin A,D, E, and K) will be needed after both SADI-S and DS to prevent vitamin deficiencies.

Do you offer long-term weight management support?

Yes, we offer ongoing support to help you keep the weight off. Our comprehensive team – which includes surgeons, physician assistants, psychologists, and dietitians – helps support you to ensure you remain successful long after your surgery have been completed.

We offer:

• Individual appointments with members of our team
• Group meetings
• Private online support forum for new and past patients
• E-mail communication through Patient Gateway with your care team

How do I get started?

Contact us at 617-525-3597 to schedule a consult with a surgeon, or schedule all your preoperative visits with the surgeon, psychologist, and dietitian.

What surgeons perform DS?

Abdelrahman Nimeri, MBBCH
Director of Bariatric Surgery

Learn more about other weight loss surgery options.