Duodenal Switch and Its Derivatives
Despite the relative popularity of Roux-en-Y gastric bypass and sleeve gastrectomy, duodenal switch (DS) remains the most effective bariatric operation currently being practiced. It results in both the greatest magnitude of excess weight loss and the most reliable resolution of comorbidities, especially type II diabetes. However, it is also perceived as carrying the highest perioperative and long-term morbidity. Therefore, DS is often reserved for patients with BMI over 50 kg/m2 or poorly controlled metabolic diseases. As of 2019, DS only accounted for 0.9% of all bariatric surgeries performed in the USA. Nevertheless, DS is recently enjoying a resurgence of clinical interest, due to the rising prevalence of super morbid obesity (BMI > 50 kg/m2) and weight recidivism after sleeve gastrectomy. Furthermore, derivative procedures such as single-anastomosis duodeno-ileostomy (SADI) procedures are being investigated as “milder” forms of DS. In this chapter, we seek to provide an in-depth overview of the pre-operative, procedural, and post-operative clinical management of patients undergoing DS surgery or one of its derivative procedures.
