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Disadvantages: Duodenal Switch (DS)

The duodenal switch is one of the most complicated bariatric surgeries and while the long term benefits of the procedure are highly renowned, the disadvantages must be noted.

All abdominal operations carry the risks of bleeding, infection in the incision, thrombophlebitis of legs (blood clots), lung problems (pneumonia, pulmonary embolisms), strokes or heart attacks, anesthetic complications, and blockage or obstruction of the intestine. These risks are greater in morbidly obese patients. Effective medical and nursing procedures used during and after the surgery have contributed to a successful outcome in the majority of obese patients.

In addition, several problems related to this specific surgical procedure are possible, although uncommon. One of these is injury to the spleen during surgery, which could require removal of the spleen. Leakage of fluid from the stomach or intestine through the staples or sutures may occur which may result in abdominal infection; this could require additional surgery for repair and for drainage of infection. Narrowing of intestinal connections may occur, which could require a second surgery to widen the opening.

Possible late complications related to this surgery could include peptic ulcer; intestinal obstruction due to adhesions; vitamin deficiencies or anemia from insufficient absorption of iron or vitamins, low blood proteins from malabsorption, resulting in fluid retention; hernia in the abdominal incision; temporary hair thinning due to changes in protein metabolism. Specific diet, physical activity, vitamin supplements, and medications may be recommended.

The diet progression after a duodenal switch procedure is similar to other bariatric procedures. Duodenal switch patients can eventually eat fat because it is usually malabsorbed. However, fat may contribute to frequent, odorous gas or stools. Dumping syndrome is not a side effect of this type of surgery. High sugar foods should be avoided due to the calorie content.

While the stomach is made smaller, it is not as small as the stomach size after a gastric bypass or vertical banded gastroplasty. After a duodenal switch, the stomach has a temporary restrictive effect for several months but eventually can tolerate a normal volume of food. Early on, portion sizes will be very small. Strict adherence to the vitamin/mineral supplement recommendations of your physician or dietitian is critical after this type of procedure.

Vitamin deficiencies can be managed with supplements. Depending on the type of supplement that you take additional calcium, iron and fat soluable vitamins may be required after this type of surgery. A high protein intake is very important.

Protein foods should be consumed first and protein supplements used for at least the first month or until adequate protein intake can be obtained from food.

For all malabsorption procedures there is a period of intestinal adaptation when bowel movements can be very liquid and frequent. This condition may lessen over time, but may be a permanent lifelong occurrence. Abdominal bloating and malodorous stool or gas may occur.

Close lifelong monitoring for protein malnutrition, anemia and bone disease is recommended. As well, lifelong vitamin supplementing is required.

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