The laparoscopic duodenal switch operation has two parts: A sleeve gastrectomy which involves removing part of the stomach but leaves a significant portion intact, including the pyloric valve which regulates the passage of food stomach contents into the small intestines and intestinal bypass in which the intestines are re-routed to a greater degree than in the Roux en Y gastric bypass procedure. Initial weight loss occurs because patients eat less, and long-term weight loss occurs because calories are not completely absorbed. Like the sleeve gastrectomy, the pyloric valve is preserved. As a result, dumping is minimized or completely avoided. Complications such as stricture, dilation and ulcers at the connection between the gastric pouch and the small intestine seen with the gastric bypass are also avoided.
Earlier versions of the duodenal switch were complicated by protein malnutrition, vitamin deficiencies and diarrhea secondary to malabsorption. The surgeons at North Shore-Long Island Jewish/Lenox Hill Hospital limit the malabsorptive component of this procedure resulting in less nutritional defects and fewer bowel movements but still achieving excellent long-term weight loss. The duodenal switch has been proven to provide the greatest weight loss as well as the longest lasting weight loss when compared to all of the other bariatric procedures. Most patients maintain their postoperative weight beyond 15 years. In addition, the duodenal switch has been studied for the longest and has the best record in alleviating diabetes, hyperlipidemia, hypercholesterolemia, hypertriglyceridemia, and obstructive sleep apnea.
Due to the greater technical difficulty and the increased risk of complications involved in performing the duodenal switch, few centers offer this procedure. North Shore-Long Island Jewish/Lenox Hill Hospital is one of the only hospitals in the entire northeastern United States where the laparoscopic duodenal switch is performed regularly. The surgeons at North Shore-Long Island Jewish/Lenox Hill Hospital have over 10 years of combined experience performing the duodenal switch and serve as instructors for this procedure.