The Duodenal Switch Procedure: The Laparoscopic DS at The Advanced Obesity Surgery Center

The Laparoscopic Sleeve Gastrectomy with Duodenal Switch (DS)

The Laparoscopic Sleeve Gastrectomy with Duodenal Switch procedure, sometimes known as the Biliopancreatic Diversion with Duodenal Switch, combines restriction (eating less because you feel full more quickly) with malabsorption of fat to give you a very powerful bariatric surgery procedure. You may have heard of the Duodenal Switch procedure referred to as the BPD/DS, the "Duodenal Switch", the "DS", or simply the "Switch".

Dr. Dennis Smith performs the Totally Laparoscopic Sleeve Gastrectomy with Duodenal Switch, with a Hand-Sewn Duodenal-Ileal Anastomosis. He was the third bariatric surgeon in the world to perform this Duodenal Switch surgery completely laparoscopically, and the first bariatric surgeon in the world to present the Hand-Sewn Duodenal-Ileal Anastomosis Technique of the Laparoscopic Duodenal Switch. There are very few bariatric surgeons in the world who regularly perform the Totally Laparoscopic Sleeve Gastrectomy with Duodenal Switch procedure.

Laparoscopic Duodenal Switch Video

WARNING: This video is graphic and contains actual surgery recorded on digital video! Do not watch unless you are fully prepared to see surgery taking place!

Press the Play Button to begin the Video. NOTE: This video has no narration at this time.

Lap Duodenal Switch Full WMV

Dr. Smith and the Laparoscopic Duodenal Switch

Dr. Smith has performed nearly 400 Totally Laparoscopic Sleeve Gastrectomy with Duodenal Switch Procedures. We continue to do these procedures regularly, and our patients are from all over the US. We generally have very short wait times from your initial contact with our office to your surgery date, depending on what insurance and medical situations you have.

Advanced Obesity Surgery's safety record is among the best, and that's because Dr. Smith's focus is, and has always been on doing the safest surgery possible rather than the most numbers of operations possible. We take the time to make sure each patient is taken care of as thoroughly and carefully as possible, pre-operatively, during surgery, and post-operatively. At this time, Dr. Smith is the only bariatric surgeon in a several state area around Georgia who regularly performs the Laparoscopic Duodenal Switch.

Dr. Smith also serves as faculty for courses in the Duodenal Switch for bariatric surgeons who are interested in adding the Duodenal Switch to their bariatric surgery armamentarium. He also has presented his Laparoscopic Duodenal Switch techniques and results at national and international meetings of bariatric surgeons.

Revisions Of, or To, the Duodenal Switch

Even if you are the most diligent patient, you can still have weight regain after bariatric surgery. There are a number of possible reasons for this, but if you are having these kinds of problems, there are things we might be able to do to help.

Revisions of Gastric Bands

If you've had a Gastric Banding procedure (such as the Lap-Band^®), Dr. Smith can laparoscopically revise your Gastric Band to the Sleeve Gastrectomy or to the Sleeve Gastrectomy with Duodenal Switch laparoscopically and in one stage, with removal of the Gastric Band. This can help restore weight loss and can help induce firther weight loss.

Laparoscopic Restapling of Sleeve Gastrectomy

If your Sleeve Gastrectomy pouch has stretched (whether it was done as a standalone operation or as part of the complete Duodenal Switch Procedure) Dr. Smith can reduce the size of your gastric pouch. This is best done with a Laparoscopic Re-Stapling of your Sleeve Gastrectomy, but can also be done Endoluminally with the ROSE Procedure (see below). A laparoscopic restapling procedure is usually an overnight stay in the hospital, and it can dramatically reduce the size of your gastric pouch. This can help you stop regaining weight or re-lose some weight you might have gained.

Laparoscopic Second Stage Duodenal Switch

Dr. Smith will also perform the Duodenal Switch small bowel component (the malabsorptive part of the Duodenal Switch) on patients who have previously had the Sleeve Gastrectomy but have lost insufficient weight or are regaining weight. This is sometimes referred to as the "second stage" because sometimes the Duodenal Switch operation is done in two stages, the first stage being the Sleeve Gastrectomy, and then later the second stage being the small bowel portion of the procedure to add malabsorption.

The ROSE Procedure^™(Restorative Obesity Surgery, Endoluminal)

Revisions of the Sleeve Gastrectomy can also be performed using the ROSE Procedure^™ to reduce the volume of the stomach pouch, if your pouch is now too large.

Please call for more informations about this endoluminal incisionless revision procedure involving the Sleeve Gastrectomy and the Duodenal Switch using the ROSE Procedure^™. This is an exciting new procedure that is very low risk, and that can help stop weight regain and even induce further weight loss.

Out Of State Patients

For those of you who are not from Georgia, we treat many patients from out-of-state, from all across the United States, and from other countries as well, and most come to us here in Georgia for their Laparoscopic Duodenal Switch surgery.

Staged Duodenal Switch Procedures

The Sleeve Gastrectomy with Duodenal Switch is sometimes done in a staged manner, in order to reduce the risk that would be involved with doing the entire Sleeve Gastrectomy with Duodenal Switch Procedure all at once. This is a good idea in situations where the Sleeve Gastrectomy portion of the operation might cause significant weight loss over a period of time, so that the remainder of the Duodenal Switch Operation could be performed with you at a much lower weight, and therefore at a much lower risk.

There are also some situations where the Sleeve Gastrectomy might be useful as a stand-alone operation. Click HERE for more information about the Sleeve Gastrectomy as a standalone procedure.

What is The Laparoscopic Sleeve Gastrectomy with Duodenal Switch?

The Laparoscopic Sleeve Gastrectomy with Duodenal Switch gives you the best weight loss (an average of around 80-85% of excess body weight) of the four major types of surgery, with few side effects.

The operation includes a "Partial Lateral Gastrectomy", also known as a "Sleeve Gastrectomy" that gives you significant restriction in how much you can eat. The Sleeve Gastrectomy portion of the operation also helps alter the hormonal impulses that come from the stomach, resulting in less feelings of hunger.

The complete Duodenal Switch operation also involves the small bowel bypass component, sometimes referred to as the "Duodenal Switch" portion of the operation, which adds malabsorption. This rearranges the small bowel, bypassing a significant portion of the small bowel, so that there is some malabsorption of the fat that you eat.

The small bowel bypass causes a diversion of your food stream, keeping it from mixing with the digestive juices until much later in the small bowel. It is only in the last 75-100 cm, the "common channel", that your food can mix with your digestive juices stream, in order to be digested and absorbed. The overall result is a powerful combination of a "restrictive" and a "malabsorptive" weight loss, that is the best and most durable weight loss of any of the four major bariatric procedures.

The Laparoscopic Duodenal Switch is especially good for you if you have a great deal of weight to lose, if you have severe insulin dependent diabetes, or if you have hypertriglyceridemia. As your stomach stretches out with time, you would usually be able to eat relatively more afterward, however the stomach is limited in its ability to stretch. This operation does require adherence to a postoperative diet for best results, as does the Laparoscopic Roux-en-Y Gastric Bypass.

Dr. Smith performs all of his Duodenal Switch operations totally laparoscopically.

Our Poster on Laparoscopic Duodenal Switch, 2005 ASBS Meeting

Click to View .pdf of Poster Presented at the 2005 ASBS Meeting: Laparoscopic Biliopancreatic Diversion with Duodenal Switch in Patients with BMI > 60
Lap DS Poster

--Dennis C. Smith, Jr., MD, et al; The Advanced Obesity Surgery Center, WellStar Health System Bariatric Surgery Program, Marietta, Georgia, USA.
Conclusions: The completely Laparoscopic Biliopancreatic Diversion with Duodenal Switch is a safe, feasible and very effective operation for patients with BMI’s in the 60’s and above.
A single-stage Laparoscopic Duodenal Switch can be performed in patients with BMI’s > 60 with a very low morbidity and mortality.

Click Here for More Detailed Information on the Laparoscopic Duodenal Switch

You can get further information on the Laparoscopic Duodenal Switch by downloading the document: Bariatric Surgery: What Are My Options?

You can also download a Diet and Nutritional Guide for the Duodenal Switch Procedure (and for the other operations) as well as forms for beginning the process for you to become a patient at The Advanced Obesity Surgery Center on our Member Pages.

If you've had a LAP-BAND^®, and the weight loss has been inadequate, Dr. Smith will evaluate you for possible laparoscopic conversion to the Bilio-Pancreatic Diversion with Duodenal Switch procedure.

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The Advanced Obesity Surgery Center
A Certified Bariatric Surgery Center of Excellence
Marietta, Georgia, USA