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The Duodenal Switch Surgery This operation obtains the best weight loss (an average of around 80-85% of excess body weight). The most important feature of the Duodenal Switch Surgery is that it diverts the food stream so that it is only in the last 75-100 cm, the "common channel", that the food can mix with the digestive stream, in order to be digested and absorbed. The result is a "malabsorptive" weight loss. Problems with this procedure have mostly to do with malabsorption, but most can be managed, when they occur, by taking supplements. The major complication to worry about with the duodenal switch surgery in the long-term is protein malabsorption. Patients who have this operation must have lifelong medical follow-up, since the side effects can be subtle, and can appear months to years after the surgery. This surgery can be done open or laparoscopically. The duodenal switch surgery is especially good for people who have a great deal of weight to lose. People can eat relatively normally afterward, as opposed to the VSRG or the RNYGB. Sometimes diarrhea and foul smelling gas are problems, but they are usually just a minor nuisance. Leaks and obstructions are possible. Nutritional and vitamin deficiencies are possible, but most can be managed with supplements. Protein malnutrition is a major problem with duodenal switch surgery, if it occurs, but the incidence would be very small.

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