Duodenal Switch F.A.Q.

How long will approvals take?
There are two determining factors relative to obtaining approval for weight loss surgery. The first is to make sure you are healthy enough to proceed which usually requires a pulmonary (medical) clearance, and a psychological clearance. Several other tests may be recommended like an UGI, GB ultrasound, Pulmonary Function Tests, Cardiac Stress Tests and a nutritional consult. Usually this can be accomplished in less than a month if the patient desires.

The second part is requirements set up by the insurance companies—many of which really are only to slow the process down. Medicare has no other requirements. Aetna US Healthcare requires a 6 month physician supervised diet but in a “preparatory program” which we have in our support group, this is reduced to only 3 months. Horizon Blue Cross also has a 6 month physician supervised diet requirement. Amerihealth and other insurance companies may also have similar requirements.


What is covered?
Three weight loss operations are covered---The Laparoscopic Adjustable Gastric Band, the Roux-en-Y Gastric Bypass, and the Duodenal Switch. The Vertical (Sleeve) Gastrectomy, which is the top half of the Duodenal Switch is not yet covered pending more information on long term results. It is the impression of the ASMBS that this will eventually be a covered procedure.


Is Laparoscopic Surgery Better?
Laparoscopic Surgery is generally better because it allows the operation to be performed with less post-operative pain, less scarring, and a smaller incidence of wound infections and hernias. Results of the Duodenal Switch however, show that the mortality of open surgery is 0.76% while that of laparoscopic surgery is over 1%. Why is this? The Duodenal Switch is such a complex operation that it takes longer than the other weight loss operations.With particularly obese patients a complication of rhabdomyolysis (death) of the gluteal muscles may occur. During laparoscopic surgery, the patient is positioned with their head above their feet on a slanted table which puts extra pressure on the gluteal muscles. If the operating time is excessive as it may be during laparoscopic duodenal switch surgery in extremely obese patients, this may occur. This and other complications from prolonged operating times may explain this increase in mortality.

One may ask the question—“Should I have a Laparoscopic Gastric Bypass or an Open Duodenal Switch” if that is the two options being considered. Although one may prefer laparoscopic surgery, the benefits of it over open surgery are short lived and if the advantages of lifestyle and additional weight loss are important, one should not sacrifice having their preferred operation to avoid an incision. In general, one leaves the hospital about 1 day sooner with laparoscopic surgery and may be able to resume activities 1-2 weeks sooner, but patients with open surgery today recover faster than they ever had as we use the special instruments and techniques adopted for laparoscopic surgery in all open procedures, allowing quicker recovery.


I Failed Weight Loss Surgery—Is it my fault?
Weight loss surgery is a tool to use to help you lose weight and keep it off because this has not been possible before. It is very common for patients to initially do very well after weight loss surgery only to regain 10-20% of their lost weight (starting out at 300 pounds, losing to 175 pounds and gaining weight to 200 pounds.) Others, who start out in the super obese category, may lose weight and keep it off but are still morbidly obese (starting out at 500 pounds, losing to 280 pounds and gaining weight back to 330 pounds). Still others will end up losing only a small amount of weight in the long term (starting at 300 pounds, losing to 200 pounds and regaining to 260 pounds).

There are many patients in all three categories. It doesn’t mean you are a failure. First of all, you did lose weight and keep it off—just not as much as you would have liked. Second, it may have been the operation that either had an anatomical change causing you to regain much of this weight, or it may have not been the ideal operation for you.

You are not a failure if this happens. It is probably not your fault. Revisional Surgery to the Duodenal Switch almost always will result in significant increased weight loss and make you feel like a success!


I am doing great after weight loss surgery.  Can I just stop taking my vitamins?
It is vitally important to take your vitamins for life as well as being checked at least yearly to insure you have adequate levels of these. Serious and even life threatening complications can occur if you ignore this. Some patients are extremely reliable for the first several years after weight loss surgery but become more lax as they get further and further from their surgery. This is a big mistake. Taking the step to have weight loss surgery is one which allows you to become more healthy and live longer but you must take your recommended vitamins and supplements or else your health, which you did this in the first place for, could be in jeopardy.