Gastric Bypass vs Duodenal Switch
Roux-en-Y Gastric Bypass (RYGB) is often compared to the newer procedure Duodenal Switch w/ BilioPancreatic Diversion (DS/BPD). Both are very similar in weight loss methods, but they have slight differences that make each surgery ideal for particular individuals.
Long-term results show duodenal switch’s superior weight loss and metabolic control when compared to RNY gastric bypass. DS/BPD results in higher BAROS* global assesment score making it more sutiable for super obese patients.
Remember, each procedure makes biological differences in anatomy that affect the body and impact your lifestyle. The duodenal switch procedure has more adverse events and is reserved for morbidly obese patients (BMI>50) or patients who want to be skinny. Here, we will explain each procedure in detail and its pros and cons so you can see which weight loss surgery option fits you best.
* BAROS (Bariatric Analysis and Reporting Outcome System)
Which Procedure is Best for Me?
The RNY bypass has been known as the gold standard of bariatric surgery and has been around since 1967. Gastric bypass surgery has a lot more long-term data and results than its newer counterpart, duodenal switch surgery. The patient needs to weigh out the risks and rewards of each surgery.
The duodenal switch has more expected weight loss than gastric bypass surgery, although it also has many more potential complications than RNY. DS/BPD and SADi-S are better for morbidly obese patients looking for durable long-term weight reduction.
Candidacy Requirements
Do I Qualify for Gastric Bypass?
Do I Qualify for Duodenal Switch?
What is the Biggest Difference?
Gastric bypass surgery is the most popular weight loss surgery but doesn’t provide the highest expected weight loss. Duodenal Switch provides the most substantial expected weight loss available but comes with more risks and complications.
1. Acid Reflux and GERD
In the duodenal switch, the stomach size is reduced and the pyloric valve, or pylorus (regulating food), stays untouched. Restriction in the stomach increases gastric pressure and reduces gastric emptying. In gastric bypass, the pyloric valve stays connected to the separated stomach, and the new pouch redirects most of the stomach acid to stay out of the esophagus. Therefore, Roux-en-Y gastric bypass is best for patients with acid reflux or gastroesophageal reflux disease.
2. Dumping Syndrome
Dumping syndrome is an abdominal discomfort accompanied by rapid heart rate, palpitation, nausea, vomiting, and explosive bowel evacuation. It is estimated that over 50% of gastric bypass patients experience dumping syndrome due to the unregulated flow of food from the stomach to the small bowel.
- Early Dumping Syndrome – Instantly after eating food. Symptoms include abdominal pain, cramping, nausea, and light-headedness.
- Late Dumping Syndrome – 1 to 2 hours after eating food. Symptoms include lack of energy, exhaustion, perspiration, and feeling “out of it.”
Staying on the post-op diet usually fixes this problem and patients usually outgrow symptoms.
3. Ulcers
If the patient has had or currently has ulcers, the duodenal switch is recommended over gastric bypass surgery. The pouch that is formed with bypass surgery is so small, that it is referred to as the “blind” stomach. It is nearly impossible for ulcers to be detected without a doctor laparoscopically scoping the stomach under anesthesia. Taking Aspirin or Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) increases the risk of ulcers.
4. Curing Comorbidities
Both procedures cure co-existing conditions like Type II Diabetes and hypertension, however, duodenal switch surgery is much more effective in the remission of obesity-related diseases. The duodenal switch also shows much quicker results in its metabolic effect.
Gastric Bypass versus Duodenal Switch Comparison Table
Statistics show that since 2005, sleeve gastrectomy and Roux-en-Y gastric bypass have been the most widely requested and effective treatments for morbid obesity and type 2 diabetes mellitus. Gastric Bypass Surgery, once known as the “benchmark,” accounted for 80% of all bariatric procedures performed in the United States. Conventional DS and its alteration SADi-S are the most suitable for super obese long term.
Today, Gastric Sleeve Surgery accounts for over 70% of all weight loss surgeries performed across the world.
Comparing Costs and Insurance Coverage
The costs of gastric bypass surgery range from $5,595 to $19,000 depending on where the surgery takes place. In Mexico, the price is as low as $5,595 and maintains a high-quality procedure. In the United States, self-pay ranges from $15,000 to $30,000 for gastric bypass surgery. Duodenal switch surgery costs anywhere from $6,000 to $35,000 around the world. Mexico Bariatric Center pioneered duodenal switch surgery in Mexico and has some of the most highly trained surgeons specializing in duodenal switch surgery. Our DS price starts at $6,595.
The criteria for bariatric surgery insurance coverage follow strict guidelines for patients who get accepted. The process takes at least one year just to be approved by most insurance providers. Patients must follow the pre-op diet, fail a strict diet program, and meet with many medical professionals, psychologists, and nutritionists before approval.
RNY Bypass vs Duodenal Switch Cost Comparison
Complications and Side Effects
Digestive Tract and Anatomy
The digestive tract after gastric bypass surgery is changed through both restriction and malabsorption. First, the stomach is formed into a small pouch called the stoma. This tiny pouch doesn’t regulate the flow of food into the small intestines, causing patients to need vitamins to help digest the food thoroughly.
The pouch can also be stretched because of little regulation. Fewer vitamins are needed than duodenal switch surgery because less of the small intestines are bypassed.
The new digestive tract after duodenal switch surgery is also changed through both restriction (by resecting about 70% of the stomach similar to gastric sleeve) and malabsorption (bypassing a large portion of the small intestine).
A larger portion of the small intestines is bypassed, or switched, which causes the DS patient to need more vitamins and supplements for their lifetime. The anatomy is more intact, although less protein and fat is absorbed causing more nutritional deficiencies.