Gastric Sleeve Surgery vs Duodenal Switch: Choose the Right Surgery

Overview of Gastric Sleeve Surgery and Duodenal Switch Surgery Comparison

Once you qualify for bariatric surgery, you and your surgeon will determine which weight loss procedure suits you best based on your health, BMI, and commitment to the procedure. One of the most popular options that are being used by bariatric surgeons these days is Vertical Sleeve Gastrectomy (VSG) or known as Gastric Sleeve. A more aggressive surgical technique to lose weight is Duodenal Switch w/ Bilio-Pancreatic Diversion (BPD/DS) and with its modified version SADI/S. Duodenal Switch is popular and performed more in Europe. Here we are comparing the two options side-by-side.

Procedures Explained: Pros and Cons

Gastric Sleeve

Vertical Sleeve surgery, now performed as a stand-alone procedure for obesity, was used as the first step to Duodenal Switch. Gastric sleeve is a restrictive procedure and it requires the removal of 80% to 85% of the stomach.

The stomach is cut and stapled simultaneously by a special instrument laparoscopically. The remaining stomach resembles a banana (sleeve) with a capacity of 4 to 6 oz.
It does NOT involve in the manipulation of the intestine and does NOT alter the natural path of digestion.
The stomach resection removes the Ghrelin-generating cells and reduces the production of Ghrelin, the hunger hormones. The patient does not get hungry as much and loses weight as the smaller stomach gets full faster.

Duodenal Switch

Duodenal Switch w/ Bilio-Pancreatic Diversion is a newer procedure than Gastric Bypass, but it works based on the same principle – restriction and malabsorption. There are three primary stages in this procedure:

The restriction is created by cutting away a big portion of the stomach similar to gastric sleeve.
The food is routed away from the first portion of the small intestine, called the duodenum. Consequently, the amount of nutrients and calories absorbed by the body is drastically reduced.
The digestive juices from the pancreas and the bile come in contact and break down the food at the lower end of the small intestine. This reduces the number of calories absorbed resulting in further weight loss.

Notable Differences: Pros and Cons

DS patients show long-term success with their weight loss and remission of comorbidities, better than gastric bypass. Surgeons are getting more experienced in duodenal switch surgery and gradually it is replacing gastric bypass as a treatment for morbid obesity. Duodenal Switch is also a common option for revisional surgery of the failed first operation.

SADI/S (Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy) – SADI/S or SIPS is a single-loop/anastomosis duodenal switch. The same banana-shape stomach is created first and the resection of the Ghrelin-producing area. The duodenum is cut below the pyloric valve and above the common bile and pancreatic ducts. An opening is made in the small bowel (3 meters of small bowel down below is used) to connect to the duodenum. The food drops from the stomach to the lower small intestine and further satisfy hunger. The malabsorptive component of this surgery is due to the common channel reduction. No diarrhea complaint is reported.

Duodenal Switch vs Gastric Bypass

Comparison of Duodenal Switch and Gastric Sleeve

Gastric sleeve and BPD/DS are done laparoscopically as opposed to open approach. Both procedures are efficacious in inducing weight loss and improvement in obesity-related conditions. The success of patients losing weight with the less invasive gastric sleeve has caused a gradual decline in the number of DS surgeries. The duodenal switch is considered as the most effective, and most complex weight loss surgery. However, the gastric sleeve procedure provides sufficient weight loss without the higher complication rates and side effects.

Weight Loss

Patients with duodenal switch lose more weight due to additional malabsorptive component (refashioning of the small intestine). Research studies at 18-24 months after surgery show that:

The patients with gastric sleeve lose an average of 60% to 70% of their excess body weight.
The patients with duodenal switch lose an average of 70% to 80% of their excess body weight

Weight loss with DS patients lasts longer also. Duodenal Switch is mainly reserved for morbidly obese.

Complications

The duodenal switch surgery is a complicated procedure and being a newer surgery the surgeons do not have the skills and the experience. On the other hand, gastric sleeve has been a mainstream procedure and the surgical complication rates have declined as surgeons are getting experienced in this rather simple surgery. Both surgeries have common complications such as staple line leak, bleeding, gastroesophageal reflux disease, abscess, stricture, deep vein thrombosis/pulmonary embolism, and hair loss.

The rerouting of the small intestine in DS introduces a number of potential surgical complications, such as leakage from anastomotic sites, stricture at the anastomotic site, intestinal obstruction, ulcers, and steatorrhea. Moreover, the new digestive tract can cause bloating and diarrhea in patients with DS.

There are also far less dietary restrictions as the digestive process is not altered in gastric sleeve surgery. The removal of the stomach may lead to some hypersensitivity towards certain foods, like chicken or eggs. As a result of the time food has to digest, the duodenal switch can cause severe malnutrition and requires regular dietary supplements. You need to be committed to lifelong monitoring of your blood to prevent any vitamin or mineral deficiencies.

Cost of Surgery And Insurance Coverage

Duodenal Switch is more involved and more expensive than gastric sleeve surgery as gastric sleeve is the first step to Duodenal Switch. The average cost of the duodenal switch is $29,000 compared to the average price of gastric sleeve surgery of $19,000 in the United States. The cost of both surgeries is lower outside the United States.

While some insurance policies cover gastric sleeve surgery, even fewer insurance policies provide coverage for duodenal switch. Patients undergoing duodenal switch procedure also incur $1500 per year on additional supplements and necessary tests.

Reversal of Obesity-Related Disease

Both surgeries lead to significant weight loss and reversal of obesity-associated conditions. With the duodenal switch, however, the patients tend to achieve a relatively lower BMI than the patients who underwent gastric sleeve surgery. Similarly, there is a higher rate of resolution of comorbid conditions, such as diabetes type 2 (T2DM), hypertension, dyslipidemia, obstructive sleep apnea, osteoarthritis, etc. with duodenal switch vs gastric sleeve surgery.

Find Out if You Pre-Qualify For
Gastric Bypass Surgery or Duodenal Switch Surgery HERE

Comparing Gastric Sleeve vs Duodenal Switch

Type of Surgery	Gastric Sleeve	Duodenal Switch
Method of Weight Loss	Restrictive Reduce Stomach Size Same Digestion	Restrictive & Malabsorptive Stomach Size Reduced Alters Digestion
Stomach Alterations	Stomach size reduced Up to 85% of the stomach is removed.	Stomach size reduced 70% of the stomach is removed – similar to gastric sleeve surgery.
Changes to Intestine	None	Intestines “Switched” New stomach is “switched,” to the last 6 feet of the small intestines around to alter the digestion process and limit food absorption.
Operating Time	1.5 hours	4 hours
Average Hospital Stay	2 nights	3 nights
Time off Work	2 to 3 weeks	3 to 4 weeks
Recovery Time	2 to 4 weeks	3 to 6 weeks
Pros	No intestinal changes: Fewer complications and side effects including dumping syndrome Hunger depressed because of reduction in Ghrelin production Lifetime Approach to Obesity Simple procedure	70-80% Expected Weight Loss Most weights lost in the first year
Disadvantages	Surgery risks or complications comparable to gallbladder removal. Stomach Could Enlarge (not to the original size). Requires Less Nutritional Supplements and Vitamins – Not as much as gastric bypass. Newer surgery with limited long-term data.	None reversible. Most complications of any surgery. More frequent bowel movements. Vitamins and supplements needed.
Surgery Description	Up to 80-85% of the stomach is removed along the greater curvature of the stomach where the hunger hormone – ghrelin occurs. This offers the sleeve patient restriction, which reduces the amount of food patients eat.	Long vertical pouch (about 4-5 oz or 120-150cc). The duodenum (first portion of the small intestine) is attached to the last 6 feet of small intestine, where food and digestive juices are rejoined after 12 feet. Moderate restriction of the volume of food that can eat. Provides moderate malabsorption of fat, which can cause bloating and diarrhea.
Realistic Expectations	Patients can expect to lose 60%-70% of excess weight in about 2 years. Long-term results were not available at this time. Easily converted to Duodenal Switch or Gastric Bypass if needed.	Patients can expect to lose 75% to 80% of excess weight. Some patients can lose too much weight. More risk of nutritional deviancies than with the RNY gastric bypass.
Post Surgery Dietary Info	Patient must eat three meals a day containing 600-800 calories per day (recommended for the first 24 months) and about 1000-1200 after that. There is no dumping or diarrhea.	Patients must eat three meals/day. Patients must strictly adhere to protein and vitamin supplements to avoid deficiencies. (Multivitamins, ADEK vitamins, Calcium, and Iron for Menstruating women).
Candidate Efficacy	The gastric sleeve surgery is useful for medium to high BMI patients (BMI > 30kg/m2) patients as a “first-stage” procedure. Much lower complication rate than the RNY Gastric Bypass or Duodenal Switch due to there being no intestinal bypass performed.	The Duodenal efficacy is effective for patients with a BMI of > 50kg/m2. Those with a BMI of <45kg/m2 may lose too much weight. The Duodenal Switch has a higher incidence of complications than any other weight loss surgery.
2-Year Follow-Up	Patients maintained a 65-70% loss of excess body weight.	Patients maintained a 79% loss of excess body weight. 9% (at 1 year) and 6% (at 2 years) of patients had failed to lose at least 50% of their excess weight.

Gastric Sleeve vs Duodenal Switch Digestive Tract