Gastric Sleeve vs Duodenal Switch Surgery

Gastric Sleeve vs Duodenal Switch

One of the most popular and effective bariatric procedures today is Vertical Sleeve Gastrectomy (VSG), otherwise known as Gastric Sleeve Surgery. The gastric sleeve is hands down the top choice for most patients looking to have extremely successful results without having many risks, side effects, or complications.

A more aggressive weight loss procedure is Biliopancreatic Diversion with Duodenal Switch (BPD/DS), otherwise known as Duodenal Switch Surgery. It is an evolved version of the gastric sleeve, combining two mechanisms of action to achieve the most significant expected weight loss.

Sleeve gastrectomy was performed in 1990 as the first stage of the duodenal switch (BPD-DS) operation. The first stand-alone sleeve surgery was performed in 1999.

If you are comparing gastric sleeve vs. duodenal switch, here is a complete guide to help find the best surgery for you.

How Gastric Sleeve Surgery Works

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 sleeved stomach resembles a tube with a 4 to 6 oz capacity.

Gastric Sleeve Surgery Schematic
  • Less Invasive Surgery

  • Reliable Weight Loss

  • Low Complication/Side Effect

  • Easy to Revise with Weight Regain

It does NOT involve the manipulation of the intestine and does NOT alter the natural path of digestion. Reduces the production of Ghrelin hunger hormones. Experience less hunger and require less food to feel full.

How Duodenal Switch Surgery Works

Duodenal Switch Surgery is a complex weight loss surgery that combines restriction (gastric sleeve) and malabsorption (gastric bypass) to produce high expected weight loss.

Duodenal Switch Surgery Schematic
  • Highest Amount of Excess Weight Loss (%EWL)

  • Highest Reduction in Comorbid Illnesses
  • Most Invasive Weight Loss Procedure

Cuts away 70% of the stomach similar to gastric sleeve. The food then bypasses the first portion of the small intestine reducing nutrients and calories absorbed by the body drastically. The bile (digestive juices) from the pancreas break down the food at the lower part of the small intestine.

Which Procedure is Best for Me?

The gastric sleeve is used for all ranges of obesity – obese, severely obese, morbidly obese, and super obese. Although it’s an excellent starter surgery, it has over 80% success rate long-term and can be readily revised in the event it fails.

Duodenal switch patients show durable results with their weight loss and remission of comorbidities, better than the gastric sleeve. As more and more surgeries are performed, surgeons are getting more experienced in the duodenal switch, and it’s gradually growing as a treatment for severe obesity.

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Candidacy Requirements

Do I Qualify for Gastric Sleeve?

  • BMI 30+

  • Existing Abdominal Scarring

  • Previous Ulcer

  • Committed to Lifestyle Change

Do I Qualify for Duodenal Switch?

  • BMI 40+

  • Type 2 Diabetes or Hypertension

  • Previous Ulcer

  • Dedicated to Following Strict Lifelong Habits

What is the Biggest Difference?

Both VSG and BPD/DS are done laparoscopically as opposed to an open incision approach. In laparoscopic sleeve gastrectomy, only physical change is made to your body. Whereas, in the classic DS surgery, physical and chemical changes are made to your body.

The duodenal switch is considered the most effective and complex weight loss surgery. However, it has higher complication rates and side effects. Both sleeve and DS 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 limited number of DS surgeries.

Amount of Weight Loss

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

  • The patients with gastric sleeve lose an average of 65% to 75% of their excess body weight.
  • The patients with duodenal switch lose an average of 75% to 85% of their excess body weight

However, with the BPD/DS, the patients tend to achieve a relatively lower BMI than those who underwent gastric sleeve surgery. Weight loss in DS patients lasts longer also. Duodenal Switch is mainly reserved for the morbidly obese.

Reversal of Obesity-Related Disease

Both surgeries lead to a significant reversal of obesity-associated conditions. 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.

Sleeve Gastrectomy versus Duodenal Switch
Comparison Table

Sleeve gastrectomy has been the most widely performed treatment for morbid obesity and obesity-related health issues in the past decade. Duodenal switch is considered a last-resort procedure for the most severely obese, usually requiring a body mass index of 45+.

Gastric SleeveDuodenal Switch
MethodRestrictiveRestrictive & Malabsorptive
StomachRemove 80-85%
(New Stomach 2-3 oz.)
Remove 70%
(New Stomach 4-5 oz.)
AnatomyNo ChangesSwitched Intestines
Duration1.5 hours3 hours
Hospital2 days2 to 4 days
Time Off1 to 2 weeks3 to 4 weeks
Recovery2 to 3 weeks4 to 6 weeks
AdvantageSimple
Low Risk
Higher %EWL
More Effective
DisadvantageLess %EWL
Less Cure Rate
Most Complications
Vitamins Required
Not Revisable
Weight Loss60-87% (%EWL)75-100% (%EWL)
Post-Op3 to 5 Meals/Day
800-1200 Cal
High-Protein
3 to 5 Meals/Day
800-1200 Cal
Strict Vitamins
Cure RateT2DM: 62%
HTN: 43%
GERD: 0%
OSA (CPAP): 63%
T2DM: 82%
HTN: 67%
GERD: 56%
OSA (CPAP): 92%
CandidacyBMI of 30+
Best 1st Procedure
BMI of 45+
Last Resort
  • (%EWL) = % Excess Weight Loss

  • T2DM = Type 2 Diabetes Mellitus
  • HTN = Hypertension

  • OSA = Obstructive Sleep Apnea

Comparing Costs and Insurance Coverage

The costs of gastric sleeve surgery range from $3,995 to $19,500, depending on where the surgery occurs. In Mexico, the price ranges from $3,995 to $8,995. To maintain a high-quality procedure, the all-inclusive package for sleeve surgery in Mexico should be over 4,595. In the United States, self-pay ranges from $15,000 to $30,000 for gastric sleeve surgery.

Duodenal switch surgery costs anywhere from $6,995 to $35,000 worldwide. At Mexico Bariatric Center®, our surgical teams pioneered the duodenal switch surgery in Mexico and have some of the most highly trained surgeons specializing in duodenal switch surgery. Our price is only $7,995.

Duodenal Switch operation is more involved than gastric sleeve surgery and, therefore, more expensive. 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, fewer insurance policies provide coverage for the duodenal switch. Patients undergoing duodenal switch procedures also incur $1500 per year on additional supplements and necessary tests.

Gastric Sleeve vs Duodenal Switch Cost Comparison

Complications and Side Effects

Complications After Gastric Sleeve

There are also far fewer post-op restrictions as gastric sleeve surgery does not alter the digestive process. The stomach removal may lead to 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 must be committed to monitoring your blood to prevent vitamin or mineral deficiencies.

Complications After Duodenal Switch

The duodenal switch surgery is a complicated procedure. Being a newer surgery, most bariatric surgeons do not have the skills or experience necessary. The rerouting of the small intestine introduces several 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 biliopancreatic diversion.

  • Excessive bleeding (~2% to ~6%)

  • Infection (~2% to 4%)

  • Adverse reactions to anesthesia (~1.2%)

  • Blood clots (2%)

  • Leaks in the gastrointestinal system (~3% to 6%)

Digestive Tract and Anatomy