Gastric Sleeve vs Duodenal Switch Surgery

Gastric Sleeve vs Duodenal Switch

One of the most popular and effective bariatric procedure today is the Sleeve Gastrectomy, 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 known as the Duodenal Switch Surgery. It is an evolved version of the gastric sleeve, combining two weight-loss components to achieve the greatest expected weight loss.

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 sleeve stomach resembles a banana with a capacity of 4 to 6 oz.

Gastric Sleeve Surgery Schematic
  • Less Invasive Surgery

  • Reliable Weight Loss

  • Low Complication/Side Effect

  • Easy to Revise if Weight Gain Occurs

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

How Duodenal Switch Surgery Works

Duodenal Switch Surgery is a very intense weight loss surgery that combines variables from both gastric sleeve (restrictive) and gastric bypass (malabsorptive) methods to produce high expected weight loss.

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

  • Highest Reduction in Comorbidities and Health-Related Problems

  • 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, although it’s a great starter surgery because it is over 80% successful long-term and can be easily revised in the event it fails.

Duodenal switch patients show long-term success 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 its 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?

Gastric sleeve and BPD/DS are done laparoscopically as opposed to open approaches. 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 the most effective, and most complex weight loss surgery. However, the gastric sleeve procedure provides sufficient weight loss without 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.

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.

Table Comparison of Gastric Bypass versus Duodenal Switch

In the past decade, the sleeve gastrectomy is the most widely performed treatment for morbid obesity and obesity-related health issues. Duodenal switch is known as 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 bypass surgery range from $5,995 to $19,000 depending on where the surgery takes place. In Mexico, the price is as low as $5,995 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. At Mexico Bariatric Center, we 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 $6,995.

Duodenal Switch is more involved and more expensive than gastric sleeve surgery. 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.

Gastric Sleeve vs Duodenal Switch Cost Comparison

Complications and Side Effects

Complications After Gastric Bypass

There are also far fewer 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.

Complications After Duodenal Switch

The duodenal switch surgery is a complicated procedure and being a newer surgery the surgeons do not have the skills and the experience. The rerouting of the small intestine 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.

  • 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