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.
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.
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+.
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
Digestive Tract and Anatomy
The new stomach is like a hot dog or a “sleeve” and has the same shape as the duodenal switch pouch but is smaller. With vertical sleeve gastrectomy surgery, there are no anatomical changes, no changes to the pyloric valve, and no intestinal bypass.
The gastric sleeve surgery significantly restricts the volume of food that can be eaten. Mixing food with bile and pancreatic enzymes occurs as before surgery with no changes. Therefore, there is no malabsorption of nutrients, dumping, or bowel movements.
The new digestive tract after duodenal switch surgery is also changed through 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.