Duodenal Switch (DS) Surgery - All You Need to Know

Reviewed by: John M. Rabkin, MD, FACS

Duodenal switch surgery (“biliopancreatic diversion with duodenal switch” or “DS”) makes the stomach smaller, reroutes the intestines, and removes the gallbladder. As a result, patients:

  • Feel less hungry
  • Feel full sooner after eating
  • Absorb fewer calories from the food they eat
  • Lose most of their excess weight within one year
  • Keep the weight off over the long-term
  • Have significant health improvement

This page covers everything you need to determine whether duodenal switch surgery is the right weight loss procedure for you.

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Weight Loss
Most of Your Excess Weight Within One Year

Weight Loss: Most of Your Excess Weight Within One Year

Duodenal switch patients lose a significant amount of weight very quickly after surgery:

  • Month 3: 30% of excess weight
  • Month 6: 45% of excess weight
  • Month 12: 65% of excess weight

By year two, the average DS patient has lost between 70% to 80% of their excess weight.

Some studies have even shown long-term excess weight loss to exceed 90%.

Equally important is the DS’s unique ability to keep the weight off over the long-term. On average, DS patients are able to reach a low weight of up to 70% or more excess weight loss and stay there for at least 5 years. For example, one study showed that 85% of patients have kept off at least 50% of their excess weight after 3 years. Other procedures tend to result in at least some weight regain over time.

These results place DS as the clear front-runner for long-term weight loss among all types of weight loss surgery (see full comparison with other procedures below).

References: (1) (2) (3) (4) (5) (6)

Health Benefits
Diabetes, Cardiac, Joints

Health Benefits: Diabetes, Cardiac, Joints

Most duodenal switch patients experience significant improvement in or a complete “cure” of obesity-related health problems, including:

Health Issue Associated with Obesity (Comorbidity)
Health Issue Associated with Obesity (Comorbidity)
Mortality Reduction/Life Expectancy (5 year mortality)
Mortality Reduction/Life Expectancy (5 year mortality)
Quality of Life Improvements
Quality of Life Improvements
Asthma
Asthma
Cardiovascular Disease
Cardiovascular Disease
Degenerative Joint Disease
Degenerative Joint Disease
Depression
Depression
Diabetes
Diabetes
Dyslipidemia hypercholesterolemia
Dyslipidemia hypercholesterolemia
Gastroesophageal Reflux Disease (GERD)
Gastroesophageal Reflux Disease (GERD)
High Blood Pressure (hypertension)
High Blood Pressure (hypertension)
Hyperlipidemia (high levels of fat in the blood)
Hyperlipidemia (high levels of fat in the blood)
Non-Alcoholic Fatty Liver Disease
Non-Alcoholic Fatty Liver Disease
Migraines
Migraines
Metabolic Syndrome
Metabolic Syndrome
Obstructive Sleep Apnea
Obstructive Sleep Apnea
Polycystic Ovarian Syndrome, Hirsutism & Menstrual Irregularity
Polycystic Ovarian Syndrome, Hirsutism & Menstrual Irregularity
Health Issue Associated with Obesity (Comorbidity)
Improvement or Resolution
Mortality Reduction/Life Expectancy (5 year mortality)
89% reduction in risk of death vs obese individuals who do not have bariatric surgery (7) (general bariatric surgery study, not specific to duodenal switch)
Quality of Life Improvements
95% of patients (8)
Asthma
Improved for 90% of patients (9)
Cardiovascular Disease
86% reduction in cardiovascular risks (10)
Degenerative Joint Disease
Complete resolution in at least 43% of patients (11 – gastric bypass study; no DS-specific studies available, but DS surgery results in at least as much weight loss as gastric bypass and therefore has at least as positive impact on joint health)
Depression
Improvement for majority of patients (12)
Diabetes
Resolved for 92% to 100% of patients, improved for 100% (13) (14)
Dyslipidemia hypercholesterolemia
Resolved in up to 100% of patients (15)
Gastroesophageal Reflux Disease (GERD)
Improved in 49% of patients (16)
High Blood Pressure (hypertension)
Improved in up to 83% of patients (17)
Hyperlipidemia (high levels of fat in the blood)
Improvement or complete resolution in 99% of patients (18)
Non-Alcoholic Fatty Liver Disease
Improved in up to 100% of patients (19)
Migraines
Most patients experience improvement (correlated with amount of weight lost – (20)
Metabolic Syndrome
Resolved or improved in up to 100% of patients (21) (22)
Obstructive Sleep Apnea
Resolved in up to 100% of patients (23)
Polycystic Ovarian Syndrome, Hirsutism & Menstrual Irregularity
Improvement or resolution in nearly all women (24) (25)

Qualify
35+ BMI with Health Issues, 40+ Without

Qualify: 35+ BMI with Health Issues, 40+ Without

You could be a good candidate for duodenal switch surgery if:

  • You have a body mass index (BMI) of 40 or more, OR
  • Your BMI is between 35 and 39.9 and you have a serious obesity-related health problem

Serious obesity-related health problems most commonly include:

  • High blood pressure
  • High cholesterol
  • Type 2 diabetes
  • Sleep apnea
  • Many others (see Health Benefits section below)

Use the BMI calculator at the top of this section to determine your body mass index.

The following conditions may pose a risk for DS patients:

  • Gastroesophageal reflux disease (GERD)
  • Inflammatory bowel disease (IBD)

Cost
$27,000 Avg Before Discounts, $2,000 Avg With Insurance
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$27,000 Avg Before Discounts, $2,000 Avg With Insurance

Average Cost By Location

On average, the total cost of duodenal switch surgery equals (in U.S. Dollars for comparison purposes):

  • United States – $27,000 (ranges from $24,000 in New Jersey to $32,500 in Nebraska)
  • Canada – procedure not widely available, so no average available
  • Australia – procedure not widely available, so no average available
  • United Kingdom – $15,780
  • Mexico – $8,060
  • India – $14,000

You should also be prepared to pay $1,500 or more per year on bariatric vitamins and supplements. However, patients typically have far fewer medication costs after the DS than before because it is so effective in eliminating health problems. More on this in the Vs. Not Having Surgery section below.

Click Here for DS Costs by Each U.S. State

A C G I K N T U W
Region Region
Average Cost Average Cost
Region ARIZONA
Average Cost $24,492

ARIZONA surgeons surveyed are located in Flagstaff, Mesa, Phoenix, Prescott, Scottsdale, Tempe and Tucson

Region CALIFORNIA
Average Cost $27,000

CALIFORNIA surgeons surveyed are located in Bakersfield, Burbank, Chico, Fresno, Los Angeles, Orange, La Jolla, Modesto, Oakland, Poway, Riverside, Sacramento, San Diego, San Francisco, San Jose and Santa Barbara

Region GEORGIA
Average Cost $30,500

GEORGIA surgeons surveyed are located in Albany, Athens, Atlanta, Augusta, Columbus, Decatur, Macon, Marietta and Savannah

Region ILLINOIS
Average Cost $26,145

ILLINOIS surgeons surveyed are located in Chicago, Champaign, Decatur, Naperville, Peoria, Rockford and Springfield

Region INDIANA
Average Cost $26,145

INDIANA surgeons surveyed are located in Bloomington, Evansville, Fort Wayne, Gary, Indianapolis and South Bend

Region KANSAS
Average Cost $27,000

KANSAS surgeons surveyed are located in Topeka, Lenexa, Wichita, Overland Park, Olathe, and Kansas City

Region NEBRASKA
Average Cost $32,500

NEBRASKA surgeons surveyed are located in Lincoln, Omaha and other towns

Region NEW JERSEY
Average Cost $24,000

NEW JERSEY surgeons surveyed are located in Newark, Trenton and Other Areas

Region TEXAS
Average Cost $28,300

TEXAS surgeons surveyed are located in Abilene, Amarillo, Austin, Corpus Christi, Dallas / Ft. Worth, Houston, Lubbock and San Antonio

Region UTAH
Average Cost $24,757

UTAH surgeons surveyed are located in Provo, Salt Lake City and St. George

Region WASHINGTON
Average Cost $28,500

WASHINGTON surgeons surveyed are located in Everett, Olympia, Seattle, Spokane, Tacoma, Vancouver and Other Areas

Vs. Not Having Surgery: Savings for DS Patients = $11,000 Per Year

Average medical costs are much lower over the long term for duodenal switch patients than if they had never had the procedure.

Starting 2 ½ years after surgery, DS patients without insurance save about $900 per month (26). That’s almost $11,000 saved per year. Fewer prescription drugs alone save patients $3,000 or more per year (27).

In other words, about 2 years and 6 months after surgery patients “break even” and start saving $11,000 per year in total medical costs.

Vs. Other Procedures: Highest Cost Without Insurance / Tied for Lowest Cost With Insurance

Duodenal switch has the highest total cost out of all available types of weight loss surgery, if you don’t have insurance. It’s tied for the lowest cost for patients with insurance.

Free Insurance Check & Cost Quote: Click here to contact a top duodenal switch surgeon

See our Types of Bariatric Surgery page for a full comparison.

Cost Components: Pre-Op, Costs During Surgery & Post-Op

Below are all potential duodenal switch surgery cost categories:

Pre-Op (Costs Before Surgery)

  • Physician-supervised weight loss program (required)
  • Dietitian/nutritionist consultations
  • Psychologist (mental health clearance)
  • Cardiologist (heart health clearance)
  • Lab/blood work, echocardiogram (also known as an “ECG” or “EKG”) and/or X-Ray fees
  • Surgeon consultation fees
  • Sleep study

Standard Costs During Surgery

  • Hospital fees
  • Surgeon fees
  • Surgical assistant fees
  • Anesthesia fees
  • Operating room fees

Non-Standard Costs During Surgery

  • Pathologist fees (for reviewing biopsies, if necessary)
  • Radiologist fees (for reviewing x-rays, if necessary)

Post-Op (Costs After Surgery)

  • Addressing any complications
  • Follow-up doctor visits
  • Bariatric vitamins
  • Extra food costs (healthier food tends to cost more)
  • Personal trainer and/or gym membership
  • New clothes (wait to go crazy with this until you reach your plateau weight)
  • Plastic surgery to remove sagging skin (more on this in the Downsides section below)

Discounts: 6 Discounts to Ask Your Surgeon About

Ask your surgeon if any of these discounts are available:

  • Self-Pay Discounts. Most surgeons offer self-pay discounts or payment plans. Just ask!
  • Other Discounts. Some offer discounts if you pay the total amount you owe in advance.
  • Same Surgeon, Different Hospitals. Some surgeons operate at more than one hospital. Hospital costs make up the biggest part of the bill, so find out if your surgeon has a choice.
  • Pre-Op Costs. Some surgeons include pre-op costs in their quoted fees. Pre-op costs include things like testing and office visits.
  • Complications. Complications, should they arise, may increase total costs. Find out who will pay if one arises during surgery. Some surgeons will include the cost of any complications in their quote while others will charge extra.
  • Health Insurance That Does Not Include Bariatric Surgery. You may still get insurance to pay for some costs that could be applied to covered treatments. For example, lab work is needed for many reasons outside of bariatric surgery. Your surgeon can help you find the loopholes in your plan.

Financing: 7 Ways to Make Surgery More Affordable

Duodenal switch loans are available almost everywhere to help pay for:

  • The entire cost of surgery
  • The part that insurance doesn’t cover, like deductibles, copays, or coinsurance

The full list of financing options to make duodenal switch surgery more affordable include (click links for more information):

  1. Payment Plan Through a Qualified Surgeon
  2. Brokers, Direct Lenders, and Credit Cards (Unsecured Medical Loans)
  3. Friends & Family
  4. Secured Medical Loans
  5. Retirement Plan Loans
  6. Permanent Life Insurance Loans
  7. Medical travel – having surgery in a location that is less expensive than where you live

Tax Savings: Tax Deductions & Special Tax-Favored Accounts

Click your country below to find out if tax savings are available:

United States: Might Be Deductible, Special Tax-Favored Accounts Available

Duodenal switch surgery is tax deductible – you can deduct all medical expenses if the costs are more than 10% of your adjusted gross income.

To receive the deductions, you’ll need to complete Schedule A of the IRS Form 1040. You’ll also need to save your medical bills and payment statements as proof.

Money in special savings accounts (or even your IRA) may also be a way to pay for part of surgery tax-free:

  1. Health Savings Account (HSA) – You can open an HSA alongside a “qualified high deductible” health plan. Tax-free HSA money can be used pay for qualified medical expenses. No other account receives better tax treatment. You can even transfer IRA money into an HSA. See the IRS’s Site for more info.
  2. Archer Medical Savings Account (Archer MSA) – Archer MSAs are like HSAs for the self-employed or small businesses. Click here for details.
  3. Health Reimbursement Account (HRA) – HRAs are only offered by employers who set them up and contribute money to them. If your company offers one, make sure your plan allows the use of HRA funds to pay for “all qualified medical expenses.” Click here for more info.
  4. Flexible Spending Account (FSA) – Both employers and employees can contribute to an FSA, also known by its IRS code, “Section 125”. Money from them can be taken out tax-free if it is used for qualified medical expenses. Click here to get the summary from the IRS.

Canada: Is Deductible

Canada is generous compared to other countries when it comes to medical tax deductions. If you have a prescription, receipt, or other documentation, you can write them off.

If surgery is covered by your insurance, you can still deduct your:

  • Out-of-pocket expenses
  • Monthly insurance premium.

If your income is below a certain amount, you may qualify for a tax credit called the refundable medical expense supplement.

Australia: Might Be Deductible

You can write off your bariatric surgery expenses if the costs are over the Australian Taxation Office (ATO) threshold.

According to the ATO:

“To claim the net medical expenses tax offset in your tax return, you will need to know the total medical expenses you incurred for yourself and your dependants. You then deduct any refunds from Medicare, your health fund or any other reimbursements that relate to those expenses received during the financial year.”

Click here for updated Medicare Benefit Tax Statement information from the Department of Human Services.

Insurance
Covered If Your Policy Includes Bariatric Surgery
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Insurance: Covered If Your Policy Includes Bariatric Surgery

Duodenal Switch

Click your country below for Duodenal Switch insurance information:

United States: Covered If Your Plan Includes Bariatric Surgery

In the U.S., Duodenal Switch is covered under any plan that includes weight loss surgery.

Use our Check My Insurance Tool to find out if it’s covered by your plan:

CHECK MY INSURANCE TOOL

Can’t find your insurance company/plan or have updated info? Click here to contact us.
Disclaimer: Accuracy not guaranteed. Contact your insurance company to confirm all benefits.

Click one of the following for more information:

How Do You Know If Your Insurance Includes Weight Loss Surgery?

It depends on where you get your insurance:

  • Individual/Family Plans & Small Group Plans (under 50 employees). The Affordable Care Act (Obamacare) requires bariatric surgery coverage in many states.
  • Large Group Plans (50+ employees) – Your company decides whether weight loss surgery is covered. Talk with your HR department or contact your insurance company to find out if it’s covered.
  • Medicare & Medicaid – Medicare and Medicaid both cover Duodenal Switch, but not all surgeons accept them.

If Your Policy Covers It: Ask for a Free Insurance Check

Many surgeons offer a free insurance check. They have a staff that is experienced at working with insurance companies.

Rather than figuring it out on our own, talk with a surgeon’s office about doing the legwork for you.

Contact a top surgeon for a free insurance check.

Following are average Duodenal Switch costs after insurance pays, depending on plan type:

  • HMO: $1,475
  • PPO: $2,542
  • POS: $2,270
  • High-Deductible Health Plan: $1,901

Click here for assumptions

  • No money has been paid towards your calendar year deductible for other services
  • Calculations made using special formulas that take into account the average plan designs from Kaiser Family Foundation’s Annual Employer Health Benefits Survey (27)

Your final out-of-pocket cost after insurance depends on several factors, including:

  • Discounts Negotiated By Your Insurance Company

    Insurance companies often have pre-negotiated rates for doctors and hospitals in their network. They may also try to negotiate deeper discounts on top of any negotiated rates.

  • Calendar Year Deductible Level

    You must pay all medical costs until you reach your calendar year deductible amount. Some expenses, like copayments and prescriptions, do not count towards your deductible. Prescriptions may have their own Calendar Year Deductible.

    After you reach the deductible, you share the cost with the insurance company. The amount you share depends on your Coinsurance percentage (see below).

    Deductibles reset on January 1st. As a result, many weight loss surgery patients “rush” to get a surgery date before the end of each year.

  • Remaining Calendar Year Deductible Amount

    The amount of money you still owe towards your deductible.

  • Hospital Copay

    The amount you will pay for each hospitalization (including weight loss surgery). Does not count towards reaching the Calendar Year Deductible.

  • Hospital Coinsurance

    The percentage of the total bill you are required to pay after you have “paid off” your Calendar Year Deductible.

  • Out-of-Pocket Maximum

    This is the most you will have to pay through deductible and coinsurance before your plan pays 100%. You will still be responsible for copayments, such as:

    • Office visits
    • Hospital copays
    • Prescription drugs
  • Total Year-to-Date Coinsurance Paid

    The total amount of coinsurance you have paid so far this calendar year. This is needed to determine whether your weight loss procedure will cause you to reach your annual out-of-pocket maximum.

If Your Policy Does NOT Cover It: Seek Partial Coverage

You may be able to get part of the costs paid for by insurance even if weight loss surgery isn’t covered. It’s all about how your doctor and hospital submit your claims to your insurance company.

For example, there are many non-bariatric surgery reasons for your doctor to recommend:

  • Cardiology exam
  • Lab work
  • Medically supervised diet program
  • Psychological exam
  • Sleep study

These are ordered for many reasons other than bariatric surgery and may be covered as a result. If your doctor submits one of these claims using a weight loss surgery CPT code (Current Procedural Terminology Code), your insurance is unlikely to cover it. But if your doctor uses a general CPT code, it probably will be covered.

While this may sound “sneaky”, it is an ethical practice. After all, these tests will be beneficial regardless of whether you move forward with surgery.

Find a Top Surgeon

The U.S. Insurance Approval Process

The entire Duodenal Switch insurance approval process takes between 1 and 12 months. The typical approval process usually happens in these steps:

  1. Your body mass index (BMI) requirements are confirmed by your physician:
    • BMI over 40 –OR–
    • BMI over 35 with one or more of the following:
      • Clinically significant obstructive sleep apnea
      • Coronary heart disease
      • Medically refractory hypertension
      • Type 2 diabetes mellitus
      • Other obesity-related health issues
  2. Complete 3 to 7 consecutive months of a medically supervised diet program.
  3. Schedule a consultation with your bariatric surgeon.
  4. Schedule a consultation with your primary care physician to get a medical clearance letter.
  5. Schedule a psychiatric evaluation to get a mental health clearance letter.
  6. Schedule a nutritional evaluation from a Registered Dietitian.
  7. Send the following to your insurance company:
    • All the above documentation
    • Detailed history of your obesity-related health problems
    • Difficulties and treatment attempts
  8. The review process usually happens in under one month.
  9. Insurance company sends approval or denial letter:
    • If approved, your surgeon’s bariatric coordinator will contact you for scheduling.
    • If denied, you can choose to appeal the denial.

Your bariatric surgeon’s office will do most of this legwork for you. They may even have all the required people on staff (registered dietitian, psychiatrist, bariatric coordinator, etc.).

Click here to access the weight loss surgeon directory to get started. Most offices will check your insurance for free to confirm coverage criteria.

For more information about Duodenal Switch insurance, see our Bariatric Surgery Insurance Patient Guide.

Disability Insurance During Recovery

Your employer decides whether to offer Disability insurance (DI). You can continue coverage as an individual if you leave the company.

DI pays you a percentage of your monthly income if you are unable to work. Short term disability insurance (STD) usually pays 66 2/3% of your salary for the first 90 or 180 days of your recovery.

Disability insurance usually includes pre-existing conditions limitations. The best way around this is to sign up during the initial enrollment period (when you’re hired). They might not allow you to enroll at any other time. You then need to stay enrolled for the entire “pre-existing conditions exclusionary period,” which lasts between 6 and 12 months. Call your insurance company, talk with HR, or review your plan documents for details.

Canada: Covered, But Long Wait Times

Jurisdictional Health Care in several Canadian provinces cover Duodenal Switch, including:

  • Alberta
  • British Columbia
  • Manitoba
  • Newfoundland and Labrador
  • Nova Scotia
  • Ontario
  • Quebec
  • Saskatchewan

If you want insurance to pay, wait times can be very long, ranging from 2 years to over 10 years.

If you don’t want to wait, you have two options:

  1. Insurance may pay for surgery outside of your province. But most provinces will not cover any expenses other than the surgery itself.
  2. Finance bariatric surgery on your own and receive treatment in a private facility.

Most weight loss surgery patients in Canada take the self-pay option. Private-pay clinics perform two-thirds of all weight loss surgeries in Canada (28).

See our Weight Loss Surgery in Canada Patient Guide for more information.

Click here to find a private-pay clinic in Canada or the United States.

Australia: Covered by Medicare & Private Insurance

Australian Medicare will pay for part of duodenal switch surgery as follows:

  • apply a set rate to your procedure that is much lower than the actual costs
  • Pays 75% of that set rate

But the rebate amount will still leave the majority of costs up to you and your private insurance.

For example:

  • If the total procedure costs = $20,000
  • And Medicare’s set rate is $850
  • Then Medicare will pay $637.50 of the total bill ($850 X 0.75)
  • You and your private insurance will be responsible for the balance

To get the current reimbursement levels for DS surgery:

  1. Click here to access the Medicare Benefits Schedule (MBS) database
  2. Type in Duodenal Switch Item Number 31581

Private insurance in Australia covers bariatric surgery, but you will need to wait at least 12 months after joining a health fund. After insurance and Medicare pay their part, you will need to pay between $1,700 and $5,300.

Contact your health fund directly for costs and coverage information. Provide them with the same Duodenal Switch Medicare Item Number: 31581.

Click here for a full list of Australian health funds and their contact information.

Click here to find a top bariatric surgeon in Australia or review our Australia Patient Guide.

Procedure
Laparoscopic, Makes Stomach 80% Smaller, Reroutes Intestines, Removes Gallbladder

Procedure: Laparoscopic, Makes Stomach 80% Smaller, Reroutes Intestines, Removes Gallbladder

Duodenal Switch (DS)

Why the Duodenal Switch Works

  • Reduced stomach size makes the patient feel full sooner after eating, causing patients to eat less
  • Removed portion of the stomach means fewer hunger-causing hormones are secreted, causing patient to feel less hungry generally
  • Rearranged intestines & removed gall bladder causes the body to absorb fewer calories and minerals

Preparing for Surgery

Your surgeon will work closely with you during the weeks leading up to surgery, including:

  • Health assessment, including questions about your medical history, medications, and surgical history
  • Order certain tests like an ECG, x-ray, and blood tests
  • Establish a pre-surgery diet regimen, including:
    • 2 Weeks Before
      • No sugar
      • Lower carbs
      • Increased protein
      • Increased veggies
      • Plenty of fluids
      • Talk with your surgeon about whether you should stop taking any medications
      • No food or drink, no tobacco
    • 2 Days Before
      • Clear liquids, broth, one protein shake per day only

While not a requirement, try to lose as much weight as possible before surgery. Here’s why:

  • The more weight you lose pre-op, the more weight you will lose after surgery
  • The lower your pre-op weight, the lower your risk of complications
  • You will regain weight if you slip into old habits. The sooner you can establish good diet and exercise habits, the more likely you will be to maintain them after surgery

See our Preparing for Weight Loss Surgery page for more information.

How the Duodenal Switch Procedure Is Performed

Before surgery, you’ll perform the typical pre-surgery routine:

  1. Remove all clothes and jewelry
  2. Put on your hospital gown
  3. Meet with your nurse and anesthesiologist
  4. Start your IV
  5. Receive medication for relaxation and sleep

To perform the surgery, the DS surgeon starts with a gastric sleeve (removes 80% of the stomach), then rearranges the intestines to reduce the amount of calories the body can absorb.

Here are the steps:

  1. A large portion of the stomach is removed to create a banana-shaped pouch connecting the esophagus to the top of the small intestine (just like a gastric sleeve).
  2. The top of the small intestine is cut, but the surgeon leaves part of the duodenum, the top part of the small intestine where most chemical digestion occurs, attached to the stomach.
  3. The surgeon then cuts the small intestine several feet down. The part that is still attached to the large intestine (colon) is connected to the duodenum.
  4. The loose part of the small intestine (the part that wasn’t just attached to the stomach) is then attached to the small intestine so the digestive juices it creates can mix with the food coming from the stomach.

Watch the following Duodenal Switch procedure videos to gain a better understanding:

Recovery
2 – 3 Days in Hospital, Back to Work in 2 Weeks, 4 – 6 Weeks to Full Recovery

Recovery: 2 – 3 Days in Hospital, Back to Work in 2 Weeks, 4 – 6 Weeks to Full Recovery

Duodenal switch patients usually:

  • Stay in the hospital for two or three days
  • Are back to work in 2 weeks
  • Have a full recovery within 4 to 6 weeks (e.g. incisions fully healed)

Here’s what to expect:

  1. Wake Up: When you first wake up, you’ll be sore and a little “out of it.” You’ll be on medication to control the pain.
  2. Move Around: Your surgeon will have you up and walking around as soon as possible after you wake up. This will reduce the risk of blood clots and jump-start your body’s healing process. Continue to walk as much as possible, increasing it a little each day.
  3. Get Released: Before releasing you, your surgical team will run some tests to ensure :
    1. You are able to drink enough to stay hydrated
    2. You can urinate normally after removing your catheter
    3. You have adequate pain relief from your pain medications
  4. Look for Warning Signs: Contact your surgeon if you experience any of the following:
    1. Difficulty swallowing
    2. Fever
    3. Signs of incision infection (pus, swelling, heat, or redness)
    4. Ongoing nausea or vomiting
    5. No improvement or worsening of pain​
  5. Transition Your Diet: Your smaller stomach will be sensitive, especially at first. You’ll start on a liquid diet and slowly transition back to solid foods (read more about this in the Diet section of this page). You may feel tired while your body gets used to less food.
  6. Ease Off Medications: Your surgeon will prescribe pain and digestion medication as needed. He may also adjust your pre-surgery medications until you’re fully healed. Follow their instructions to the letter.
  7. Return to Your “New Normal” Life: Avoid swimming or bathing until your incisions have fully healed. Many patients return to normal life and work within a couple of weeks, but plan for up to 4 to 6 weeks off to be on the safe side. Full exercise and heavy lifting should resume within one to two months.
  8. Have Follow-Up Visits During First Year: Follow-ups with your surgeon’s team will happen about one week post-op, then 4 weeks post-op, then every 3 or 4 months to ensure that everything is on track, including:
    1. Discuss weight loss
    2. Encourage regular exercise
    3. Obtain lab work and make necessary adjustments to medications and dietary supplements
    4. Understand diet and identify any potential eating disorders
    5. Determine whether any potential complications may be arising
    6. Track status of obesity-related health issues
    7. Involve your family physician to help evaluate progress and ensure a successful transition
  9. Transition to Semi-Annual or Yearly Follow-Up Visits – After you’ve reached your “low point” weight, your surgeon will probably still want to see you at least once per year (29). During those visits you may meet with several team members, including your surgeon, dietitian, and mental health care provider. They will probably request lab work to ensure that vitamin levels and other indicators are where they should be. If you experience any issues in between visits, don’t wait for your next visit… call your doctor right away.

Diet & Life After
Less Hungry, Restricted Diet, Strict Vitamin Regimen, Regular Exercise, Changing Relationships

Diet & Life After: Less Hungry, Restricted Diet, Strict Vitamin Regimen, Regular Exercise, Changing Relationships

Most duodenal switch patients lose a lot of weight very quickly – the average is 65% of excess weight within 12 months, and up to 90% of excess weight within 2 or 3 years.

But there are trade-offs. DS surgery is only a tool – long-term success requires diligence and sometimes difficult change in other areas.

The following sections give you an idea about what to expect before and after surgery. Every surgeon is different, and every patient is different. Please talk with your surgeon before acting on any of the following advice.

Food & Drink
Your Diet Transition Schedule

Food & Drink : Your Diet Transition Schedule

Timeframe Range
2+ Weeks Before Surgery

Recovering from surgery has its own set of challenges. Do not wait until after surgery to start your new life. Establish the following long-term diet habits ahead of time to:

  1. Optimize your body’s immune system for a quicker recovery
  2. Ease the transition into your new diet after surgery
  3. Make you much more likely to reach and maintain your weight loss goals

Long-Term Habits to Begin Before Surgery

Food

  • Eat as healthy as possible, protein first
  • 60+ grams of protein per day
  • Small portion sizes
  • Cut food into small pieces
  • Eat slowly, chew food thoroughly
  • No more than 3 small meals per day
  • Limit snacking (no more than 2 small snacks per day)
  • Limit high-fat foods
  • No fibrous foods like asparagus, celery, or broccoli
  • No starchy foods like rice, pasta, or bread
  • No greasy or spicy foods
  • No whole milk products
  • No sugar
  • Take your vitamins

Drinks

  1. Plenty of low-calorie fluids (64+ oz [2+ liters] per day)
  2. Sip fluids, don’t gulp
  3. Do not drink anything 30 minutes before, during, or after meals
  4. No sodas or sugary drinks
  5. Limit caffeine

Other Habits

  1. Start a diet journal
  2. Join a support group
  3. 30+ minutes of exercise, 5+ days per week
2 Weeks Before Surgery

You will be on a special diet 2 weeks before surgery to reduce the risk of complications.

Add the following to the full ‘2+ Weeks Before’ list above :

  • No caffeinated drinks
  • No carbonated drinks
  • No over-the-counter herbal supplements

The typical 2 week pre-op meal plan includes:

  • Breakfast: Protein shake that is low-sugar and low-carbs
  • Lunch: Lean meat and vegetables
  • Dinner: Lean meat and vegetables

The purpose of this diet is to:

  • Shrink your liver and reduce your intra-abdominal fat. This will make your organs easier to see and work with during surgery.
  • Help you lose weight before surgery. The lower your weight, the lower your risk of complications
  • Optimize your immune system for a quicker recovery
1 Week Before Surgery

Your surgeon will ask you to stop taking several medications one week before surgery, such as:

  • Any arthritis medications
  • Time-released medications – switch to non-time-released
  • NSAIDs (nonsteroidal anti-inflammatory drugs), such as:
    • Acetaminophen (Tylenol)
    • Aspirin (many brands)
    • Ibuprofen (Advil, Motrin)
    • Naproxen (Aleve)
  • Other anticoagulants, such as:
    • Enoxaparin (Lovenox)
    • Clopidogrel (Plavix)
    • Dipyridamole (Persantine)
    • Ticlopidine (Ticlid)
    • Warfarin (Coumadin)

Avoiding these medications will reduce the risk of bleeding and stomach problems after surgery.

Consult with your doctor or pharmacist prior to stopping or changing any of your medications.

2 Days Before Surgery

You should stop eating all foods and drink only clear liquids during the 2 days before surgery. This will clear out your digestive system before surgery.

Clear fluids options include :

  • Clear broth (beef, chicken, or vegetable)
  • Jell-O (sugar free)
  • Juice without pulp or added sugar (such as apple juice or pulp-free orange juice)
  • Popsicles (sugar-free)
  • Tea (caffeine-free, unsweetened)
  • Water

Do NOT consume…

  • Food of any kind
  • Thick or pulpy drinks of any kind
  • Caffeinated drinks
  • Carbonated drinks
  • Sugary drinks
Midnight Before Surgery to 7 Days After Surgery (Varies by Surgeon)

Your digestive system must be completely free of food or liquids during surgery.
This will reduce the risk of breathing in stomach-contents which can cause all sorts of problems like serious infection or pneumonia.

A clean digestive system is especially important for patients with gastroesophageal reflux disease (GERD) or gastric paresis (paralysis of the stomach) (30).

When you brush your teeth before heading to the hospital, rinse and spit out the water (don’t swallow).

In Hospital (1 -2 Days) thru Day 7 After Surgery

You will transition into drinking “richer” clear liquids along with the following guidelines:

  • Sip your liquids,no gulping
  • Do not use a straw or drink from a bottle as this can cause gas bubbles

Drinks that your nurse will provide may include:

  • Water or Ice (since you can’t eat anything yet, chewing ice may be more satisfying)
  • Clear broth (beef, chicken, or vegetable)
  • Drink mixes (sugar-free), like Crystal Light or Kool-Aid
  • Jell-O (sugar-free)
  • Thin juice or drinks without pulp or added sugar (such as apple juice, Propel Water, Powerade Zero, etc.)
  • Popsicles (sugar-free)
  • Tea (caffeine-free, unsweetened)

Your stomach is in healing mode, so go very easy on it when you return from the hospital.

Be sure to drink plenty of fluids, but don’t drink too quickly. Maintain the same clear liquids only diet that you were on in the hospital.

Take all vitamins and supplements recommended by your surgeon.

If you have no nausea or vomiting, your surgeon may allow you to try thicker items ahead of schedule (see below).

Other Habits

Day 1 to Week 2 After Surgery (Varies by Surgeon)

Your healing should be well underway. It’s now time to introduce thicker drinks and pureed foods. As soon as you’re ready, your surgeon will start you on many small “meals” per day which may include:

  • Clear liquids list from previous stages
  • Protein shakes
  • Clear broths (beef, chicken or vegetable)
  • Cream of Wheat
  • Cream soups (no chunks)
  • Carnation Instant Breakfast (sugar free)
  • Greek Yogurt
  • Natural applesauce
  • Sherbet (sugar-free)
  • Skim or Lactose-Free Milk Products
  • Thicker sugar-free juices like low-sodium V-8 or pulp-free orange juice
  • Vitamins and supplements

Remember: No soft or solid food and no drinks with chunks or seeds.

You can also drink clear liquids between meals.

While drinking anything:

  • Take small sips
  • Stop immediately as soon as you feel full or feel any pressure
Day 2 to Week 3 After Surgery (Varies by Surgeon)

By this point it should be safe to add softer solids to your diet, but take it slow!

When you’re ready to start pureed foods, blend water, skim milk, broth, or sugar-free juice with one of the following:

  • Beans
  • Cooked vegetables
  • Eggs
  • Fish
  • Ground meats (lean)
  • Soft fruits

As soon as the pureed foods are going down without a problem, work your way into soft foods like:

  • Cooked vegetables
  • Ground meats (lean)
  • Soft fruits (no seeds or skin)

And remember those habits you formed in the weeks and months leading up to surgery? Here’s where they start to come in really handy.

General diet guidelines during this stage include:

Food

  • Test one new food at a time to confirm you can tolerate it
  • Eat as healthy as possible, protein first
  • 60+ grams of protein per day
  • Small portion sizes
  • Cut food into small pieces
  • Eat slowly, chew food thoroughly
  • No more than 3 small meals per day
  • Limit snacking (no more than 2 small snacks per day)
  • Limit high-fat foods
  • No fibrous foods like asparagus, celery, or broccoli
  • No starchy foods like rice, pasta, or bread
  • No greasy or spicy foods
  • No whole milk products
  • No sugar
  • Take your vitamins

Drinks

  • Plenty of low-calorie fluids (64+ oz [2+ liters] per day)
  • Sip fluids, don’t gulp
  • Do not drink anything 30 minutes before, during, or after meals
  • No sodas or sugary drinks
  • Limit caffeine

Other Habits

Day 3 to Weeks 4+ After Surgery (Varies by Surgeon)

Complete your slow transition to your “new normal” long-term diet.

Your focus should be on eating your proteins first, in solid form (not protein shakes). Here’s why:

  • You need 80g of protein to stay healthy, and getting that much can be tough if you fill up on other food first
  • Liquid protein is okay while you are in healing mode, but can lead to weight regain if continued after recovery
  • Get the majority of your calories from solids. You’ll feel hungry sooner if you get your calories from liquids instead of solids. This can lead to weight regain.

Other points to consider, in addition to those reviewed in Day 2 to Week 3 above, include:

  • Test one food at a time to make sure you can tolerate it
  • Eat healthy “whole” foods (avoid processed foods)
  • Eat slowly and chew thoroughly
  • No starchy foods like rice, bread, and pasta
  • No whole milk products
  • 64+ oz (2+ liters) of fluids spread throughout the day
  • No drinking 30 minutes before or after meals
  • Weeks 4+ Meal Plans & Shopping List
  • Complete Duodenal Switch Diet Guide
Diet Requirements
Timeframe (Varies Widely By Surgeon) – Diet Requirements

Recovering from surgery and adjusting to your new stomach size have their own set of challenges. Do not wait until after surgery to start your new life… establish the following long-term diet habits ahead of time to:

  1. Optimize your body’s immune system for a quicker recovery
  2. Ease the transition into your new diet after surgery
  3. Make you much more likely to reach and maintain your weight loss goals

Long-Term Habits to Begin Before Surgery

Food

  • Eat as healthy as possible, protein first
  • 60+ grams of protein per day
  • Small portion sizes
  • Cut food into small pieces
  • Eat slowly, chew food thoroughly
  • No more than 3 small meals per day
  • Limit snacking (no more than 2 small snacks per day)
  • Limit high-fat foods
  • No fibrous foods like asparagus, celery, or broccoli
  • No starchy foods like rice, pasta, or bread
  • No greasy or spicy foods
  • No whole milk products
  • No sugar
  • Take your vitamins

Drinks

  • Plenty of low-calorie fluids (64+ oz [2+ liters] per day)
  • Sip fluids, don’t gulp
  • Do not drink anything 30 minutes before, during, or after meals
  • No sodas or sugary drinks
  • Limit caffeine

Other Habits

Your surgeon will have you on a special diet starting 2 weeks before surgery to reduce the risk of complications.

In addition to the full ‘2+ Weeks Before’ list above, also begin…

  • No caffeinated drinks
  • No carbonated drinks
  • No over-the-counter herbal supplements

The typical 2 week pre-op meal plan includes:

  • Breakfast: Protein shake that is low-sugar and low-carbs
  • Lunch: Lean meat and vegetables
  • Dinner: Lean meat and vegetables

The purpose of this diet is to:

  • Make surgery easier to perform, reduce operating time and reduce the risk of complications – this diet will shrink your liver and reduce your intra-abdominal fat, making your organs easier to see and work with during surgery.
  • Help you lose weight prior to surgery – the lower your weight, the lower your risk of complications
  • Optimize your immune system for a quicker recovery

Click the buttons below for a deeper dive into your 2 Week Pre-Op diet and the complications it will help you avoid.

In addition to the “2+ Weeks” and “2 Weeks Before” restrictions listed above, your surgeon will ask you to stop taking several medications one week prior to surgery such as:

  • Any arthritis medications
  • Any time-released meds – switch to non-time-released
  • NSAIDs (nonsteroidal anti-inflammatory drugs), such as:
    • Acetaminophen (Tylenol)
    • Aspirin (many brands)
    • Ibuprofen (Advil, Motrin)
    • Naproxen (Aleve)
  • Other anticoagulants, such as:
    • Enoxaparin (Lovenox)
    • Clopidogrel (Plavix)
    • Dipyridamole (Persantine)
    • Ticlopidine (Ticlid)
    • Warfarin (Coumadin)

Avoiding these meds will reduce the risk of bleeding and stomach problems after surgery.

Consult with your doctor or pharmacist prior to stopping or changing any of your medications.

2 Days Before Surgery – Clear liquids only

In order to fully clean out your digestive system prior to surgery, your surgeon will ask you to stop all foods and drink only clear liquids during the 2 days before surgery.

Clear fluids options include…

  • Clear broth (beef, chicken, or vegetable)
  • Jell-O (sugar free)
  • Juice without pulp or added sugar (such as apple juice or pulp-free orange juice)
  • Popsicles (sugar-free)
  • Tea (caffeine-free, unsweetened)
  • Water

Do NOT consume…

  • Food of any kind
  • Thick or pulpy drinks of any kind
  • Caffeinated drinks
  • Carbonated drinks
  • Sugary drinks
Midnight Before Surgery – Nothing to eat or drink

Your digestive system must be completely free of food or liquids when surgery is performed.

The main reason is to reduce the risk of pulmonary aspiration which happens when stomach contents get into the lungs, causing all sorts of problems like serious infection or pneumonia.

While recommended for most Duodenal Switch patients, the after-midnight fasting instructions are especially important for patients with gastroesophageal reflux disease (GERD) or gastric paresis (paralysis of the stomach which is more common among people with diabetes)(31).

When you brush your teeth before heading to the hospital, rinse and spit out the water (don’t swallow).

In Hospital to 7 Days After Surgery (Varies by Surgeon) Clear liquids only

After surgery, your surgical team will slowly transition you into drinking “richer” clear liquids along with the following guidelines:

  • Sip your liquids slowly… no gulping
  • Do not use a straw or drink from a bottle as this can cause gas bubbles to form

Drinks that your nurse will provide may include:

  • Water or Ice (since you can’t eat anything yet, chewing ice may be more satisfying)
  • Clear broth (beef, chicken, or vegetable)
  • Drink mixes (sugar-free), like Crystal Light or Kool-Aid
  • Jell-O (sugar-free)
  • Thin juice or drinks without pulp or added sugar (such as apple juice, Propel Water, Powerade Zero, etc.)
  • Popsicles (sugar-free)
  • Tea (caffeine-free, unsweetened)

Your stomach is in healing mode, so go very easy on it when you return from the hospital.

Be sure to drink plenty of fluids, but don’t drink too quickly. Maintain the same, clear liquids only diet that you were on in the hospital.

Take all vitamins and supplements recommended by your surgeon.

If you have no nausea or vomiting before the 7 day mark, your surgeon may allow you to slowly try thicker “Week 2” items ahead of schedule (expand that section below for examples).

Other Habits

Your healing should be well underway, and it’s time to slowly introduce thicker drinks and pureed foods. As soon as you’re ready, your surgeon will start you on multiple small “meals” per day which may include:

  • Clear liquids list from previous stages
  • Protein shakes
  • Clear broths (beef, chicken or vegetable)
  • Cream of Wheat
  • Cream soups (no chunks)
  • Carnation Instant Breakfast (sugar free)
  • Greek Yogurt
  • Natural applesauce
  • Sherbet (sugar-free)
  • Skim or Lactose-Free Milk Products
  • Thicker sugar-free juices like low-sodium V-8 or pulp-free orange juice
  • Vitamins and supplements

Remember: No soft or solid food and no drinks with chunks or seeds.

You can also drink clear liquids between meals.

While drinking anything:

  • Take small sips
  • Stop immediately as soon as you feel full or feel any pressure

By this point it should be safe to add softer solids to your diet, but take it slowly!

When you’re ready to introduce pureed foods, do so by blending water, skim milk, broth, or sugar-free juice with one of the following:

  • Beans
  • Cooked vegetables
  • Eggs
  • Fish
  • Ground meats (lean)
  • Soft fruits

As soon as the pureed foods are going down without a problem, work your way into soft foods like:

  • Cooked vegetables
  • Ground meats (lean)
  • Soft fruits (no seeds or skin)

And remember those habits you formed in the weeks and months leading up to surgery? Here’s where they start to come in really handy.

General diet guidelines during this stage include:

Food

  • Test one new food at a time to confirm you can tolerate it
  • Eat as healthy as possible, protein first
  • 60+ grams of protein per day
  • Small portion sizes
  • Cut food into small pieces
  • Eat slowly, chew food thoroughly
  • No more than 3 small meals per day
  • Limit snacking (no more than 2 small snacks per day)
  • Limit high-fat foods
  • No fibrous foods like asparagus, celery, or broccoli
  • No starchy foods like rice, pasta, or bread
  • No greasy or spicy foods
  • No whole milk products
  • No sugar
  • Take your vitamins

Drinks

  • Plenty of low-calorie fluids (64+ oz [2+ liters] per day)
  • Sip fluids, don’t gulp
  • Do not drink anything 30 minutes before, during, or after meals
  • No sodas or sugary drinks
  • Limit caffeine

Other Habits

Day 3 to Weeks 4+ After Surgery (Varies by Surgeon) Slowly test solid foods

From this point forward you will complete your slow transition to your “new normal” long-term diet.

Your focus should be on eating your proteins first, in solid form (not protein shakes). Here’s why:

  • You need 80g of protein to stay healthy, and getting that much can be tough if you fill up on other food first
  • Liquid protein is okay while you are in healing mode, but can lead to weight regain if continued after recovery
  • Your new sleeve stomach works by making you feel full sooner. Liquid flows through your stomach much more easily than solids, so your sleeve can’t “do it’s job” if you’re not allowing it to fill up. In other words, you’ll feel hungry sooner if you get your calories from liquids instead of solids, making you more likely to gain back weight.

Other points to consider, in addition to those reviewed in Day 2 to Week 3 above, include:

  • Test one food at a time to make sure you can tolerate it
  • Eat healthy “whole” foods (avoid processed foods)
  • Eat slowly and chew thoroughly
  • No starchy foods like rice, bread, and pasta
  • No whole milk products
  • 64+ oz (2+ liters) of fluids spread throughout the day
  • No drinking 30 minutes before or after meals
  • Weeks 4+ Meal Plans & Shopping List
  • Complete Duodenal Switch Diet Guide

Vitamins & Supplements
5 Lifelong Supplements

Vitamins & Supplements

Due to the extent of malabsorption after duodenal switch surgery, you will need to take 10 to 15 pills per day for the rest of your life. If you stop taking any prescribed vitamins, you will be twice as likely to develop vitamin deficiency (31).

To the average person, not getting enough vitamins doesn’t sound like a big deal. But when you change the architecture of your digestive system to the extent of the duodenal switch, it can become a life-threatening problem as our Bariatric Vitamins page explains.

Your surgeon will most likely prescribe the following supplements after surgery…

  • Multi-vitamin/mineral supplement
  • Additional calcium
  • Additional iron
  • Fat soluble vitamins (A, D, E, and K) in a ‘dry’ form
  • Probiotics (beneficial bacteria found in the intestinal tract)
  • Additional copper
  • Additional zinc

Routine blood tests and follow ups with your doctor are essential to make sure your body is getting enough supplements. You’ll often be asked to meet with a nutritionist or dietitian around the same time as your check-ups with your doctor.

Vitamins
Multivitamin (32) (33)

A daily multivitamin with mineral supplements will help prevent hair loss and general nutrition problems.

  • 1 to 2 per day
  • Chewable and liquid versions are best
  • At least 200% of the Recommended Dietary Allowance (RDA) of iron, folic acid, thiamine, copper, selenium, and zinc
Calcium (34)

Calcium citrate supplements will keep your bones strong.

  • Must be calcium citrate (NOT other forms of calcium)
  • 500 – 600 mg doses
  • Take 3 times per day forever
  • Chewable and liquid versions are best
  • Try to find one that includes Vitamin D
Folate (folic acid) (35)

Patients who don’t get enough folate are at a higher risk of anemia.

  • Needed in up to 40% of gastric bypass patients (36)
  • If deficient, take 200% the recommended daily intake
Iron (37) (38)

Patients low on iron are more likely to have a stroke, heart attack, or other blood-related problems.

Some patients may require additional iron, which should be taken with Vitamin C for better absorption. For these patients, Iron supplements must be taken forever.

Thiamin (Vitamin B1)

Thiamin deficiency, also called Beriberi, can result in loss of appetite, headaches, nausea, weakness, irritability, depression, abdominal discomfort, pain in the limbs, shortness of breath, and swollen feet or legs

Deficiency may occur after vomiting, skipped meals, or missed supplementation

Vitamin A (39)

At its worst, Vitamin A deficiency can lead to blindness. Other concerns include an increased risk of serious infection, gastroenteritis, kidney stones, and dry skin.

Most duodenal switch patients will need additional supplement for all fat soluble vitamins, including A, D, E, and K.

This often comes in the form of 3 fat-soluble vitamin tablets per day (1 per meal).

Vitamin D (40) (41) (42)

Without enough Vitamin D, you’re at risk of developing rickets, a weakening of the bones, muscles, and teeth.

  • Chewable and liquid versions are best
  • 3,000 International Units per day
  • Take with food
  • Take 2 hours apart from any Iron supplement (including a multivitamin that contains iron)

Talk with your surgeon to be sure, but you may be able to find a calcium supplement that fulfills your Vitamin D requirements.

Vitamin E (43)

Vitamin E deficiency can harm brain cells and red blood cells.

Most duodenal switch patients will need additional supplement for all fat soluble vitamins, including A, D, E, and K.

This often comes in the form of 3 fat-soluble vitamin tablets per day (1 per meal).

Vitamin K (44)

Vitamin K is needed for strong bones, so deficiencies can ultimately lead to osteoporosis. It also plays a big role in helping the blood clot (coagulate).

Most duodenal switch patients will need additional supplement for all fat soluble vitamins, including A, D, E, and K.

This often comes in the form of 3 fat-soluble vitamin tablets per day (1 per meal).

Vitamin B12

Your central nervous system relies on Vitamin B12, and not getting enough of it could lead to serious issues like numbness, memory loss or even paralysis.

  • 1000 mcg. under your tongue, 2-3 times per week (or 500 mcg. daily). Other options include nasal spray and shots from your doctor.
  • Must be taken forever
Zinc (45)

Healthy Zinc levels prevents myriad issues including low blood sugar, reproductive issues, brain disorders, poor circulation, skin, nail, and hair issues, and reduced sense of smell and taste.

Eating less protein after surgery and malabsorption caused by the procedure may lead to zinc deficiency (46).

Talk with your surgeon about appropriate zinc supplementation.

Copper (47)

Copper deficiency can result in several blood and brain issues like anemia, netropenia, myelopathy, peripheral neuropahty, and optic neuropathy.

Most DS patients will need long-term copper supplementations (48).

Talk with your surgeon about appropriate copper supplementation.

Body Part Affected
Vitamins – Body Part Affected
Multivitamin (49) (50) – Entire body

A daily multivitamin with mineral supplements will help prevent hair loss and general nutrition problems.

  • 1 to 2 per day
  • Chewable and liquid versions are best
  • At least 200% of the Recommended Dietary Allowance (RDA) of iron, folic acid, thiamine, copper, selenium, and zinc
Calcium (51) – Bone

Calcium nitrate supplements will keep your bones strong.

  • Must be calcium citrate (NOT other forms of calcium)
  • 500 – 600 mg doses
  • Take 3 times per day forever
  • Chewable and liquid versions are best
  • Try to find one that includes Vitamin D
Folate (folic acid) (52) – Blood

Patients who don’t get enough folate are at a higher risk of anemia.

  • Needed in up to 40% of gastric bypass patients (53)
  • If deficient, take 200% the recommended daily intake
Iron (54) (55) – Blood

Patients low on iron are more likely to have a stroke, heart attack, or other blood-related problems.

Some patients may require additional iron, which should be taken with Vitamin C for better absorption. For these patients, Iron supplements must be taken forever.

Thiamin (Vitamin B1) – Entire Body

Thiamin deficiency, also called Beriberi, can result in loss of appetite, headaches, nausea, weakness, irritability, depression, abdominal discomfort, pain in the limbs, shortness of breath, and swollen feet or legs.

Deficiency may occur after vomiting, skipped meals, or missed supplementation

Vitamin A (56) – Entire Body

At its worst, Vitamin A deficiency can lead to blindness. Other concerns include an increased risk of serious infection, gastroenteritis, kidney stones, and dry skin.

Most duodenal switch patients will need additional supplement for all fat soluble vitamins, including A, D, E, and K.

This often comes in the form of 3 fat-soluble vitamin tablets per day (1 per meal).

Vitamin D (57) (58) (59) – Entire Body

Without enough Vitamin D, you’re at risk of developing rickets, a weakening of the bones, muscles, and teeth.

  • Chewable and liquid versions are best
  • 3,000 International Units per day
  • Take with food
  • Take 2 hours apart from any Iron supplement (including a multivitamin that contains iron)

Talk with your surgeon to be sure, but you may be able to find a calcium supplement that fulfills your Vitamin D requirements.

Vitamin E deficiency can harm brain cells and red blood cells.

Most duodenal switch patients will need additional supplement for all fat soluble vitamins, including A, D, E, and K.

This often comes in the form of 3 fat-soluble vitamin tablets per day (1 per meal).

Vitamin K is needed for strong bones, so deficiencies can ultimately lead to osteoporosis. It also plays a big role in helping the blood clot (coagulate).

Most duodenal switch patients will need additional supplement for all fat soluble vitamins, including A, D, E, and K.

This often comes in the form of 3 fat-soluble vitamin tablets per day (1 per meal).

Your central nervous system relies on Vitamin B12, and not getting enough of it could lead to serious issues like numbness, memory loss or even paralysis.

  • 1000 mcg. under your tongue, 2-3 times per week (or 500 mcg. daily). Other options include nasal spray and shots from your doctor.
  • Must be taken forever

Healthy Zinc levels prevents myriad issues including low blood sugar, reproductive issues, brain disorders, poor circulation, skin, nail, and hair issues, and reduced sense of smell and taste.

Eating less protein after surgery and malabsorption caused by the procedure may lead to zinc deficiency (62).

Talk with your surgeon about appropriate zinc supplementation.

Copper deficiency can result in several blood and brain issues like anemia, netropenia, myelopathy, peripheral neuropahty, and optic neuropathy.

Most DS patients will need long-term copper supplementations (63).

Talk with your surgeon about appropriate copper supplementation.

Exercise
2.5 hours per week, spread out over 2 to 4 days

Exercise: 2.5 hours per week, spread out over 2 to 4 days

Duodenal Switch

Exercise is almost as important as your diet when it comes to long-term success:

  • Patients who exercise regularly lose more weight over the long-term
  • Physical and mental health benefits are incredible

How much exercise do you need to for noticeable results?

One study of gastric bypass patients found that 2.5 hours per week resulted in 5.7% greater excess weight loss (49).

Working out regularly will also lead to quicker and better health improvement after surgery (50).

To help you stay on track, block out time to exercise at the same times on the same days of the week.

Also, spread your 2.5 hours per week out over 3 or 4 days (in other words, 30 to 45 minutes 3 or 4 days per week). This will make it less intimidating to get started each day and will help you build endurance.

Exercise Types

There should be 3 main goals of your exercise routine:

  • Endurance – walking, stationary bike, and especially swimming
  • Flexibility – a good stretching routine. Yoga is best since it incorporates proper breathing and uses your own body weight to build strength
  • Strength – exercise balls, weights, and yoga

Learn more about exercise after weight loss surgery.

Your Brain
Less Hungry, Careful About Food Addiction, New Mentality Will Change Behavior & Relationships

Your Brain: Less Hungry, Careful About Food Addiction, New Mentality Will Change Behavior & Relationships

Ghrelin Hormone & Hunger

Duodenal Switch

You may feel less hungry following surgery.

When your stomach is empty, it secretes a hormone called ghrelin into your bloodstream. This causes your brain to generate hunger impulses.

After you eat, the amount of secreted ghrelin drops then slowly rises until your next meal. Since your stomach will be so much smaller after Duodenal Switch, the amount of ghrelin it secretes may also go down.

Less ghrelin in your system means you will feel less hungry than you did before surgery.

See our page about Obesity & Genetics for more information.

Food Addiction

Our bodies secrete certain hormones (like ghrelin) that tell us when we’re hungry. Junk food may override those hormone signals by overstimulating our reward centers. This is just like the way our bodies and brains react to an addictive drug.

You may have food addiction if your desire for food takes priority over other important parts of your life, such as:

  • Personal health
  • Family
  • Friends
  • Work
  • Your appearance
  • Avoiding obesity related health issues like hypertension, sleep apnea, or diabetes

If left unchecked, food addiction can lead to obesity. If not addressed before surgery, it can also lead to weight regain.

To find out if you may be suffering from food addiction, take our Food Addiction Quiz.

Relationships After Weight Loss

Duodenal Switch

Being thin again, or being thin for the first time, may be a shocking experience. Many patients express amazement at:

  • No more obesity discrimination. For example, strangers tend to be nicer to thin people.
  • Being treated with more respect
  • Getting more romantic interest from others
  • Building deeper relationships by being able to physically keep up with kids and more physically fit friends
  • Getting more compliments from others
  • Increased self-confidence and the effect that has on others

But there may be negatives to being thin as well.

People who you’ve known for a long time will not be used to the way you look and may not know how to act around you. For example:

  • How will overweight friends or family members feel when you’re losing weight but they are not?
  • Will your new healthier diet and smaller portion sizes make meals with others awkward?
  • Could intimacy with your spouse or partner be affected?
  • Could your spouse or partner become jealous now that others are noticing you more?
  • How will your coworkers react? Should you even tell them you are having surgery?
  • Will your friends or family make it difficult for you to stay on track by making bad diet choices?
  • Could your new self-confidence create conflict with people who are used the “old” you?

And what about the new “skinny lens” you see the world through? For example:

  • Would this person be treating me the same way if I hadn’t lost all this weight?
  • How do I handle obesity discrimination now that I’m on the “other side”?

Be prepared for both the good and the challenging “shocks” of dramatic weight loss following surgery.

For real life experiences and advice from other patients, see our Relationships After Weight Loss surgery page.

Downsides
Risk of Complications, Side Effects, & Weight Regain

Downsides: Risk of Complications, Side Effects, & Weight Regain

Duodenal switch surgery results in a high survival rate (99+%, or 99 out of 100 patients) (51). However, it does carry a risk of complications and side effects, some of which can be prevented. Click below to learn more.

Preventing Duodenal Switch Complications

Duodenal Switch

The patient is often to blame for complications as a result of not following their doctor’s instructions.

Behaviors that will dramatically reduce your risk of Duodenal Switch complications:

  • Pick a good surgeon
  • Follow your surgical team’s advice to the letter
  • Educate yourself
  • Educate your family
  • Lose as much weight as possible prior to surgery
  • Eat a healthy diet in the months leading up to surgery
  • Get tested for sleep apnea syndrome several weeks before surgery (and address the issue if it exists before moving forward)
  • Plan for at least 2 weeks of recovery time
  • Exercise right away after surgery, but take it easy at first.
    1. Compression stockings
    2. Pneumatic compression devices
    3. Blood thinners after surgery
  • Have an effective support system of friends, family, and weight loss surgery support groups

See our Bariatric Surgery Complications page for more information about each of these points.

Duodenal Switch Complications

The risk of DS complications depends on the patient’s weight before surgery.

For example, in one study of 190 DS patients (52), the percent of patients experiencing serious complications were as follows:

  • BMI below 50: 6.7% of patients
  • BMI 50 or higher: 12% of patients

In the same study, the percent of patients experiencing any complication were:

  • BMI below 50: 14.4% of patients
  • BMI 50 or higher: 24% of patients

The primary somewhat “unique” complication that is specific to duodenal switch surgery is:

  • Vitamin deficiencies/malnutrition – the DS surgery is effective partly because it prevents the body from absorbing as many calories as it used to. The downside is that it also prevents the body from absorbing as much vitamins and minerals, especially Vitamin A, Vitamin D, Vitamin E, Vitamin K, Iron, Calcium and Protein. This is the reason that a strict adherence to a prescribed vitamin regimen is essential for DS patients (see Diet & Life After section).

Other complications such as deep-vein thrombosis, bowel obstruction, infection, and hernias are associated with other procedures as well and so are not discussed in detail here.

For a full list of complications that are possible after any bariatric surgery (and surgery in general), see our Complications page.

Duodenal Switch Side Effects: Digestion & Sagging Skin

Digestion Issues

  • Difficulty Swallowing – this could be an issue with any restrictive procedure (like Duodenal Switch or Lap-Band) since the food will have smaller digestive openings to pass through following surgery. Difficulty swallowing is caused by eating too much, eating too quickly or not chewing food well enough and can usually be taken care of by addressing these issues.
  • GERD – About 1 in every 5 patients experience Gastroesophageal reflux disease (GERD) in the first 12 months. The good news is that this tends to be a shorter-term issue. After 3 years, the GERD rate drops to around 3% (53).
  • Bowel Movement Changes (if present, they can often be improved with diet changes):
    • Frequency – On average, DS patients will have 2 to 3 bowel movements per day, but some patients have reported having up to 10 or even 20 per day.
    • Diarrhea or loose stools
    • Foul-smelling stools or flatulence
    • Constipation is possible but rare after DS surgery

Other potential duodenal switch side effects include:

  • Gallstones
  • Indigestion (Dyspepsia)
  • Intolerance to certain foods
  • Nausea and vomiting

Sagging Skin

For most obese patients, the skin has been stretched out for so long to accommodate the extra weight that it has lost its elasticity. Duodenal switch surgery causes most patients to lose a lot of weight very quickly, and your skin simply can’t keep up.

The extra skin may be embarrassing. It can also cause several issues ranging from minor to severe, including:

  • Difficulty getting dressed
  • Difficulty exercising, which may impact long-term weight maintenance and health
  • Skin fold rashes or breakdown of skin
  • Skin fold infections

In some cases, patients manage sagging skin with body-contouring undergarments. In more serious cases, patients have plastic surgery to remove the excess skin. Surgery to remove excess skin is often covered by insurance.

See our Plastic Surgery After Weight Loss page for more information.

Weight Regain

While it’s possible, weight regain is much less of an issue after duodenal switch surgery than after other types of weight loss surgery due to its unique combination of:

  • Restriction – DS patients’ stomach size has been reduced by 80%, causing them to feel full sooner after eating. As a result, they eat less at meal time.
  • Reduced Hunger – A smaller stomach means fewer hunger-causing hormones, causing DS patients to eat less generally.
  • Malabsorption – Duodenal switch surgery has a much larger degree of calorie malabsorption than any other procedure (gastric bypass is primarily mineral-malabsorptive). As a result, far fewer calories are absorbed after eating.

This unique combination of eating less and absorbing less causes DS patients to lose more weight than any other procedure and to be more likely to keep their weight off over the long-term (54) (55).

Revision
Surgical Options to Address Weight Regain

Revision: Surgical Options to Address Weight Regain

Revision after duodenal switch surgery is uncommon. It is required in about 2.5% of patients due to:

  • Malnutrition (less than 1% of patients) – Usually corrected with a relatively simple procedure, although the procedure does carry a risk of complications.
  • Insufficient weight loss (about 1.5% of patients) – Most DS patients experience significant and long-term weight loss after DS surgery.
  • Other even less common issues like excessive diarrhea, abdominal pain, and weight regain.

Only 0.2% (1 out of 500) duodenal switch patients require a total reversal (56) (57).

If you are considering a DS revision, click here to contact a top DS surgeon .

Vs Other Types of Surgery
Best Weight Loss & Health Improvement, Less Hunger, Not Reversible

Vs Other Types of Surgery: Best Weight Loss & Health Improvement, Less Hunger, Not Reversible

Duodenal switch surgery is one of the least common types of weight loss surgery, probably because:

  • Most surgeons lack the technical expertise to perform it (and don’t have the motivation to learn it because there are other simpler-to-perform options that also have impressive results)
  • Other procedures result in similar short-term weight loss (but compared to the DS, other procedures also 1) result in less long-term weight loss and 2) are much more likely to result in at least some weight regain)
  • It requires more diligent follow up by the surgeon and the patient than other procedures to prevent vitamin deficiencies.

As a result, DS surgery tends to be recommended most often to “super morbidly obese” patients (BMI of 50+). And because heavier patients carry a higher risk of complications, the procedure tends to be stigmatized as higher-risk than it actually is (complication rates are similar to gastric bypass when evaluating patients of similar weight).

Regardless of your BMI, if you are willing to seek out (and potentially travel to) an experienced surgeon and commit to diligent follow up, duodenal switch will likely lead to (58):

  • More long-term weight loss than any other procedure
  • Better health improvement than any other procedure
Picture of Procedure (click to expand)
Picture of Procedure (click to expand)
Video of Procedure
Video of Procedure
External Device Placed Inside Body?
External Device Placed Inside Body?
Year Device/Product Approved
Year Device/ Product Approved
Average Total Cost Before Insurance (U.S.)
Average Total Cost Before Insurance (U.S.)
Covered by Insurance?
Covered by Insurance?
Financing Available?
Financing Available?
BMI Requirements
BMI Requirements
Avg % Excess Weight Loss After 5 Years
Avg % Excess Weight Loss After 5 Years
Health Improvement
Health Improvement
Procedure Type
Procedure Type
Complication Rate
Complication Rate
Mortality Rate
Mortality Rate
Reversible?
Reversible?
Time Until Removed
Time Until Removed
Alters Path of Digestion (Higher Risk of Mal-absorption)?
Alters Path of Digestion (Higher Risk of Mal-absorption)?
Procedure Time (Average)
Procedure Time (Average)
Hospital Stay (Average)
Hospital Stay (Average)
Recovery Time (Back to Work) – Average
Recovery Time (Back to Work) – Average
Diet Challenges (Procedure-Specific; Click here for general diet changes to expect)
Diet Challenges (Procedure-Specific; Click here for general diet changes to expect)
Food Cravings Likely to Decrease?
Food Cravings Likely to Decrease?
Difficulty Swallowing? (due to food backing up because of smaller stomach)
Difficulty Swallowing? (due to food backing up because of smaller stomach)
Digestion & Bowel Movement Post-Recovery (Relatively common issues)
Digestion & Bowel Movement Post-Recovery (Relatively common issues)
Qualified Surgeons
Qualified Surgeons
Patient Guides
Patient Guides
 
Duodenal Switch
Picture of Procedure (click to expand)
Video of Procedure
Duodenal Switch
External Device Placed Inside Body?
No
Year Device/Product Approved
n/a
Average Total Cost Before Insurance (U.S.)
$27,000
Covered by Insurance?
Yes (other than some individual policies)
Financing Available?
Yes
BMI Requirements
35 – 39.9 with health problems; 40+ without (but more common for 50+)
Avg % Excess Weight Loss After 5 Years
65 – 75%
Health Improvement
Compare % excess weight loss; the more weight loss, the more health improvement
Procedure Type
Laparoscopic
Complication Rate
Up to 24%
Mortality Rate
Up to 1.1% (but procedure tends to be performed on heavier patients who have higher risk)
Reversible?
No
Time Until Removed
n/a
Alters Path of Digestion (Higher Risk of Malabsorption)?
Yes
Procedure Time (Average)
3.5 – 4.5 hours
Hospital Stay (Average)
2 to 3 days
Recovery Time (Back to Work) – Average
~2 weeks
Diet Challenges(Procedure-Specific; Click here for general diet changes to expect)
Malabsorption will require life-long vitamin supple-mentation.
Food Cravings Likely to Decrease?
Maybe
Difficulty Swallowing? (due to food backing up because of smaller stomach)
Possible
Digestion & Bowel Movement Post-Recovery (Relatively common issues)
Might be significant, including frequency, diarrhea, and/or foul-smelling stools/ flatulence.
Qualified Surgeons
Fewer Options – Click Here to Find Surgeon
Patient Guides
(this page)
 
Gastric Sleeve
Picture of Procedure (click to expand)
Video of Procedure
Gastric Sleeve
External Device Placed Inside Body?
No
Year Device/Product Approved
n/a
Average Total Cost Before Insurance (U.S.)
$19,000
Covered by Insurance?
Yes (other than some individual policies)
Financing Available?
Yes
BMI Requirements
35 – 39.9 with health problems; 40+ without
Avg % Excess Weight Loss After 5 Years
64 – 75%
Health Improvement
Compare % excess weight loss; the more weight loss, the more health improvement
Procedure Type
Laparoscopic
Complication Rate
Up to 10%
Mortality Rate
0.19%
Reversible?
No
Time Until Removed
n/a
Alters Path of Digestion (Higher Risk of Malabsorption)?
No
Procedure Time (Average)
~2 hours
Hospital Stay (Average)
2 to 3 days
Recovery Time (Back to Work) – Average
~2 weeks
Diet Challenges (Procedure-Specific; Click here for general diet changes to expect)
Potential problem foods: Dairy
Food Cravings Likely to Decrease?
Maybe
Difficulty Swallowing? (due to food backing up because of smaller stomach)
Possible
Digestion & Bowel Movement Post-Recovery (Relatively common issues)
GERD (reflux) in ~1 out of 5 patients after 1 year, drops to 1~ out of 33 patients after 3 year. Some patients experience diarrhea.
Qualified Surgeons
Broad Network – Click Here to Find Surgeon
 
Gastric Bypass
Picture of Procedure (click to expand)
Video of Procedure
Gastric Bypass
External Device Placed Inside Body?
No
Year Device/Product Approved
n/a
Average Total Cost Before Insurance (U.S.)
$24,000
Covered by Insurance?
Yes (other than some individual policies)
Financing Available?
Yes
BMI Requirements
35 – 39.9 with health problems; 40+ without
Avg % Excess Weight Loss After 5 Years
50 – 70%
Health Improvement
Compare % excess weight loss; the more weight loss, the more health improvement
Procedure Type
Laparoscopic
Complication Rate
Up to 15%
Mortality Rate
0.24%
Reversible?
No
Time Until Removed
n/a
Alters Path of Digestion (Higher Risk of Malabsorption)?
Yes
Procedure Time (Average)
~4 hours
Hospital Stay (Average)
2 to 3 days
Recovery Time (Back to Work) – Average
~2 weeks
Diet Challenges (Procedure-Specific; Click here for general diet changes to expect)
Potential problem foods:Sugars, Refined fats, Carbs, Dairy. Malabsorption will require life-long vitamin supple-mentation.
Food Cravings Likely to Decrease?
Maybe
Difficulty Swallowing? (due to food backing up because of smaller stomach)
Possible
Digestion & Bowel Movement Post-Recovery (Relatively common issues)
Dumping syndrome occurs in ~80% of patients who eat sugar, refined fats, or carbs.
Qualified Surgeons
Broad Network – Click Here to Find Surgeon
 
Lap-band
Picture of Procedure (click to expand)
Video of Procedure
Lap-band
External Device Placed Inside Body?
Yes
Year Device/Product Approved
2011 (FDA10)
Average Total Cost Before Insurance (U.S.)
$15,000
Covered by Insurance?
Yes (other than some individual policies)
Financing Available?
Yes
BMI Requirements
35 – 39.9 with health problems; 40+ without
Avg % Excess Weight Loss After 5 Years
25 – 80% (extremely variable among patients)
Health Improvement
Compare % excess weight loss; the more weight loss, the more health improvement
Procedure Type
Laparoscopic
Complication Rate
Up to 33%
Mortality Rate
0.10%
Reversible?
Yes
Time Until Removed
Patient-Specific (not necessarily required)
Alters Path of Digestion (Higher Risk of Malabsorption)?
No
Procedure Time (Average)
~1 hour
Hospital Stay (Average)
Outpatient to 1 day
Recovery Time (Back to Work) – Average
~2 weeks
Diet Challenges (Procedure-Specific; Click here for general diet changes to expect)
Potential problem foods: Dairy. Should not drink anything within 30 minutes before or after eating
Food Cravings Likely to Decrease?
No
Difficulty Swallowing? (due to food backing up because of smaller stomach)
Possible
Digestion & Bowel Movement Post-Recovery (Relatively common issues)
Reflux and vomiting common if band too tight (can be adjusted). Some patients experience constipation.
Qualified Surgeons
Broad Network – Click Here to Find Surgeon
Patient Guides
 
Gastric Balloon
Picture of Procedure (click to expand)
Video of Procedure
Gastric Balloon
External Device Placed Inside Body?
Yes
Year Device/Product Approved
2015 (FDA11)
Average Total Cost Before Insurance (U.S.)
$8,150
Covered by Insurance?
Possible with aggressive negotiation and appeals
Financing Available?
Yes
BMI Requirements
Between 30 & 40 in U.S. (above 27 elsewhere)
Avg % Excess Weight Loss After 5 Years
n/a (must be removed after 6 months; weight loss during that time is 26 – 46%)
Health Improvement
Compare % excess weight loss; the more weight loss, the more health improvement
Procedure Type
Through Mouth
Complication Rate
Up to 10%
Mortality Rate
Close to 0%
Reversible?
Yes
Time Until Removed
6 months max
Alters Path of Digestion (Higher Risk of Malabsorption)?
No
Procedure Time (Average)
30 minutes or less
Hospital Stay (Average)
Outpatient
Recovery Time (Back to Work) – Average
3 – 4 days
Click here for general diet changes to expect)
Potential Problem Foods: Pasta and other foods that might stick to balloon in stomach.
Food Cravings Likely to Decrease?
No
Difficulty Swallowing? (due to food backing up because of smaller stomach)
Unlikely
Digestion & Bowel Movement Post-Recovery (Relatively common issues)
Vomiting possible (but often avoidable with proper habits). “Feeling bloated” reported by some patients.
Qualified Surgeons
Fewer Options – Click Here to Find Surgeon
 
vBloc
Picture of Procedure (click to expand)
Video of Procedure
vBloc
External Device Placed Inside Body?
Yes
Year Device/Product Approved
2015 (FDA9)
Average Total Cost Before Insurance (U.S.)
$18,500
Covered by Insurance?
Possible with aggressive negotiation and appeals
Financing Available?
Yes
BMI Requirements
35 – 39.9 with health problems; 40 – 45 without (none over 45)
Avg % Excess Weight Loss After 5 Years
17 – 28%
Health Improvement
Compare % excess weight loss; the more weight loss, the more health improvement
Procedure Type
Laparoscopic
Complication Rate
3 – 4%
Mortality Rate
Close to 0%
Reversible?
Yes
Time Until Removed
Patient-Specific (not necessarily required)
Alters Path of Digestion (Higher Risk of Malabsorption)?
No
Procedure Time (Average)
60 to 90 minutes
Hospital Stay (Average)
Outpatient
Recovery Time (Back to Work) – Average
3 – 4 days
Diet Challenges (Procedure-Specific; Click here for general diet changes to expect)
None, but healthier eating recommended for better results
Food Cravings Likely to Decrease?
Yes
Difficulty Swallowing? (due to food backing up because of smaller stomach)
No
Digestion & Bowel Movement Post-Recovery (Relatively common issues)
None
Qualified Surgeons
Fewer Options – Click Here to Find Surgeon

Duodenal Switch Positives

Duodenal Switch

Duodenal switch seems to be the most underrated and under-performed procedure based on its positive outcomes:

  • Long-term weight loss is better than any other procedure, and patients are much less likely to regain weight (59).
  • Health improvement is equal to or better than any other procedure, and health issues are less likely to come back (since DS patients are less likely to regain weight) (60).
  • Reduced hunger – only gastric sleeve, duodenal switch, and vBloc Therapy make you feel less hungry.
  • Risk of short-term complications is similar to gastric sleeve and gastric bypass (but higher than Lap-Band, vBloc Therapy, gastric balloon, and AspireAssist).
  • Risk of long-term complications is lower than Lap-Band and similar to gastric sleeve and gastric bypass (not enough long-term research exists for the other procedures).
  • No external device – there is no external device left inside the body after duodenal switch surgery as there is with Lap-Band, gastric balloon, vBloc Therapy, and AspireAssist, so there is no risk of device-related complications. While the risk of device-related complications is relatively low for vBloc Therapy, gastric balloon, and AspireAssist, it is a concern and should be considered for Lap-Band.
  • No dumping syndrome – dumping syndrome is experienced by up to 7 out of 10 gastric bypass patients, although many patients report this being a “good thing” since it helps them keep their diet on track. Dumping syndrome is uncommon after duodenal switch surgery.
  • Cost with Insurance – The cost of duodenal switch is tied for the lowest with gastric sleeve, gastric bypass, and Lap-Band surgery (gastric balloon, vBloc Therapy, and AspireAssist usually are not covered by insurance).

Duodenal Switch Negatives

The impressive weight loss and health improvement results of the DS carry some trade-offs:

  • Fewer surgeons perform DS than the other procedures, meaning you may have to travel to have surgery, correspond remotely for follow-up care, and find a local doctor to collaborate with as needed (click here to find a top DS surgeon)
  • Not reversible – Unlike Lap-band, gastric balloon, vBloc Therapy, and AspireAssist, duodenal switch surgery is irreversible. You cannot change back your smaller stomach. This is not necessarily a negative, but it is worth noting. More on this below.
  • Risk of short-term complications is higher than the less involved procedures like Lap-Band, gastric balloon, vBloc Therapy, and AspireAssist.
  • Requires a stricter adherence to a vitamin regimen and periodic tests to confirm that vitamin levels are within the appropriate range.
  • Cost Without Insurance – If you don’t have insurance that covers weight loss surgery, the DS is the most expensive type of weight loss surgery (it’s tied for the lowest cost if your insurance covers it).

Is Being Irreversible a Bad Thing?

The fact that duodenal switch is difficult to reverse may not be a bad thing.

First, it should be considered a “trade off”. You would be choosing the the highest likelihood of long-term weight loss and health improvement and taking on the possibilities of the downsides listed in the Downsides section above.

Second, many of the downsides can be improved with adjustments to your diet or, at worst, another surgery.

Finally, patients’ bodies tend to tolerate the DS better than “reversible” procedures like Lap-Band, which carry other risks such as:

  • Esophageal dilation
  • Pouch dilation
  • Food trapping
  • Port problems (since the sleeve does not use a port or any other implanted device)

Talk through each of these issues with your surgeon before making a decision.

Click here for studies that compare Duodenal Switch to other surgery types.

Summary of Findings When Comparing Duodenal Switch to Other Procedures
Summary of Findings When Comparing Duodenal Switch to Other Procedures
The data set is comprised of 3 retrospective clinical studies, 6 prospective clinical studies, and 2 randomized controlled trials (RCTs), which involved 429 patients in the gastric sleeve group and 428 patients in the gastric bypass group. In nonrandomized clinical studies, gastric sleeve displayed similar efficacy in remission of Type 2 Diabetes compared with the standard gastric bypass. In the RCTs, gastric sleeve had a lower effect than that of gastric bypass. No correlation was made between either or the procedures and Type 2 Diabetes remission, and percent weight loss was not observed for either procedure. Conclusions: Based on the current evidence, gastric sleeve has a similar effect on Type 2 Diabetes remission as gastric bypass.K
The data set is comprised of 3 retrospective clinical studies, 6 prospective clinical studies, and 2 randomized controlled trials (RCTs), which involved 429 patients in the gastric sleeve group and 428 patients in the gastric bypass group. In nonrandomized clinical studies, gastric sleeve displayed similar efficacy in remission of Type 2 Diabetes compared with the standard gastric bypass. In the RCTs, gastric sleeve had a lower effect than that of gastric bypass. No correlation was made between either or the procedures and Type 2 Diabetes remission, and percent weight loss was not observed for either procedure. Conclusions: Based on the current evidence, gastric sleeve has a similar effect on Type 2 Diabetes remission as gastric bypass.K
The operation times of the gastric bypass patients were longer than those of both the gastric sleeve and mini gastric bypass patients. The gastric bypass and mini gastric bypass patients experienced higher major complication rate than the gastric sleeve patients. The weight loss of the gastric sleeve patient at 5 years was 28.3%, and the mean BMI was 27.1. The gastric bypass patients exhibited a 5-year weight loss similar to the gastric sleeve patients, and the mini gastric bypass patients exhibited greater weight loss than both of the other groups. Both the gastric bypass and mini gastric bypass patients exhibited significantly better glycemic control and lower blood lipids than the gastric sleeve patients, but the gastric sleeve patients exhibited a lesser micronutrient deficiency than the gastric bypass and mini gastric bypass groups. All three of the groups exhibited improved quality of life at 5 years after surgery, and there was no significant between-group difference in this measure. Conclusions: Gastric sleeve appears to be an ideal bariatric surgery, and the efficacy of this surgery is not inferior to that of gastric bypass.J
The operation times of the gastric bypass patients were longer than those of both the gastric sleeve and mini gastric bypass patients. The gastric bypass and mini gastric bypass patients experienced higher major complication rate than the gastric sleeve patients. The weight loss of the gastric sleeve patient at 5 years was 28.3%, and the mean BMI was 27.1. The gastric bypass patients exhibited a 5-year weight loss similar to the gastric sleeve patients, and the mini gastric bypass patients exhibited greater weight loss than both of the other groups. Both the gastric bypass and mini gastric bypass patients exhibited significantly better glycemic control and lower blood lipids than the gastric sleeve patients, but the gastric sleeve patients exhibited a lesser micronutrient deficiency than the gastric bypass and mini gastric bypass groups. All three of the groups exhibited improved quality of life at 5 years after surgery, and there was no significant between-group difference in this measure. Conclusions: Gastric sleeve appears to be an ideal bariatric surgery, and the efficacy of this surgery is not inferior to that of gastric bypass.J
A total of 21 studies involving 18,766 morbidly obese patients were eventually selected according to the inclusion criteria. No significant difference was found in % excess weight lost during 0.5 to 1.5-year follow-up, but after that, gastric bypass achieved higher % excess weight loss than LSG. Except for type 2 diabetes mellitus (gastric bypass had higher resolution or improvement rates), the difference between these two procedures in the resolution or improvement rate of other comorbidities did not reach a statistical significance. There were more adverse events (complications) in gastric bypass compared with gastric sleeve. In conclusion, gastric bypass is superior to gastric sleeve in efficacy but inferior to gastric sleeve in safety.I
A total of 21 studies involving 18,766 morbidly obese patients were eventually selected according to the inclusion criteria. No significant difference was found in % excess weight lost during 0.5 to 1.5-year follow-up, but after that, gastric bypass achieved higher % excess weight loss than LSG. Except for type 2 diabetes mellitus (gastric bypass had higher resolution or improvement rates), the difference between these two procedures in the resolution or improvement rate of other comorbidities did not reach a statistical significance. There were more adverse events (complications) in gastric bypass compared with gastric sleeve. In conclusion, gastric bypass is superior to gastric sleeve in efficacy but inferior to gastric sleeve in safety.I
Compared with gastric sleeve, gastric bypass had significantly better effect in resolving type 2 diabetes mellitus, hypertension, hypercholesterolemia, gastroesophageal reflux disease, and arthritis. However, gastric bypass had higher incidence of complications and reoperation, and longer operation time than gastric sleeve.G
Compared with gastric sleeve, gastric bypass had significantly better effect in resolving type 2 diabetes mellitus, hypertension, hypercholesterolemia, gastroesophageal reflux disease, and arthritis. However, gastric bypass had higher incidence of complications and reoperation, and longer operation time than gastric sleeve.G
Overall complication rates among patients undergoing gastric sleeve (SG) (6.3%) were significantly lower than for gastric bypass (RYGB) (10.0%, P < 0.0001). Serious complication rates were similar for SG (2.4%) and RYGB (2.5%, P = 0.736). Excess body weight loss at 1 year was 13% lower for SG (60%) than for RYGB (69%, P < 0.0001). SG was closer to RYGB than Lap-band (LAGB) with regard to remission of obesity-related comorbidities.H
Overall complication rates among patients undergoing gastric sleeve (SG) (6.3%) were significantly lower than for gastric bypass (RYGB) (10.0%, P < 0.0001). Serious complication rates were similar for SG (2.4%) and RYGB (2.5%, P = 0.736). Excess body weight loss at 1 year was 13% lower for SG (60%) than for RYGB (69%, P < 0.0001). SG was closer to RYGB than Lap-band (LAGB) with regard to remission of obesity-related comorbidities.H
PYY levels increased similarly after either procedure. The markedly reduced ghrelin levels in addition to increased PYY levels after gastric sleeve, are associated with greater appetite suppression and excess weight loss compared with gastric bypass surgery.A
(Editors’s note: both ghrelin and peptide YY effect appetite. See our Obesity and Genetics page for more details)
PYY levels increased similarly after either procedure. The markedly reduced ghrelin levels in addition to increased PYY levels after gastric sleeve, are associated with greater appetite suppression and excess weight loss compared with gastric bypass surgery.A
(Editors’s note: both ghrelin and peptide YY effect appetite. See our Obesity and Genetics page for more details)
Lap-band Surgery vs Gastric Sleeve
Lap-band Surgery vs Gastric Sleeve
Bariatric surgery is an effective treatment strategy in morbidly obese adolescents who have failed medical management. Gastric sleeve results in greater short term weight and BMI loss when compared to gastric banding (e.g. Lap-Band). Longer follow up with more patients will be required to confirm the long term safety and efficacy of gastric sleeve in adolescent patients.L
Bariatric surgery is an effective treatment strategy in morbidly obese adolescents who have failed medical management. Gastric sleeve results in greater short term weight and BMI loss when compared to gastric banding (e.g. Lap-Band). Longer follow up with more patients will be required to confirm the long term safety and efficacy of gastric sleeve in adolescent patients.L
Weight loss and loss of feeling of hunger after 1 year and 3 years are better after gastric sleeve than Lap-band surgery. Gastroesophageal Reflux Disease (GERD) is more frequent at 1 year after gastric sleeve and at 3 years after Lap-band surgery. The number of re-operations is important in both groups, but the severity of complications appears higher in gastric sleeve.B
Weight loss and loss of feeling of hunger after 1 year and 3 years are better after gastric sleeve than Lap-band surgery. Gastroesophageal Reflux Disease (GERD) is more frequent at 1 year after gastric sleeve and at 3 years after Lap-band surgery. The number of re-operations is important in both groups, but the severity of complications appears higher in gastric sleeve.B
Weight loss and loss of feeling of hunger after 1 year and 3 years are better after gastric sleeve than Lap-band. GERD is more frequent at 1 year after gastric sleeve and at 3 years after Lap-band. The number of re-operations is important in both groups, but the severity of complications appears higher in gastric sleeve.C
Weight loss and loss of feeling of hunger after 1 year and 3 years are better after gastric sleeve than Lap-band. GERD is more frequent at 1 year after gastric sleeve and at 3 years after Lap-band. The number of re-operations is important in both groups, but the severity of complications appears higher in gastric sleeve.C
Gastric sleeve may become the ideal operation for staging in patients with body mass index (BMI) >55, for treating morbidly obese patients with severe medical conditions, as an excellent alternative to adjustable bands in lower BMI patients, or for conversion of Lap-band patients.D
Gastric sleeve may become the ideal operation for staging in patients with body mass index (BMI) >55, for treating morbidly obese patients with severe medical conditions, as an excellent alternative to adjustable bands in lower BMI patients, or for conversion of Lap-band patients.D
Multiple Procedures vs Gastric Sleeve
Multiple Procedures vs Gastric Sleeve
The gastric sleeve operation is able to achieve significant weight loss comparable to the gastric bypass and duodenal switch operations but with the low morbidity profile similar to that of Lap-band placement.E
The gastric sleeve operation is able to achieve significant weight loss comparable to the gastric bypass and duodenal switch operations but with the low morbidity profile similar to that of Lap-band placement.E
Gastric sleeve has been highly effective for weight reduction for morbid obesity even as the sole bariatric operation. Gastric dilatation was found in only 1 patient in this short-term follow-up. Weight regain following gastric sleeve may require conversion to gastric bypass or duodenal switch. Follow-up will be necessary to evaluate long-term results.F
Gastric sleeve has been highly effective for weight reduction for morbid obesity even as the sole bariatric operation. Gastric dilatation was found in only 1 patient in this short-term follow-up. Weight regain following gastric sleeve may require conversion to gastric bypass or duodenal switch. Follow-up will be necessary to evaluate long-term results.F
Summary of Findings When Comparing Gastric Sleeve Surgery to Other Procedures
Year of Study
The data set is comprised of 3 retrospective clinical studies, 6 prospective clinical studies, and 2 randomized controlled trials (RCTs), which involved 429 patients in the gastric sleeve group and 428 patients in the gastric bypass group. In nonrandomized clinical studies, gastric sleeve displayed similar efficacy in remission of Type 2 Diabetes compared with the standard gastric bypass. In the RCTs, gastric sleeve had a lower effect than that of gastric bypass. No correlation was made between either or the procedures and Type 2 Diabetes remission, and percent weight loss was not observed for either procedure. Conclusions: Based on the current evidence, gastric sleeve has a similar effect on Type 2 Diabetes remission as gastric bypass.K
2015
The operation times of the gastric bypass patients were longer than those of both the gastric sleeve and mini gastric bypass patients. The gastric bypass and mini gastric bypass patients experienced higher major complication rate than the gastric sleeve patients. The weight loss of the gastric sleeve patient at 5 years was 28.3%, and the mean BMI was 27.1. The gastric bypass patients exhibited a 5-year weight loss similar to the gastric sleeve patients, and the mini gastric bypass patients exhibited greater weight loss than both of the other groups. Both the gastric bypass and mini gastric bypass patients exhibited significantly better glycemic control and lower blood lipids than the gastric sleeve patients, but the gastric sleeve patients exhibited a lesser micronutrient deficiency than the gastric bypass and mini gastric bypass groups. All three of the groups exhibited improved quality of life at 5 years after surgery, and there was no significant between-group difference in this measure. Conclusions: Gastric sleeve appears to be an ideal bariatric surgery, and the efficacy of this surgery is not inferior to that of gastric bypass.J
2015
A total of 21 studies involving 18,766 morbidly obese patients were eventually selected according to the inclusion criteria. No significant difference was found in % excess weight lost during 0.5 to 1.5-year follow-up, but after that, gastric bypass achieved higher % excess weight loss than LSG. Except for type 2 diabetes mellitus (gastric bypass had higher resolution or improvement rates), the difference between these two procedures in the resolution or improvement rate of other comorbidities did not reach a statistical significance. There were more adverse events (complications) in gastric bypass compared with gastric sleeve. In conclusion, gastric bypass is superior to gastric sleeve in efficacy but inferior to gastric sleeve in safety.I
2014
Compared with gastric sleeve, gastric bypass had significantly better effect in resolving type 2 diabetes mellitus, hypertension, hypercholesterolemia, gastroesophageal reflux disease, and arthritis. However, gastric bypass had higher incidence of complications and reoperation, and longer operation time than gastric sleeve.G
2014
Overall complication rates among patients undergoing gastric sleeve (SG) (6.3%) were significantly lower than for gastric bypass (RYGB) (10.0%, P < 0.0001). Serious complication rates were similar for SG (2.4%) and RYGB (2.5%, P = 0.736). Excess body weight loss at 1 year was 13% lower for SG (60%) than for RYGB (69%, P < 0.0001). SG was closer to RYGB than Lap-band (LAGB) with regard to remission of obesity-related comorbidities.H
2013
PYY levels increased similarly after either procedure. The markedly reduced ghrelin levels in addition to increased PYY levels after gastric sleeve, are associated with greater appetite suppression and excess weight loss compared with gastric bypass surgery.A
(Editors’s note: both ghrelin and peptide YY effect appetite. See our Obesity and Genetics page for more details)
2008
Lap-band Surgery vs Gastric Sleeve
Bariatric surgery is an effective treatment strategy in morbidly obese adolescents who have failed medical management. Gastric sleeve results in greater short term weight and BMI loss when compared to gastric banding (e.g. Lap-Band). Longer follow up with more patients will be required to confirm the long term safety and efficacy of gastric sleeve in adolescent patients.L
2015
Weight loss and loss of feeling of hunger after 1 year and 3 years are better after gastric sleeve than Lap-band surgery. Gastroesophageal Reflux Disease (GERD) is more frequent at 1 year after gastric sleeve and at 3 years after Lap-band surgery. The number of re-operations is important in both groups, but the severity of complications appears higher in gastric sleeve.B
2006
Weight loss and loss of feeling of hunger after 1 year and 3 years are better after gastric sleeve than Lap-band. GERD is more frequent at 1 year after gastric sleeve and at 3 years after Lap-band. The number of re-operations is important in both groups, but the severity of complications appears higher in gastric sleeve.C
2006
Gastric sleeve may become the ideal operation for staging in patients with body mass index (BMI) >55, for treating morbidly obese patients with severe medical conditions, as an excellent alternative to adjustable bands in lower BMI patients, or for conversion of Lap-band patients.D
2005
Multiple Procedures vs Gastric Sleeve
The gastric sleeve operation is able to achieve significant weight loss comparable to the gastric bypass and duodenal switch operations but with the low morbidity profile similar to that of Lap-band placement.E
2007
Gastric sleeve has been highly effective for weight reduction for morbid obesity even as the sole bariatric operation. Gastric dilatation was found in only 1 patient in this short-term follow-up. Weight regain following gastric sleeve may require conversion to gastric bypass or duodenal switch. Follow-up will be necessary to evaluate long-term results.F
2006

For a more-detailed comparison, see our Types of Bariatric Surgery page.

Quiz: Which Weight Loss Surgery Is Best for You?

Quiz: Which Weight Loss Surgery Is Best for You? 1/10

Your Results

What is your gender?

Are you pregnant, or do you plan to be over the next two years?

Input your Height and Weight

Do you have any weight-related health issues (diabetes, asthma, hypertension, sleep apnea, joint problems, etc.)?

How do you feel about regular visits with a bariatric professional (doctor, dietician, etc.)?

Would the risk of uncomfortable side effects like nausea, vomiting, or diarrhea be a good motivator for you to maintain the right diet, or would you rather avoid those side effects at all costs?

Do you have insurance that covers bariatric surgery?

Are you on anticoagulation medication (blood thinners)?

Are you comfortable with the idea of an external device being left inside your body after surgery?

Are you willing to be on a serious regimen of vitamins and supplements for the rest of your life?

Unfortunately, none of the available types of weight loss surgery seem to be a good fit.

Here's why: Earlier you said that you have not thoroughly explored other treatments for obesity. That is required for all procedures except gastric balloon. Your body mass index ("BMI", which is based on your height and weight) is over 40, and gastric balloon is only available for BMI's between 30 and 40. So unfortunately, none of the available procedures seem to be a good fit.

Unfortunately, none of the available types of weight loss surgery seem to be a good fit for you.

Body Mass Index & Health Conditions

Your body mass index is XX.

In order to qualify for gastric sleeve, gastric bypass, duodenal switch, Lap-Band surgery, your body mass index (BMI) must be 40+ or between 35 and 40 only if you also have weight-related health issues.

For vBloc Therapy, your body mass index (BMI) must be 40+ or between 35 and 45 only if you also have weight-related health issues.

Gastric balloon requires a BMI between 30 and 40 (with or without health issues).

Even though your BMI would qualify you for the gastric balloon, you said anything less than 50% excess weight loss is unacceptable. Unfortuantely, gastric balloon only results in about 20% excess weight loss.

Learn more about Gastric Balloon

Since you are or are planning to be pregnant, you should not have weight loss surgery at this time.

Most women should wait least one year to 18 months after bariatric surgery before getting pregnant. This is the timeframe when many patients experience the biggest amount of weight loss, and it is the most difficult period for keeping your body’s nutritional needs in line.

Many bariatric surgery procedures prevent patients from getting the vitamins their bodies need from the foods they eat. So even after you’ve waited the 12 to 18 months, you’ll need to make sure you stay on top of your bariatric vitamins both before and during your pregnancy.

Learn More About Pregnancy After Weight Loss Surgery

Thank you for completing Bariatric Surgery Source’s "Which Weight Loss Surgery Is Best for You?" quiz! The results are in...

Winner:

Gastric sleeve surgery, also called “vertical sleeve gastrectomy”, drastically reduces the size of the stomach which causes patients to feel full sooner and lowers the production of hunger-inducing hormones, leading to significant long-term weight loss and health improvement.

Gastric bypass surgery, also called “ Roux-en-Y gastric bypass”, makes the stomach smaller and reroutes the intestines, causing patients to feel full sooner and absorb less food, resulting in significant long-term weight loss and health improvement.

The endoscopic intragastric balloon, or “gastric balloon,” is a relatively new, non-invasive, and temporary procedure whereby a durable silicone balloon is passed through the mouth, down into the stomach, and filled with saline to make patients feel full sooner, leading to significant short-term weight loss.

It was developed to "bridge the gap" between pure diet and exercise and a more complicated bariatric procedure like gastric sleeve surgery.

The Biliopancreatic Diversion with Duodenal Switch (BPD-DS), or “Duodenal Switch” (DS) for short, deserves more credit and attention than it’s been given. On average, it results in more weight loss than any other procedure.

Its mortality risks are on par with other procedures, and it may be the best procedure for those with a 50+ body mass index (“super-obese”) in terms of average weight loss and elimination of obesity health problems.

However, its higher rate of serious complications and the amount of malabsorption that it causes command careful consideration before moving forward.

Gastric banding, also called Lap-Band surgery, is quickly losing popularity due to the high number of patients requiring band removal over the long-term. However, the procedure still has a lot going for it such as being adjustable and reversible.

vBloc Therapy is an FDA-approved two-pronged method to help individuals with a BMI between 35 and 45 lose weight and control hunger.

First, vBloc Therapy uses an implanted vagal nerve stimulator that blocks hunger signals and reduces how hungry you feel day to day.

Second, a network of highly trained surgeons, nurses, and dietitians will use robust tools, technologies, and action plans to get your weight down and get it at your new low.

Your Projections After 6 Months: Lose XX

Your Projections After 2 Years: Lose XX

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Runner Up:

Gastric sleeve surgery, also called “vertical sleeve gastrectomy”, drastically reduces the size of the stomach which causes patients to feel full sooner and lowers the production of hunger-inducing hormones, leading to significant long-term weight loss and health improvement.

Gastric bypass surgery, also called “Roux-en-Y gastric bypass”, makes the stomach smaller and reroutes the intestines, causing patients to feel full sooner and absorb less food, resulting in significant long-term weight loss and health improvement.

The endoscopic intragastric balloon, or “gastric balloon,” is a relatively new, non-invasive, and temporary procedure whereby a durable silicone balloon is passed through the mouth, down into the stomach, and filled with saline to make patients feel full sooner, leading to significant short-term weight loss.

It was developed to "bridge the gap" between pure diet and exercise and a more complicated bariatric procedure like gastric sleeve surgery.

The Biliopancreatic Diversion with Duodenal Switch (BPD-DS), or “Duodenal Switch” (DS) for short, deserves more credit and attention than it’s been given. On average, it results in more weight loss than any other procedure.

Its mortality risks are on par with other procedures, and it may be the best procedure for those with a 50+ body mass index (“super-obese”) in terms of average weight loss and elimination of obesity health problems.

However, its higher rate of serious complications and the amount of malabsorption that it causes command careful consideration before moving forward.

Gastric banding, also called Lap-Band surgery, is quickly losing popularity due to the high number of patients requiring band removal over the long-term. However, the procedure still has a lot going for it such as being adjustable and reversible.

vBloc Therapy is an FDA-approved two-pronged method to help individuals with a BMI between 35 and 45 lose weight and control hunger.

First, vBloc Therapy uses an implanted vagal nerve stimulator that blocks hunger signals and reduces how hungry you feel day to day.

Second, a network of highly trained surgeons, nurses, and dietitians will use robust tools, technologies, and action plans to get your weight down and get it at your new low.

Your Projections After 6 Months: Lose XX

Your Projections After 2 Years: Lose XX

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Expand Your Detailed Results

Click the sections below to learn why you received these results…

Weight Loss

The more "involved" procedures like gastric sleeve, gastric bypass, duodenal switch, Lap-Band aggressively restrict the amount of food your stomach can hold ("restrictive") and/or alter your digestive system to reduce the amount of food your body can absorb ("malabsorptive"). As a result, they are much more likely to lead to weight loss that exceeds 50% of your excess weight.

The less involved restrictive procedures like gastric balloon and vBloc Therapy typically result in a more moderate amount of weight loss.

You said anything less than 50% excess weight loss is unacceptable, so your best options may be the more "involved" procedures like gastric sleeve, gastric bypass, duodenal switch, or Lap-Band.

You said you are only interested in less involved procedures, so gastric sleeve, gastric bypass, duodenal switch, and Lap-Band are probably not for you. Less involved procedures, including Gastric Balloon or vBloc Therapy, may be more appropriate.

Failed Diet Programs

Most types of weight loss surgery - gastric sleeve, gastric bypass, duodenal switch, Lap-Band, and vBloc Therapy - are only appropriate for people who have tried and failed with a medically supervised diet program.

Gastric balloon surgery is the only procedure that does not require this.

Talk with your surgeon about how to get started with a supervised diet program.

Failed Diet Programs

Most types of weight loss surgery - gastric sleeve, gastric bypass, duodenal switch, and Lap-Band, and vBloc Therapy - are only appropriate for people who have tried and failed with a medically supervised diet program.

Gastric balloon surgery is the only procedure that does not require this.

Talk with your surgeon about how to get started with a supervised diet program.

Health Improvement

You indicated that you currently have weight-related health issues, which will likely improve and may even be "cured" following weight loss surgery. Generally speaking, the more weight you lose, the more health improvement you are likely to experience. Following is the average excess weight loss by procedure, from highest to lowest:

  1. Duodenal switch (65% - 90%)
  2. Gastric Sleeve & Gastric Bypass (tie at 65% - 75%)
  3. Lap-Band (45% - 70%)
  4. vBloc Therapy (20 - 25%)
  5. Gastric Balloon (~20%, but removed after 6 months)

However, weight loss and health improvement are not the whole story, and several other factors have been taken into account in our recommendations.

Body Mass Index & Health Conditions

Your body mass index is XX.

In order to qualify for gastric sleeve, gastric bypass, duodenal switch, Lap-Band surgery, your body mass index (BMI) must be 40+ or between 35 and 40 only if you also have weight-related health issues.

For vBloc Therapy, your body mass index (BMI) must be 40+ or between 35 and 45 only if you also have weight-related health issues.

Gastric balloon requires a BMI between 30 and 40 (with or without health issues).

Patients Under 18

While bariatric surgery is performed on patients under 18 years of age, your surgeon will have several concerns including: whether you are disciplined enough to adhere to strict diet and exercise requirements (many teens are not ready for or cannot prepare for that level of dedication), whether your family and friends will be supportive enough, whether you can properly evaluate the risks vs the rewards of surgery, whether the procedure could potentially affect your growth or bone density (especially malaborptive procedures), and the unknowns about the long-term effect of having an external device in your body (for those procedures that include one like Lap-Band or vBloc). The gastric balloon is not an option as it is currently only allowed for patients over 18.

Patients 65 or Older

Since you are 65 or older, it is possible that bariatric surgery is a good option, but you may be less likely to qualify than younger patients due to higher risks.

For example, one study evaluated 100 patients over the age of 65 and found that bariatric surgery for seniors has similar benefits and no additional risks compared to patients under 65. Their results showed that morbidly obese patients over 65 have shorter hospital stays following bariatric surgery than younger patients. The same study showed that after two years older patients lost almost 76% of their excess weight.

However, a much larger aggregate study of over 25,000 patients showed that seniors experience less weight loss and more complications than younger patients and concluded that, "Limiting bariatric surgical procedures to those younger than 65 years is warranted because of the high morbidity and mortality associated with these operations in older patients."

Ongoing Doctor Visits

After the initial surgery, Lap-Band and vBloc Therapy may require several doctor visits to "fine tune" the device to the point that it is just right for you. The other procedures tend to require less long-term follow up doctor visits, including gastric sleeve, gastric bypass, gastric balloon, and duodenal switch. You indicated that seeing your doctor regularly is not an issue for you, so this is just for your information.

Ongoing Doctor Visits

Since avoiding the doctor is important to you, you may want to stick with procedures that tend to require less frequent follow up, including gastric sleeve, gastric bypass, gastric balloon, or duodenal switch. After the initial surgery, certain procedures like Lap-Band and vBloc Therapy may require several doctor visits to "fine tune" the device to the point that it is just right for you.

Ongoing Doctor Visits

Since avoiding the doctor is important to you, you may want to stick with procedures that tend to require less frequent follow up, including gastric sleeve, gastric bypass, gastric balloon, or duodenal switch. After the initial surgery, certain procedures like Lap-Band and vBloc Therapy may require several doctor visits to "fine tune" the device to the point that it is just right for you.

Food Cravings

There are several reasons people crave food, including food addiction, an overproduction of hunger-causing hormones, and hunger impulses sent from the stomach to the brain. Since food cravings are a big issue for you now, they are likely to continue after surgery unless you choose a procedure that specifically addresses them.

Although weight loss after vBloc Therapy is not as great as many of the other procedures, it is specifically designed to block hunger impulses sent to the brain. Gastric sleeve has impressive weight loss and reduces food cravings by completely removing a large portion of your hormone-secreting stomach.

Food Cravings

There are several reasons people crave food, including food addiction, an overproduction of hunger-causing hormones, and hunger impulses sent from the stomach to the brain. Since food cravings are an issue for you now, they are likely to continue after surgery unless you choose a procedure that specifically addresses them.

Although weight loss after vBloc Therapy is not as great as many of the other procedures, it is specifically designed to block hunger impulses sent to the brain. Gastric sleeve has impressive weight loss and reduces food cravings by completely removing a large portion of your hormone-secreting stomach.

Dumping Syndrome

For some patients, eating foods high in fat, carbohydrates, or sugar, eating foods that are too hot or too cold, or drinking liquids during meals can result in dumping syndrome. Symptoms include bloating, diarrhea, dizziness, heart palpitations, nausea, rapid heart rate, sweating, and vomiting.

While very uncomfortable if it happens, this can actually be a good thing as it provides a very strong deterrent against "cheating" on your new bariatric diet which can lead to better long-term weight loss.

Dumping syndrome is experienced by about 4 out of every 5 gastric bypass patients. The other procedures are much less likely to cause this issue.

Since you indicated that you're open to your body reacting negatively to the wrong diet choices, you may want to keep gastric bypass on your list of possible procedures.

Since you indicated that you don't want to worry about the symptoms associated with dumping syndrome, you may want to remove gastric bypass from your list of procedures to consider.

Insurance

The fact that your insurance covers weight loss surgery is great news, although some individual procedures may not be covered. Even after a new procedure has been proven in the scientific community, it often takes years for insurance companies to add it to their list

Your policy will probably cover gastric sleeve, gastric bypass, Lap-Band, and duodenal switch since they have all been around for a long time.

Gastric balloon and vBloc Therapy will probably not be covered directly, but your surgeon's office may be able to help you get some of the costs covered. However, these procedures may be covered on a case-by-case basis.

Read the Bariatric Insurance Guide

Insurance

You indicated that you're not sure whether your insurance covers weight loss surgery. If you find out that it's covered, note that some procedures may not be included in your policy. Even after a new procedure has been proven in the scientific community, it often takes years for insurance companies to add them to their list.

If your specific policy covers bariatric surgery, it will probably cover gastric sleeve, gastric bypass, Lap-Band, and duodenal switch since those procedures have been around for a long time.

Gastric balloon and vBloc Therapy will probably not be covered directly, but your surgeon's office may be able to help you get part of the procedure costs covered. However, these procedures may be covered on a case-by-case basis.

Read the Bariatric Insurance Guide

Anticoagulation Medicine

Since you are currently taking anticoagulation medication (blood thinners), you will have a higher risk of marginal ulcers forming in the new stomach pouch created during a gastric bypass procedure. As a result, if you are on the fence between gastric bypass and a different procedure, you may want to choose the other procedure.

Anticoagulation Medicine

If you are currently taking anticoagulation medication (blood thinners), you will have a higher risk of marginal ulcers forming in the new stomach pouch created during a gastric bypass procedure. As a result, if you are on the fence between gastric bypass and a different procedure, you may want to choose the other procedure.

Implanted Device

Gastric balloon, vBloc Therapy, and Lap-Band each include a different types of device that is left inside the body. Gastric sleeve, gastric bypass, and duodenal switch do not.

Since you're open to that idea, we haven't given this any weight in our recommendation - we just wanted you to be aware.

Since you are uncomfortable with the thought of a device being left inside your body, you may want to avoid gastric balloon, vBloc, and Lap-Band.

Reversible Procedures

Generally speaking, the reversible procedures, including vBloc Therapy, Lap-Band, and gastric balloon, do not result in as much weight loss or as much health improvement as the "permanent" gastric sleeve, gastric bypass, and duodenal switch procedures.

However, they do have a few points in their favor:

  1. Weight loss can still be significant, especially depending on your goals
  2. They allow you to "stick your toe in the weight loss surgery waters" without taking the full leap, especially when diet and exercise aren't working
  3. The risk of serious complications tends to be lower
  4. They can serve as a "bridge" (first step) to a permanent procedure. The more weight you lose before a permanent procedure, the lower the risk of complications and the more long-term weight loss you are likely to achieve.

Since the ability to reverse your procedure is important to you, you should move vBloc Therapy, gastric balloon, and Lap-Band surgery higher up your list.

Since the ability to reverse your procedure is not important to you, you may want to focus more on other procedure differences like potential weight loss, health improvement, and risks.

Vitamins & Supplements

All weight loss procedures require some level of supplementation, although some are more serious with their requirements than others. The two malabsorptive procedures, gastric bypass and duodenal switch, alter the path of your digestion to prevent your body from absorbing as much food. While this tends to lead to greater weight loss, it also carries with it a higher risk of malnutrition. As a result, you will be on a more robust and stricter vitamin and supplement regimen than with the other procedures.

Since you indicated that you are not willing to be on a serious regimen of vitamins and supplements for the rest of your life, you should think hard about whether weight loss surgery is right for you.

The only procedure that does not require permanent long-term supplementation is gastric balloon because the balloon is usually removed after 6 months.

The "restrictive" procedures tend to lead to much lower instances of vitamin deficiency, but you still may need to be on a more moderate regimen of vitamins since your body will not be able to hold (and therefore absorb nutrients from) as much food.

The malabsorptive procedures require strict, lifelong supplementation, so you should probably avoid those procedures.

Find a Top Surgeon

Start to Finish
7 Steps to Long-Term Weight Loss

Start to Finish: 7 Steps to Long-Term Weight Loss

Step 1: Start Working with a Top Surgeon As Soon As Possible

Top surgeons will help you effectively navigate the various procedure choices, pre-surgery steps, financing, and insurance options:

  1. Many surgeons offer a free initial consultation, free local seminar, or free webinar. These will give you a better idea of what to expect and allow you to ask questions.
  2. Many also provide a free insurance check. They will also help you appeal any denials or find financing.
  3. Most insurance companies need proof of a medically supervised diet program. Your surgeon will set this up for you if you haven’t done so already.
  4. Your surgeon will push you towards new habits that will be essential to success after surgery. Many surgeons will recommend support group meetings for feedback from actual patients.

Step 2: Two Weeks Out: Prepare for Surgery

You will have completed your pre-op tests, physical, and any other required steps. You should have insurance approval by this point.

You should also be well on your way towards developing your diet and lifestyle habits.

In the week or two leading up to surgery, you’ll go to the hospital pre-surgery department. They will perform an EKG, blood work, and any last minute tasks or other pre-op tests.

You’ll meet with the surgeon one more time to wrap up final tests and forms. The night before surgery, do not eat or drink anything starting at midnight.

Step 3: Surgery Day

You’ll arrive at the hospital at least two hours before surgery to allow for prep time. The duodenal switch procedure itself will take about 4 hours to perform. Immediately after surgery, you’ll have a dedicated nurse to manage your pain and check your vitals.

Click here for more about what to expect in the hospital.

Step 4: Recovery

Most Duodenal Switch patients are in the hospital for 2 or 3 days. You can’t eat or drink anything for at least 24 hours after surgery. And your your surgeon will want you to get up and walk around as soon as possible to start the healing process.

You’ll leave as soon as your surgeon is confident that you are well on the road to full recovery. You’ll need someone to drive you home from the hospital and care for you for at least a few days following surgery. Full recovery generally happens within 2 to 4 weeks.

Click here for more about the recovery process.

Step 5: Adjust to Your New Post-Surgery Diet & Lifestyle

For the first 4 to 5 weeks after surgery, you will go from a clear liquid diet to your “new normal” Duodenal Switch diet. You should also continue your transition into a more active lifestyle. You will feel full sooner, less hungry, and start to experience weight loss within a couple weeks.

Your surgeon’s dietitian or nutritionist will help you determine an appropriate diet. See the Diet & Life After section of this page for more information.

Step 6: Attend Support Groups Regularly

Regular support group participation leads to:

  1. Reduce post-op recovery time
  2. Lead to as much as 12% more long-term weight loss

Your surgeon will be able to recommend an in-person group near you.

Step 7: Ongoing Doctor Visits

Your surgeon will schedule a follow up visit within 2 weeks to ensure you are recovering well and to answer any questions. Later visits will be scheduled as-needed.

Help & Support
Patient Experiences & Ask the Expert

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Questions From Other Visitors*

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Chronic Diarrhea After Duodenal Switch (DS) Surgery*

I had my DS surgery on June 5, 2013 and have brutal diarrhea - the watery kind. I was wondering how dangerous this is. My gastro doc says I can…


Burning Stomach 7 Days After Duodenal Switch*

I had the duodenal switch 7 days ago and the pain isn't too bad, my stomach just burns really bad. Any advise?


Paraesophageal Hernia After Duodenal Switch Gastric Reduction*

I have been having chest pains and knew I had a hiatal hernia. Now I am understanding it is a paraesophageal hernia after a visit to E.R.I'm trying to navigate…


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References

  1. Prachand VN, et al. Duodenal Switch Provides Superior Weight Loss in the Super-Obese (BMI≥50kg/m2) Compared With Gastric Bypass. Ann Surg. 2006 October; 244(4): 611–619.
  2. Henry Buchwald; Yoav Avidor; Eugene Braunwald; Michael D. Jensen; Walter Pories; Kyle Fahrbach; Karen Schoelles Bariatric Surgery: A Systematic Review and Meta-analysis JAMA. 2004;292(14):1724-1737.
  3. Gianfranco A, et al.   Long-Term Effect of Biliopancreatic Diversion on Blood Pressure in Hypertensive Obese Patients.   Am Journ Hypertens 2005/06 (18):780-784.
  4. Cossu ML, et al. Duodenal Switch without Gastric Resection: Results and Observations after 6 Years.   Obes Surg 2004 (14): 1354-1359.
  5. Hamoui N, Chock B, Anthone GJ. Revision of the Duodenal Switch: Indications, Technique, and Outcomes. J Am Coll Surg. Vol. 204, 603 – 608, 2007
  6. American Society for Metabolic and Bariatric Surgery. ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient. March 2008. Available at: http://www.asmbs.org/Newsite07/resources/bgs_final.pdf. Accessed: Sept 14, 2009.

[ Last editorial review/modification of this page : 12/05/2016]

* Disclaimer: The information contained in this website is provided for general information purposes and your specific results may vary depending on a variety of circumstances. It is not intended as nor should be relied upon as medical advice. Rather, it is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician(s). Before you use any of the information provided in the site, you should seek the advice of a qualified medical, dietary, fitness or other appropriate professional. Read More