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

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

Read and click the sections below for everything you need to know about the procedure.

01 How Duodenal Switch Surgery Works

How Duodenal Switch Surgery Works

Procedure reduces stomach size by 80% Patient feels full sooner while eating due to smaller stomach Patient feels less hungry because smaller stomach secretes fewer hunger-causing hormones Rearranged intestines & removed gall bladder causes the body to absorb fewer calories and minerals

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

1.  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.

2.  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:

02 Weight Loss

Weight Loss

70+% of excess weight within 2 years

Enter your height & weight, then click the button:

Enter your height & weight, then click the button:

100%

Excess Weight Remains

Procedure Done

From Day 1: Feel Less Hungry & Full Sooner While Eating

Continued Weight Loss

Low Weight Reached Between Year 1 & Year 2

0 months

100%

Excess Weight Remains

Your Body Mass Index (BMI) is XXX.

duodenal switch is only available for patients with a BMI of 30 or higher.

However, you do qualify for other types of weight loss procedures.

Click here to learn your options.

Click to Learn More

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)

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03 Health Benefits

Health Benefits

Cures or improves diabetes, sleep apnea, hypertension, and at least 12 other conditions

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Most duodenal switch patients experience significant improvement in or a complete “cure” of obesity-related health problems, including those listed in the table below.

Note that patients who have a strict follow-up schedule with their surgeon at 3-, 6-, and 12-months post-op see greater improvements in or remission of their diabetes, high blood pressure (hypertension), and high cholesterol than patients who skip these visits (7).

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 (8) (general bariatric surgery study, not specific to duodenal switch)
Quality of Life Improvements
95% of patients (9)
Asthma
Improved for 90% of patients (10)
Cardiovascular Disease
86% reduction in cardiovascular risks (11)
Degenerative Joint Disease
Complete resolution in at least 43% of patients (12 – 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 (13)
Diabetes
Resolved for 92% to 100% of patients, improved for 100% (14) (15)
Dyslipidemia hypercholesterolemia
Resolved in up to 100% of patients (16)
Gastroesophageal Reflux Disease (GERD)
Improved in 49% of patients (17)
High Blood Pressure (hypertension)
Improved in up to 83% of patients (18)
Hyperlipidemia (high levels of fat in the blood)
Improvement or complete resolution in 99% of patients (19)
Non-Alcoholic Fatty Liver Disease
Improved in up to 100% of patients (20)
Migraines
Most patients experience improvement (correlated with amount of weight lost – (21)
Metabolic Syndrome
Resolved or improved in up to 100% of patients (22) (23)
Obstructive Sleep Apnea
Resolved in up to 100% of patients (24)
Polycystic Ovarian Syndrome, Hirsutism & Menstrual Irregularity
Improvement or resolution in nearly all women (25) (26)

04 Qualify

Qualify

30+ body mass index (BMI) required Click here to calculate your BMI

Enter your height & weight, then click the button:

Enter your height & weight, then click the button:

30+

duodenal switch
Required BMI

  • Below 18.5Underweight

  • 18.5 – 24.9Healthy Weight

  • 25.0 – 29.9Overweight

  • 30.0 – 34.9Obese

  • 35.0 – 39.9Severely Obese

  • 40.0 – 49.9Morbidly Obese

  • 50 or higherSuper Obese

Weight Loss Procedure Qualification Info

BMI's ranging from 30 to 34.9 may qualify for Gastric Balloon. This BMI range may also qualify for other procedures if the patient has poorly controlled diabetes or metabolic syndrome.

BMI's ranging from 35 to 40 may qualify for Gastric Balloon. This BMI range may also qualify for other procedures if the patient has poorly controlled type 2 diabetes, a higher risk of cardiovascular disease, or suffers from another weight-related health issue.

BMI's ranging from 40.1 to 45 may qualify for any weight loss procedure other than Gastric Balloon.

BMI's ranging from 45.1 to 55 may qualify for any weight loss procedure other than Gastric Balloon or vBloc Therapy.

BMI's above 55 may qualify for any weight loss procedure other than Gastric Balloon, vBloc Therapy, or AspireAssist.

Health Risk: High

You are considered to be underweight, so you do not qualify for weight loss surgery.

You should take physician-approved steps to gain weight.

Health Risk: Low

Your weight is considered healthy, so you do not qualify for weight loss surgery.

Health Risk: Moderate

Your BMI is too low to qualify for weight loss surgery.

Your health risk increases to “High” if two or more of the following apply to you:

  • - You smoke cigarettes
  • - Family history of premature heart disease
  • - High blood glucose (blood sugar)
  • - High blood pressure (hypertension)
  • - Low HDL-cholesterol (“good” cholesterol)
  • - High LDL-cholesterol (“bad” cholesterol)
  • - High triglycerides

Your risk of health issues are even higher if your waist circumference is over 35 inches (88 cm) for women or 40 inches (102 cm) for men.

Health Risk: High

You have a high risk of obesity-related health problems.

Your risk is even higher if your waist circumference is over 35 inches (88 cm) for women or over 40 inches (102 cm) for men.

Your BMI indicates that you may be a good candidate for the gastric balloon procedure. You may also qualify for one of the other available weight loss procedures if you have uncontrolled diabetes or metabolic syndrome.

Health Risk: High

You have a high risk of obesity-related health problems.

Your risk is even higher if your waist circumference is over 35 inches (88 cm) for women or over 40 inches (102 cm) for men.

Your BMI indicates that you may qualify for any one of the available weight loss procedures, including gastric balloon.

Health Risk: Very High

You have a very high risk of obesity-related health problems.

Your risk is even higher if your waist circumference is over 35 inches (88 cm) for women or over 40 inches (102 cm) for men.

Your BMI indicates that you may qualify for any available weight loss procedure other than the gastric balloon (max BMI is 40).

Health Risk: Very High

You have a very high risk of obesity-related health problems.

Your BMI indicates that you may qualify for any available weight loss procedure other than the gastric balloon (max BMI is 40) or vBloc Therapy (max BMI is 45).

Health Risk: Very High

You have a very high risk of obesity-related health problems.

Your BMI indicates that you may qualify for any available weight loss procedure other than the gastric balloon (max BMI is 40), vBloc Therapy (max BMI is 45), or AspireAssist (max BMI is 55).

Click to Learn More

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)

05 Insurance

Insurance

DS is covered if your policy includes bariatric surgery Click here to use our Check My Insurance Tool

Move Slider or Input Plan Details

Total Surgery Cost

Plan Deductible

Year-to-Date Deductible Amount Already Paid

Hospital Copay

Hospital Coinsurance

Year-to-Date Coinsurance Amount Already Paid

Annual Out of Pocket Max

DUODENAL SWITCH COST-AFTER-INSURANCE ESTIMATOR

Projected Out Of Pocket Costs After Insurance

Data is for illustrative purposes only. Please check with your insurance company for specific costs and benefit information.

Duodenal Switch Insurance Tools

Cost-After-Insurance Estimator

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Choose your plan, state, and insurance company below.

Can’t find your insurance company/plan or have updated info? Click here to contact us.

This tool provides estimates only. Please contact your insurance company to verify your actual out of pocket costs.

Click to Learn More

Click your country below for Duodenal Switch insurance information:

1.  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:

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Choose your plan, state, and insurance company below.

Can’t find your insurance company/plan or have updated info? Click here to contact us.

This tool provides estimates only. Please contact your insurance company to verify your actual out of pocket costs.

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.

2.  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 (27).

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.

3.  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.

06 Cost Without Insurance

Cost Without Insurance

Total Cost: $27,300, on average Loan Payment: $556/month, on average Discounts & Tax Savings: Usually available

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This tool provides estimates only. Please contact your insurance company to verify your actual loan estimator.

Your Location

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about discounts:

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DISCOUNTS
6 Discounts to Ask Your Surgeon About

Talk with your surgeon about whether any of these discounts are available:

Click to Learn More

Average Cost By Location

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

  • United States – $27,300 (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.

1.  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

2.  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 (28). That’s almost $11,000 saved per year. Fewer prescription drugs alone save patients $3,000 or more per year (29).

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.

3.  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.

4.  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)

5.  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.

6.  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

7.  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.

07 Recovery

Recovery

Hospital Stay: 2 to 3 days Time Off Work: 1 to 3 weeks Full Recovery: 4 to 6 weeks Pain: Manageable – same as any laparoscopic surgery Diet & Activity: Slow transition back to normal

DUODENAL SURGERY RECOVERY

Hospital Stay: Up to 1 Day

Most duodenal switch patients stay in the hospital for 2 to 3 days to get through the initial healing process.

Plan for a full 2 weeks off of work, and have family or friends available for daily help for at least the first week. Full recovery typically takes 6 weeks.

Click to Learn More

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 (30). 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.

08 Diet & Life After

Diet & Life After

Restricted diet with strict supplementation regimen Regular exercise Less hungry than before surgery Personal relationships may change

FOOD & DRINK

Focus on eating proteins first, in solid form (not shakes). Get the majority of your calories from solid foods to avoid weight regain. Eat healthy "whole" foods (avoid processed foods). Drink 64+ oz (2+ liters) of liquids per day, but no drinking 30 minutes before or after meals.

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

YOUR BRAIN

After surgery you will feel less hungry, but that won't fix food addiction. Food addiction issues should be addressed before surgery. Rapid weight loss will also affect relationships with family, friends, coworkers, and strangers - both positively and negatively.

EXERCISE

Exercise is almost as important as diet for long-term success. Plan to exercise 2.5 hours per week spread out over 3 or 4 days. Patients who do so lose more weight and report a much higher quality of life.

FOOD & DRINK
VITAMINS & SUPPLEMENTS
YOUR BRAIN
EXERCISE
Click to Learn More

1.  Food & Drink

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) (31).

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

2.  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 (32).

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 (33) (34)

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 (35)

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) (36)

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

  • Needed in up to 40% of gastric bypass patients (37)
  • If deficient, take 200% the recommended daily intake
Iron (38) (39)

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 (40)

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 (41) (42) (43)

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 (44)

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 (45)

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 (46)

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 (47).

Talk with your surgeon about appropriate zinc supplementation.

Copper (48)

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 (49).

Talk with your surgeon about appropriate copper supplementation.

Body Part Affected
Vitamins – Body Part Affected
Multivitamin (50) (51) – 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 (52) – 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) (53) – Blood

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

  • Needed in up to 40% of gastric bypass patients (54)
  • If deficient, take 200% the recommended daily intake
Iron (55) (56) – 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 (57) – 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 (58) (59) (60) – 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.

3.  Exercise

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 (50).

Working out regularly will also lead to quicker and better health improvement after surgery (51).

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.

4.  Your Brain

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.

09 Downsides

Downsides

Moderate risk of complications Risk of vitamin deficiency/malnutrition Side effects may include digestion issues & sagging skin

Complications
  • Very high survival rate (99.7%)
  • General anesthesia risks exist, as with any procedure
  • Your surgeon will monitor your vitamin levels closely to prevent vitamin deficiency.
  • 3 most common are relatively rare and usually caught/treated while still in hospital: Staple line leaks (2 % of patients), bleeding (1% of patients), and stenosis/strictures (<1% of patients)
Side Effects
  • Gastroesophageal reflux disease (GERD) experienced by 20% of patients during the first year. Drops to 3% after 3 years.
  • Intolerance to certain foods may cause nausea, vomiting or indigestion. Fixed by changing diet or eating habits
  • Gallstone formation occurs in about half of all patients as a result of rapid weight loss
  • Bowel movement (BM) changes such as frequecy of BM's, loose stools, foul-smelling stools/flatulence, or constipation, if present, are often improved with diet changes
  • Sagging skin as a result of rapid weight loss
  • Increased risk of bone fractures
Click to Learn More

1.  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.

2.  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.

3.  Duodenal Switch Side Effects: Digestion, Sagging Skin, & Bone Fracture Risk

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.

Increased Fracture Risk

As a result of changed bone metabolism due to extreme weight loss and nutrient deficiencies, duodenal switch patients may have an increased risk of bone fracture (54).

4.  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 (55) (56).

10 DS Vs. 6 Other Weight Loss Procedures

DS Vs. 6 Other Weight Loss Procedures

The best proceure for weight loss & health improvement One of 3 procedures that is not reversible One of 3 procedures that reduces hunger Most complicated procedure to perform, so fewer surgeons offer it More diligent follow-up required by surgeon and patient to avoid vitamin deficiencies

Picture of Procedure

Video of Procedure

Avg Excess Weight Loss

Health Improvement

BMI Needed to Qualify

Covered by Insurance?

Financing Available

Avg Total Cost With Insurance (U.S.)

Avg Total Cost Without Insurance (U.S.)

Procedure Type

Year of Peer-Reviewed Research

Device Placed In Body?

Reversible?

Time Until Removed

Path of Digestion

Procedure Time (Approx)

Complication Rate

Survival Rate

Hospital Stay (Avg)

Recovery Time
(Avg Back to Work)

Difficulty Swallowing?

Digestion & Bowel Movement Problems

Diet Risks

Food Cravings Decreased

Lifelong Vitamins Required

Qualified Surgeons

Patient Guides

The average duodenal switch patient loses between 65% and 90% of their excess weight within 2 years and has kept most of the weight off after 5 years.
Duodenal switch surgery improves or cures at least 15 obesity-related health problems, including diabetes, hypertension, sleep apnea, and many others.
35 - 39.9 with health problems; 40+ without (but more common for 50+)
For policies that cover weight loss surgery, duodenal switch is included
Duodenal switch financing is available, subject to credit approval

$2,000

Actual out of pocket costs depend on your insurance plan.

$27,000

Costs vary by surgeon and hospital.
Most duodenal switch procedures are performed laparoscopically.
Duodenal switch surgery is backed by a significant amout of long-term research.
No external device is used (other than materials for "sealing" the smaller stomach and establishing the new intestinal route).
Not usually reversed
not applicable (duodenal switch is not usually reversed)
Part of the small intestines are bypassed after duodenal switch surgery.
Duodenal switch surgery usually takes about 4 hours to perform.
Non-severe complications are much more common than severe complications Learn Risks & How to Minimize
Survival rate may be lower than other procedures because DS surgery tends to be performed on heavier patients who have higher risk.
Most DS patients remain in the hospital for 2 to 3 days.
Most duodenal switch patients are able to return to work within 2 weeks.
Can be caused by eating too quickly, too much or not chewing food enough and can usually be fixed by avoiding these issues.
Might be significant, including frequency, diarrhea, and/or foul-smelling stools/flatulence.
Malabsorption will require life-long vitamin supplementation.
Food cravings may be reduced after duodenal switch surgery due to fewer hunger-causing hormones being released by the smaller stomach.
Lifelong vitamins will need to be taken to compensate for patients eating less food as a result of a smaller stomach and for the lack of absorption resulting from the rerouted intestine.
The gastric balloon is a temporary procedure. Depending on the balloon type you choose, it must be removed 3 months, 6 months, or 1 year after insertion.
Gastric balloon patients are more likely to see health improvements than people of similar weight who do not have the procedure.
Between 30 & 40 in U.S. (above 27 elsewhere)
Gastric balloon is not usually covered by insurance
Gastric balloon financing is available, subject to credit approval

$8,150

Gastric balloon is usually not covered by insurance.

$8,150

Costs vary by surgeon and hospital.
Gastric balloon requires no incisions.
The gastric balloon is a relatively new procedure so long-term studies are limited.
An inflated silicon balloon remains in the stomach for 6 months.
The balloon must be removed after 6 months (Orbera and ReShape balloons).
The balloon must be removed after 6 months (Orbera and ReShape balloons).
The path of digestion is unchanged with the gastric balloon.
Gastric balloon usually takes about 30 minutes to perform.
Non-severe complications are much more common than severe complications. Learn Risks & How to Minimize
Gastric balloon survival rate is very high since the procedure requires no incisions and since complication risks are very low.
Most balloon patients leave the hospital the same day as the procedure.
Most balloon patients are able to return to work within a few days.
Can be caused by eating too quickly, too much or not chewing food enough and can usually be fixed by avoiding these issues.
Vomiting possible (but often avoidable with proper habits). “Feeling bloated” reported by some patients.
Potential Problem Foods: Pasta and other foods that might stick to balloon in stomach.
Food cravings will remain the same with the gastric balloon.
The balloon must be removed after 6 months (Orbera and ReShape balloons), so lifelong vitamins are not required.
The average gastric sleeve patient loses between 65% and 75% of their excess weight within 2 years and has kept most of the weight off after 5 years.
Gastric sleeve surgery improves or cures at least 15 obesity-related health problems, including diabetes, hypertension, sleep apnea, and many others.
35 - 39.9 with health problems; 40+ without
For policies that cover weight loss surgery, gastric sleeve is included
Gastric sleeve financing is available, subject to credit approval

$2,000

Actual out of pocket costs depend on your insurance plan.

$19,000

Costs vary by surgeon and hospital.
Most gastric sleeve procedures are performed laparoscopically.
Gastric sleeve surgery is backed by a significant amout of long-term research.
No external device is used (other than materials for "sealing" the smaller stomach).
Not usually reversed
not applicable (gastric sleeve is not usually reversed)
The path of digestion remains the same after gastric sleeve (although part of the stomach is removed).
Gastric sleeve surgery usually takes about 2 hours to perform.
Non-severe complications are much more common than severe complications. Learn Risks & How to Minimize
Gastric sleeve mortality risk is equal to that of any other routine surgical procedure.
Most gastric sleeve patients remain in the hospital for 2 to 3 days.
Most gastric sleeve patients are able to return to work within 2 weeks.
Can be caused by eating too quickly, too much or not chewing food enough and can usually be fixed by avoiding these 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.
Potential problem foods: Dairy
Food cravings may be reduced after gastric sleeve surgery due to fewer hunger-causing hormones being released by the smaller stomach.
Lifelong vitamins will need to be taken to compensate for patients eating less food as a result of a smaller stomach.
The average gastric bypass patient loses between 65% and 75% of their excess weight within 2 years and has kept most of the weight off after 5 years.
Gastric bypass surgery improves or cures at least 15 obesity-related health problems, including diabetes, hypertension, sleep apnea, and many others.
35 - 39.9 with health problems; 40+ without
For policies that cover weight loss surgery, gastric bypass is included
Gastric bypass financing is available, subject to credit approval

$2,000

Actual out of pocket costs depend on your insurance plan.

$24,000

Costs vary by surgeon and hospital.
Most gastric bypass procedures are performed laparoscopically.
Gastric bypass surgery is backed by a significant amout of long-term research.
No external device is used (other than materials for "sealing" the smaller stomach pouch and establishing the new intenstinal route).
Not usually reversed
not applicable (gastric bypass is not usually reversed)
Part of the small intestines are bypassed after gastric bypass surgery.
Gastric bypass surgery usually takes about 4 hours to perform.
Non-severe complications are much more common than severe complications. Learn Risks & How to Minimize
Gastric bypass mortality risk is equal to that of any other routine surgical procedure.
Most gastric bypass patients remain in the hospital for 2 to 3 days.
Most gastric bypass patients are able to return to work within 2 weeks.
Can be caused by eating too quickly, too much or not chewing food enough and can usually be fixed by avoiding these issues.
Dumping syndrome occurs in ~80% of patients who eat sugar, refined fats, or carbs.
Potential problem foods: Sugars, Refined fats, Carbs, Dairy. Malabsorption will require life-long vitamin supplementation.
Food cravings may be reduced after gastric bypass surgery due to fewer hunger-causing hormones being released by the smaller stomach pouch.
Lifelong vitamins will need to be taken to compensate for patients eating less food as a result of a smaller stomach and for the lack of absorption resulting from the rerouted intestine.
Gastric Band surgery has highly variable results, with excess weight loss after 2 years ranging from 45% to 70%.
Gastric Band surgery improves or cures at least 15 obesity-related health problems, including diabetes, hypertension, sleep apnea, and many others.
35 - 39.9 with health problems; 40+ without
For policies that cover weight loss surgery, Gastric Band is included
Gastric Band financing is available, subject to credit approval

$2,000

Actual out of pocket costs depend on your insurance plan.

$15,000

Costs vary by surgeon and hospital.
Most Gastric Band procedures are performed laparoscopically.
Gastric Band surgery is backed by a significant amout of long-term research.
A silicone and silastic band is left around the top of the stomach, and a balloon around the inside of the band connects to a tube that leads to a round half-dollar-sized port just below the skin.
The Gastric Band can be removed.
Gastric Band removal is not required unless the patient develops a device-related complication.
The path of digestion is unchanged with the Gastric Band.
Gastric Band surgery usually takes about 1 hour to perform.
Non-severe complications are much more common than severe complications Learn Risks & How to Minimize
Gastric Band mortality risk is equal to that of any other routine surgical procedure.
Most Gastric Band patients leave the hospital the same day or the day after the procedure.
Most Gastric Band patients are able to return to work within 2 weeks.
Can be caused by eating too quickly, too much or not chewing food enough and can usually be fixed by avoiding these issues.
Reflux and vomiting common if band too tight (can be adjusted). Some patients experience constipation.
Potential problem foods: Dairy. Should not drink anything within 30 minutes before or after eating
Food cravings will remain the same after Gastric Band surgery.
Lifelong vitamins will need to be taken to compensate for patients eating less food as a result of the smaller stomach pouch created by the band.
The average vBloc patient loses 25% of their excess weight within 1 year. Longer-term studies are not yet available.
While studies are limited, vBloc Therapy has been found to improve hypertension, diabetes, and several obesity-related health factors.
35 - 39.9 with health problems; 40 - 45 without (none over 45)
vBloc Therapy is not usually covered by insurance
vBloc Therapy financing is available, subject to credit approval

$18,500

vBloc Therapy is not usually covered by insurance.

$18,500

Costs vary by surgeon and hospital.
Most vBloc procedures are performed laparoscopically.
vBloc Therapy is a relatively new procedure so long-term studies are limited.
The vBloc Therapy device is placed below the rib cage just under the skin. Leads (wires) connect the device to the vagal nerve, just above the stomach.
The vBloc Device can be removed.
vBloc device removal is not required unless the patient develops a device-related complication.
The path of digestion is unchanged with vBloc Therapy.
vBloc implant usually takes less than 90 minutes to perform.
Non-severe complications are much more common than severe complications Learn Risks & How to Minimize
vBloc mortality risk is equal to that of any other routine surgical procedure.
Most vBloc patients leave the hospital the same day as the procedure.
Most vBloc patients are able to return to work within a few days.
Most vBloc patients do not have any issue with swallowing.
Most vBloc patients do not experience digestion or bowel movement problems.
No medical risks, but healthier eating recommended for better results.
The vBloc device was specifically designed to control how often hunger impulses reach the brain.
vBloc device settings should be such that enough food will be eaten to provide the right amount of vitamins and minerals. Your doctor should monitor your vitamin levels.
AspireAssist studies are currently limited, but one study showed 31.5% excess weight loss after 4 years.
Early AspireAssist studies indicate a positive impact on diabetes, hypertension, and hyperlipidemia, but more reasearch is needed to confirm.
35 - 55, regardless of health problems
AspireAssist is not usually covered by insurance
AspireAssist financing is available, subject to credit approval

$10,500

AspireAssist is not usually covered by insurance.

$10,500

Costs vary by surgeon and hospital.
The AspireAssist procedure passes a tube through the mouth and down into the stomach. The tube is then pulled through the abdominal wall through a small incision.
AspireAssist is a relatively new procedure so long-term studies are limited.
A silicone “A-tube” connects the stomach to the Skin-Port™ located on the outside of your abdomen. The Skin-Port™ is the opening between your external device and the tube leading to your stomach. An Emergency Clamp component prevents any leakage of stomach contents if the A-tube and Skin-Port become disconnected.
The AspireAssist device can be removed.
AspireAssist removal is not required unless the patient develops a device-related complication.
The path of digestion is unchanged with AspireAssist (although some food is routed out of the body directly from the stomach).
The AspireAssist procedure usually takes about 15 minutes to perform.
Non-severe complications are much more common than severe complications. Learn Risks & How to Minimize
Available studies to date have shown zero deaths as a result of having the AspireAssist procedure.
Most AspireAssist patients leave the hospital the same day as the procedure.
Most AspireAssist patients are able to return to work within a few days.
Most AspireAssist patients do not have any issue with swallowing.
Low risk of vomiting (17% of patients), constipation (4.5% of patients), or diarrhea (4.5% of patients)
Potential malabsorption will require some monitoring and may result in a vitamin regimen
Food cravings will remain the same with the AspireAssist device.
Whether vitamins are required depends on each patient and how they are using the device. Your doctor should monitor your vitamin levels.
Click to Learn More

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 (57):

  • More long-term weight loss than any other procedure
  • Better health improvement than any other procedure

1.  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 (58).
  • 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) (59).
  • 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).

2.  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.

11 Start to Finish

Start to Finish

7 steps to long-term weight loss

01

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.

02

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.

03

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.

04

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.

05

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.

06

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.

07

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.

12 Help & Support

Help & Support

Ask the expert Patient experiences

Patient Experiences

Ask the Expert & Patient Experiences*

To meet face-to-face and in-person with other patients, talk with your surgeon about weight loss surgery support groups available in the area.

Our community would also love to read your experiences with the balloon. Your insights are invaluable to making sure other people have the tools to meet their goals.

In addition, we are happy to answer any questions you have about the procedure.

Please use the form below to share your experience or ask a question.

Click for Form & Visitor Submissions

Ask the
Expert

Ask the Expert & Patient Experiences*

To meet face-to-face and in-person with other patients, talk with your surgeon about weight loss surgery support groups available in the area.

Our community would also love to read your experiences with the balloon. Your insights are invaluable to making sure other people have the tools to meet their goals.

In addition, we are happy to answer any questions you have about the procedure.

Please use the form below to share your experience or ask a question.

Click for Form & Visitor Submissions

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Questions From Other Visitors*

Click below to see contributions from other visitors to this page…

Super Weight Loss Surgery Success (After Duodenal Switch Surgery)*

Reading and listening to weight loss surgery success stories made me apprehensive. I knew it was possible, but I knew many people failed. I did not want to be a…


Cliff's DS Journey*

I had the duodenal switch surgery (BPD/DS) in Oct. 2004, at the time of surgery I weighed 380 lbs. I'm now 52 yrs. old and my weight has fluctuated between…


Diabetes & 100 Lbs Gone 10 Months After DS Surgery*

I had DS on 1/22/2013 and I have lost 100 lbs. My diabetes is gone and my cardiologist is thrilled. I go to a nutritionist get my blood tested and…


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…


13 Find a Top Duodenal Switch Surgeon

Find a Top Duodenal Switch Surgeon

Ask for a free insurance check or cost quote Attend a free seminar or webinar Schedule a phone or in-person consultation (both often free)

Search the Lap Band Surgeon directory below to find a top surgeon by country and region:

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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 : 03/14/2017 ]

* 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