Medically Reviewed by:John Rabkin, MD, FACSBoard Certified Bariatric Surgeon
During the duodenal switch surgery (“biliopancreatic diversion with duodenal switch” or “DS”), your surgeon will make your stomach smaller, reroute your intestines, and remove your gallbladder. As a result:
- You will feel less hungry
- You will feel full sooner while eating
- Your body will absorb fewer calories from the food you eat
- You will lose up to 65% of your excess weight within a year
- For example: if you’re 5’ 4” and weigh 220 lbs, you will lose up to 55+ lbs within 1 year
- If you’re 5′ 9” and weigh 300 lbs, you will lose up to 95+ lbs within 1 year
- You will improve or cure your diabetes, hypertension, asthma, sleep apnea, and other obesity-related health problems
Read the sections below for everything you need to know about the duodenal switch procedure.
TABLE OF CONTENTS
Click on any of the topics below to jump directly to that section
- How It Works
- Weight Loss
- Health Benefits
- How to Qualify
- Cost Without Insurance
- Preparing For Surgery
- Diet & Life After
- Compare VS. Other Procedures
- Duodenal Switch Summary
- Patient Community & Expert Advice
- Find a Weight Loss Surgeon
- 80% of your stomach will be removed, causing you to feel full sooner while eating
- You will feel less hungry because your smaller stomach will secrete fewer hunger-causing hormones
- Your intestines will be rearranged & your gallbladder will be removed, causing your body to absorb fewer calories and minerals
To perform the duodenal switch procedure, your surgeon will first create a gastric sleeve (remove 80% of the stomach), then rearrange your intestines to reduce the amount of calories and minerals your body can absorb.
Watch the duodenal switch procedure video to gain a better understanding:
- You will lose up to 65% of your excess weight within 1 year
- For example, if you’re 5’ 4” and weigh 220 lbs, you will lose up to 55+ lbs within 1 year
- If you’re 5' 9” and weigh 300 lbs, you will lose up to 95+ lbs within 1 year
- You will lose even more after the 1st year
Duodenal switch patients lose a significant amount of weight very quickly after surgery:
- Month 3: 30% of excess weight
- Month 6: 45% of excess weight
- Month 12: 65% of excess weight
By year two, the average DS patient has lost between 70% to 80% of their excess weight.
Some studies have even shown long-term excess weight loss to exceed 90%.Click Here to See How Much Weight You Could Lose
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).
- Duodenal switch surgery will cure or improve your diabetes, sleep apnea, hypertension, and at least 12 other conditions
Compared to other weight loss surgeries, duodenal switch cures the highest number of obesity-related health conditions (1). Patients who are not “cured” of their ailments typically experience dramatic improvements and an overall better quality of life.
The most common health improvements include:
- Obstructive Sleep Apnea
- High blood pressure
- Joint health
- Psychosocial (mental health, self confidence)
|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 (11) (general bariatric surgery study, not specific to duodenal switch)|
|Quality of Life Improvements||95% of patients (12)|
|Asthma||Improved for 90% of patients (13)|
|Cancer||Risk decrease for colon, breast, endometrial, and pancreatic forms of cancer (14)|
|Cardiovascular Disease||86% reduction in cardiovascular risks (15)|
|Degenerative Joint Disease||Complete resolution in at least 43% of patients (16 – 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 (16)|
|Diabetes||Resolved for 92% to 100% of patients, improved for 100% (17) (18)|
|Dyslipidemia hypercholesterolemia||Resolved in up to 100% of patients (19)|
|Gastroesophageal Reflux Disease (GERD)||Improved in 49% of patients (20)|
|High Blood Pressure (hypertension)||Improved in up to 83% of patients (21)|
|Hyperlipidemia (high levels of fat in the blood)||Improvement or complete resolution in 99% of patients (22)|
|Knee Health||For every pound of weight lost, there is a 4 pound reduction in pressure on the knee joint(13)|
|Metabolic Syndrome||Improved in up to 100% of patients (23)|
|Migraines||Most patients experience improvement (correlated with amount of weight lost – (24)|
|Metabolic Syndrome||Resolved or improved in up to 100% of patients (25) (26)|
|Obstructive Sleep Apnea||Resolved in up to 100% of patients (27)|
|Polycystic Ovarian Syndrome, Hirsutism & Menstrual Irregularity||Improvement or resolution in nearly all women (28) (29)|
- 35+ body mass index (BMI) required
- If your BMI is under 40, you must have at least one obesity-related health problem
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)
For a list of frequently asked questions about qualifying, see our “Do I Qualify For Weight Loss Surgery?” page.
- Duodenal switch surgery is covered if your insurance policy includes bariatric surgery
Duodenal switch insurance coverage varies by state but ultimately depends on whether your specific policy includes bariatric surgery.
Your insurance will cover the DS procedure if your specific policy includes weight loss surgery and you have:
- Completed a medically supervised diet program
- A body mass index (BMI) over 35 with health problems or over 40 without health problems
Your duodenal switch out-of-pocket costs with insurance may be as low as $0. However, most insurance plans require you to pay part of the costs in the form of copays, deductibles, and coinsurance.
See our Bariatric Surgery Insurance Guide for everything you need to know about getting insurance to pay for surgery.
- Average Patient Pays: $500 to $5,000 with insurance, $25,000 to $30,000 without insurance
- If you get a medical loan, the loan payment is $556 a month, on average
- You can usually get discounts &/or tax savings
Average Cost By Location
The average duodenal switch cost in the United States is $27,000, according to the Annual Surgeon Cost Survey from Bariatric Surgery Source. However, there can sometimes be a dramatic price difference from state to state. Click here to expand a list of average duodenal switch costs by state and region.
|ARIZONA surgeons surveyed are located in Flagstaff, Mesa, Phoenix, Prescott, Scottsdale, Tempe and Tucson|
|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|
|GEORGIA surgeons surveyed are located in Albany, Athens, Atlanta, Augusta, Columbus, Decatur, Macon, Marietta and Savannah|
|ILLINOIS surgeons surveyed are located in Chicago, Champaign, Decatur, Naperville, Peoria, Rockford and Springfield|
|INDIANA surgeons surveyed are located in Bloomington, Evansville, Fort Wayne, Gary, Indianapolis and South Bend|
|KANSAS surgeons surveyed are located in Topeka, Lenexa, Wichita, Overland Park, Olathe, and Kansas City|
|NEBRASKA surgeons surveyed are located in Lincoln, Omaha and other towns|
|NEW JERSEY surgeons surveyed are located in Newark, Trenton and Other Areas|
|TEXAS surgeons surveyed are located in Abilene, Amarillo, Austin, Corpus Christi, Dallas / Ft. Worth, Houston, Lubbock and San Antonio|
|UTAH surgeons surveyed are located in Provo, Salt Lake City and St. George|
|WASHINGTON surgeons surveyed are located in Everett, Olympia, Seattle, Spokane, Tacoma, Vancouver and Other Areas|
If your insurance does not cover bariatric surgery, here are some considerations:
- Your insurance may still cover lab work, pre-op testing, and other non-surgical expenses.
- Talk with your surgeon about special discounts for “cash-pay” patients
- If your total annual out-of-pocket costs for ALL medical treatment (not just bariatric surgery) is above a certain level, you may be able to deduct the costs from your income taxes.
- Financing is available in the form of medical loans if your credit score is at least 650.
- If you properly prepare before you have surgery, it reduces your risks during surgery, leads to more weight loss, & saves you money
There are several ways that your surgeon will help you prepare for duodenal switch surgery.
Initially, they will have you complete a health assessment and order lab work to ensure that you are a good candidate for surgery.
Assuming everything looks safe to proceed, they will ask you to begin your pre-op diet at least 2 weeks prior to surgery.
Following your surgeon’s pre-op advice is essential because:
- It will cause you to lose weight before surgery.
- Research has shown that the amount of weight you lose before surgery is directly correlated with how much you will lose after surgery.
- Further, your risk of complications will go down if you lose weight before surgery.
See our Preparing for Weight Loss Surgery page for more information.
- Hospital Stay: You will be in the hospital for 2 to 3 days
- Time Off Work: You will need to take 1 to 3 weeks off of work
- Full Recovery: You will be “fully recovered” in 4 to 6 weeks
- Pain: The pain is manageable – it’s the same as any laparoscopic surgery and managed with medication
- Diet & Activity: There will be a slow transition from clear liquids to solid foods and back to regular activity and exercise
When you first wake up from duodenal switch surgery, you’ll feel a little sore but on medication to control the pain. Your surgeon will have you up and moving around as soon as possible to reduce the risk of blood clots and to speed up the healing process.
You’ll be discharged from the hospital in 2 or 3 days after your surgeon confirms that you’re on the road to full recovery.
Once home, your smaller DS stomach will be sensitive 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.
Your surgeon will prescribe pain and digestion medication as needed. They may also adjust your pre-surgery medications until you’re fully healed.
See our Bariatric Surgery Recovery page for more information.
- Restricted diet with strict supplementation regimen
- Regular exercise
- Less hungry than before surgery
- Personal relationships may change
Your Diet Transition Schedule
It will take time to transition to your long-term duodenal switch diet – up to 4+ weeks, depending on your surgeon’s preferences. Here is how that transition will look:
|Timeframe Range||Diet Requirements|
|2+ Weeks Before Surgery||Practice your post-DS diet|
|2 Weeks Before Surgery||High protein, low sugar, low carbs|
|1 Week Before Surgery||Stop or change some medications|
|2 Days Before Surgery||Clear liquids only|
|Midnight Before Surgery to 7 Days After Surgery (Varies by Surgeon)||Nothing to eat or drink|
|In Hospital (1 -2 Days) thru Day 7 After Surgery||Clear liquids only|
|Day 1 to Week 2 After Surgery (Varies by Surgeon)||Add thicker drinks & smooth foods (no chunks)|
|Day 2 to Week 3 After Surgery (Varies by Surgeon)||Slowly test pureed & soft solid foods|
|Day 3 to Weeks 4+ After Surgery (Varies by Surgeon)||Slowly test solid foods|
There is also good chance that you will permanently 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 for everything you need to know about your post-surgery and long-term diet.
Your Lifelong Vitamins & Dietary 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 (36).
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.
Your New Exercise Routine
Exercising 2 to 3 hours per week will lead to more long-term weight loss, better physical health improvement, and better mental health.
Relationships After Weight Loss
No more obesity discrimination. Getting treated with more respect. Getting more romantic interest from others. Feeling more self-confident. What could be bad about that?While it seems like life as a thin person will make everything better, there are several potentially negative circumstances to mentally prepare yourself for.
- 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”?
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”?
As long as you are mentally prepared beforehand, you will be able to address or prepare for many of the above situations before surgery.
For real life experiences and advice from other patients, see our Relationships After Weight Loss surgery page.
- Moderate risk of complications
- Risk of vitamin deficiency/malnutrition
- Side effects may include digestion issues & sagging skin
The duodenal switch surgery survival rate is close to 100%, but there are complications and side effects to be aware of.
The risk of complications depends on your weight before surgery. In one study of 190 duodenal switch patients (56), the percent of patients experiencing serious complications was directly correlated with how overweight they were.
Vitamin deficiencies is one of the biggest risks because the duodenal switch procedure prevents the body from absorbing as much vitamins and minerals, especially Vitamin A, Vitamin D, Vitamin E, Vitamin K, Iron, Calcium and Protein.
For this reason, a strict adherence to a prescribed vitamin regimen is essential, and your surgeon will continually monitor your vitamin levels to ensure that there are no issues.
Other issues that may arise after any weight loss procedure include digestion issues, sagging skin, and weight regain.
Duodenal-switch related digestion issues that may arise include:
- Difficulty Swallowing – Since the food you eat will have smaller digestive openings to pass through following surgery, you may have a harder time swallowing your food if you eat too much, too quickly, or don’t chew your food well enough.
- GERD – About 1 in every 5 DS patients experience GERD (gastroesophageal reflux disease) in the first 12 months following surgery. The good news is that this tends to be a shorter-term issue. After 3 years, the GERD rate drops to around 3% (57).
- Other Potential Digestion & Bowel Movement Changes – If you experience any of the following, it can often be improved with diet changes:
- Frequency of bowel movements – 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
- Nausea or vomiting
- Indigestion (dyspepsia)
- Intolerance to certain foods
- Foul-smelling stools or flatulence
- Constipation is possible but rare after DS surgery
If you are considering duodenal switch surgery, your skin has been stretched out for so long to accommodate your extra weight that it has lost its elasticity. After surgery, your weight will fall off very quickly, and your extra skin will be left behind.
In addition to being embarrassing, your extra skin can cause physical problems like making it harder to get dressed and exercise or skin rashes and infections.
Body-contouring undergarments may be enough to address the issue, but some patients need surgery to remove the extra skin.
See our Plastic Surgery After Weight Loss page for more information.
For a full list of complications that are possible after any bariatric surgery (and surgery in general), see our Complications page.
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.
- The best procedure 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
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 (61):
- More long-term weight loss than any other procedure
- Better health improvement than any other procedure
1. Duodenal Switch Positives Vs. Other Procedures
Duodenal switch has the following advantages when comparing other types of bariatric surgery:
- Long-term weight loss is better than any other procedure, and patients are much less likely to regain weight (62).
- 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) (63).
- Reduced hunger – only gastric sleeve and duodenal switch make you feel less hungry.
- Risk of short-term complications is similar to gastric sleeve and gastric bypass (but higher than Lap-Band, 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, and AspireAssist, so there is no risk of device-related complications. While the risk of device-related complications is relatively low for 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 balloonb and AspireAssist usually are not covered by insurance).
Duodenal Switch Negatives Vs. Other Procedures
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 DS surgeon)
- Not reversible – Unlike Lap-band, gastric balloon, 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, 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).
- 7 steps to long-term weight loss if you undergo the duodenal switch procedure
01. Start Working with a Weight Loss Surgeon As Soon As Possible
Your surgeon will do most of the work required to get you approved for surgery, including all of the work with your insurance company and guiding you through all of the pre- and post-surgery steps necessary for long-term success.
If you already know that you qualify for duodenal switch base on your BMI and health conditions, the next step is to as your surgeon to check your insurance benefits. Most practices will do this for free.
02. Two Weeks Out: Prepare for Surgery
In the 2 weeks prior to surgery you will visit your surgeon’s office and/or your hospital’s pre-surgery department for an EKG, blood work, and other tests to ensure that it is safe to proceed with surgery.
The night before surgery, your surgeon will insist that you do not eat or drink anything starting at midnight.
03. Surgery Day
You will need to get to the hospital at least 2 hours prior to surgery. The duodenal switch procedure itself will take about 4 hours to perform. After surgery, you’ll have a dedicated nurse to manage your pain and check your vitals.
Most duodenal switch patients are in the hospital for 2 or 3 days. You will be discharged from the hospital as soon as your surgeon is confident that you are on the right path towards recovery.
You will not be allowed to eat or drink anything for at least 24 hours after surgery, and your surgeon have you up and walking around as soon as possible to start the healing process.
When you are ready to go home, you will need to have someone available to drive you home and care for you for at least 3 to 4 days after surgery. You should be fully recovered within 4 weeks.
05. Adjust to Your New Post-Surgery Diet & Lifestyle
You will slowly transition from a clear liquid diet to your “new normal” long-term duodenal switch diet. You will immediately notice that you feel full sooner while eating less hungry in general, and your weight will start to fall off quickly.
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 begin slowly progressing towards your new exercise routine.
06. Attend Support Groups Regularly
Ample research has found that regular support group participation leads to both lower post-op recovery time as well as much more long-term weight loss. Your surgeon’s office will have at least a couple of support group options for you to try out, and many online duodenal switch communities exist to get you the support and encouragement you need.
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.
- You can "ask the expert"
- You can read about the experiences of other duodenal switch patients
Questions From Other Visitors*
Click below to see contributions from other visitors to this page.
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…
- You can ask a local bariatric practice for a free insurance check or cost quote
- You can attend a free in-person seminar or an online webinar offered by a local weight loss surgeon
- You should schedule a phone or in-person consultation (both often free), if you are interested in learning more about weight loss surgery