What’s the difference between gastric sleeve and duodenal switch?

Gastric sleeve and duodenal switch are two types of weight loss surgery. Bariatric procedures like these can help people with obesity or obesity-related health problems lose weight when diet and lifestyle changes aren’t working. There are many options for bariatric surgery, and while your doctor can help you understand the difference between the procedures, the choice is ultimately up to you.

Here, we’ll dig into two popular bariatric surgeries — gastric sleeve and duodenal switch. For each, you’ll learn:

  • What happens during surgery
  • Who qualifies for surgery
  • What you can expect during recovery
  • How much weight you can lose
  • The average cost of the procedure

What happens during gastric sleeve surgery?

During gastric sleeve surgery, also called sleeve gastrectomy, a doctor operates through a series of small incisions in your abdomen. They use a stapler to separate your stomach into two parts, then create a seal along the staple line. They remove the outer section — about 80% of your stomach — leaving a small “sleeve” about the size of a banana.

Gastric sleeve surgery causes weight loss by permanently limiting the amount of food you can eat in one sitting. It also decreases your appetite by reducing your stomach’s ability to create hunger-causing hormones.

What happens during duodenal switch surgery?

Duodenal switch (DS) surgery happens in two parts. First, the surgeon performs a sleeve gastrectomy (described in the previous section). Then, they disconnect the stomach from the small intestine and reattach it farther down. As a result, food goes directly from your stomach to the end of the small intestine, bypassing about 80 to 90% of your small bowel. 

Like gastric sleeve, duodenal switch limits your food intake to help with weight loss. However, it goes a step further by shortening the path through your digestive system and reducing the amount of nutrients and calories your body can absorb from food.

Loop duodenal switch surgery (SADI)

Single anastomosis duodenal switch surgery (SADI), also called a loop duodenal switch, improves on traditional duodenal switch surgery. Both procedures have the same two steps: removing part of the stomach and rerouting the small intestine. However, with loop duodenal switch, the small intestine is only severed in one place, near the stomach. (Traditional DS involves an extra cut farther down the small intestine.) 

SADI causes weight loss just like traditional duodenal switch — by limiting food intake and nutrient absorption. Because it involves fewer alterations to the small intestine (dividing and reconnecting the small intestine in one place instead of two), SADI is associated with a lower risk of complications and malnutrition than DS.

Who qualifies for gastric sleeve and duodenal switch surgery?

Most weight loss surgeries have the same basic qualifications. Patients must either have a body mass index (BMI) of 40 or higher OR have a BMI of 35 to 40 with at least one obesity-related health condition. Those with a BMI of 30 or higher with uncontrollable type 2 diabetes or metabolic syndrome may also qualify for gastric sleeve surgery.

Duodenal switch surgery is a little different. For both traditional and loop duodenal switch surgeries, patients must have a BMI of 50 or higher OR a severe form of obesity-related disease. DS and SADI have the greatest weight loss potential of all bariatric surgeries, but they also have an increased risk of complications. These procedures are recommended when the health benefits outweigh the potential risks.

What is recovery like after gastric sleeve and duodenal switch surgery?

No matter which type of bariatric surgery you have, you’ll need to follow strict guidelines to reintroduce foods into your diet during your recovery. For the first week after your surgery, you’ll be on a clear liquid diet. After that, you’ll slowly add in different food groups, in this order

  1. Non-clear liquids
  2. Pureed foods
  3. Soft foods
  4. Solid foods (normal diet)

Each step of this process may take around a week or more, depending on how your body adjusts after your surgery. Your provider will also recommend taking specific vitamins after your procedure to help make up for your decreased food intake. Even after you’re fully recovered, these vitamins should remain a regular part of your daily routine.

How much weight can you lose with gastric sleeve and duodenal switch?

You’ll need to make healthy lifestyle changes to see the best weight loss results after your surgery. These include cutting out high-calorie snacks, eating nutrient-dense foods, and exercising regularly. With the right effort, patients can typically lose around 60% of their excess weight in the two years following their gastric sleeve surgery. For duodenal switch and SADI, this number is around 80%.

What does gastric sleeve cost compared to duodenal switch?

The average cost of gastric sleeve surgery in the U.S. is $16,750, and duodenal switch surgery is $22,580. However, the actual price you pay could be thousands more. New Choice Health’s Bariatric Surgery Patient Assist Program can help you find a fair price for your procedure, as well as cash pay discounts and financing options that can lower your out-of-pocket costs for the surgery.

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