In the field of weight loss surgery, there are three standard bariatric procedures that help patients lose weight and keep the weight off. The oldest procedure is the gastric bypass, although the gastric sleeve has gained popularity in recent years due to its perceived simplicity. Yet aside from the bypass and the sleeve, a third bariatric procedure is emerging as an effective tool for bariatric patients with a higher body mass index (BMI) known as the duodenal switch. In our practice, we perform the gastric sleeve and the duodenal switch, so in this blog we will compare and contrast the two bariatric procedures.

The gastric sleeve and the duodenal switch are excellent weight loss options for patients with a body mass index greater than 35. The gastric sleeve is recommended for patients who have a BMI between 35 and 45, while the duodenal switch is reserved for patients who fall within the higher BMI range of 45+.

The gastric sleeve and the duodenal switch are both great procedures that will help patients lose a significant amount of weight, yet some differences between the two will impact your decision when choosing a bariatric procedure.

Duodenal Switch Surgery

The duodenal switch, otherwise known as the biliopancreatic diversion with duodenal switch, BPD-DS, is the least commonly performed bariatric surgical procedure. In our practice, we tend to reserve the duodenal switch for our heavier patients who need to maximize their weight loss.

The duodenal switch (DS) is a combination of the sleeve gastrectomy and the gastric bypass. During the operation, the surgeon will perform a sleeve gastrectomy by creating a smaller, banana-shaped stomach. The stomach is then connected directly to the lower one-third of the small intestine. This procedure effectively results in a change of the stomach’s size and shape and a bypass of food through two-thirds of the intestines.

Therefore, the duodenal switch is highly effective in helping patients lose weight because they have a smaller pouch, and the bypass of the intestines results in a metabolic and hormonal effect.

Gastric Sleeve Surgery

The gastric sleeve, otherwise known as the Vertical Sleeve Gastrectomy (VSG), is a procedure in which the size and the shape of the stomach are changed. 

The vertical sleeve gastrectomy involves placing a tube through the mouth into the stomach along the lesser curve. The surgeon will divide the fat attachments along the greater curve of the stomach. Then, using laparoscopic staplers, the surgeon will divide the stomach along the tube, beginning on the lower edge of the stomach (near the pylorus) to the upper edge (near the esophagus). The surgeon will remove about 70 to 80% of the stomach, leaving a banana-shaped pouch. Unlike the gastric bypass, the sleeve will not alter how food travels through your intestines. 

Gastric Sleeve vs Duodenal Switch

Weight Loss Expectations

When looking at expected weight loss for the gastric sleeve vs. the duodenal switch, the duodenal switch is more effective in helping patients lose a higher percentage of their weight. That is the main reason bariatric surgeons reserve the duodenal switch for patients who have a higher body mass index and need to maximize their weight loss.

Statistically, the duodenal switch has the best overall weight loss results compared to the gastric sleeve. On average, patients who have the duodenal switch can expect to lose 80 to 100% of their excess weight. Meanwhile, patients who have the gastric sleeve can expect to lose an average of 60 to 65% excess weight loss.

It is important to understand that when we as surgeons refer to “excess weight,” we are not talking about total weight. Excess weight loss is a percentage of your excess body weight. For example, if you are 200 pounds and your goal is to be 100 pounds, then you have 100 pounds of excess weight.

Nutrition and Malabsorption

Due to the alteration of the intestinal anatomy in the duodenal switch, patients who have this procedure are at a higher risk of experiencing malnutrition. Similarly, duodenal switch patients have a higher rate of experiencing dumping syndrome (which results from eating highly processed foods) because of the more severe alteration of the anatomy.

Therefore, it is extremely important for duodenal switch patients to get adequate nutritional intake and avoid highly processed and sugary food.

Overall Health Impact

The duodenal switch is a combination of the gastric sleeve and the gastric bypass. Therefore just as we do not recommend the gastric sleeve for patients who experience gastroesophageal reflux disease, we do not recommend the duodenal switch for these patients either. Instead, if you suffer from GERD (acid reflux), we recommend getting the gastric bypass to avoid long-term, severe symptoms that could be extremely difficult to control, aside from having a revision.


Overall, both the gastric sleeve and the duodenal switch are safe and effective procedures that help patients lose a significant amount of weight. Both procedures create hormonal and metabolic changes that allow the patient to lose weight and get rid of weight-related medical problems like diabetes, high blood pressure, high cholesterol, etc. The duodenal switch is also much more effective at diabetes resolution than the gastric sleeve. Similarly, the duodenal switch is more effective in resolving weight-related medical problems long term, and most patients will see faster metabolic results.

When you come in for your initial visit, we will review your weight, medical history, and any health conditions that could impact your results. We will also want to understand your weight loss expectations to help you choose the best weight loss procedure to fit your lifestyle.

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