Duodenal Switch vs. Gastric Sleeve

Duodenal Switch vs. Gastric Sleeve

Individuals who are considering bariatric surgery for weight loss have multiple options. From traditional gastric bypass surgery to Duodenal Switch surgery to gastric sleeve, each type of surgery has its own benefits and risks.

When deciding which surgery is right for you, it is essential to compare your options. You should understand the similarities and differences between the two types of bariatric procedures .  When reviewing Gastric Sleeve vs Duodenal Switch, there are a number of factors to consider:

Comparison chart

 

Gastric Sleeve           Duodenal Switch

Method of Weight Loss

Restrictive                   Restrictive & Malabsorptive

 

Duration of Procedure

1.5 Hour                           4 Hour

 

Length of Hospital Stay

2 Nights                            2-3 Nights 

 

Estimated Weight Loss

65% of Excess Weight      65-90% of Excess Weight

 

Weight Loss at 1 Year

60-70%                              70%

 

Comorbidities

High Resolved Rate           Significant Resolved Rates

 

Hypertension Resolved

68%                                    43%

 

Diabetes Resolved

55%                                     92-100%

 

Migrations Resolved

40%                                     Major Improvements

 

GERD Resolved

50%                                    49%

 

Mortality

0.1%                                    0.3%

 

Asthma

90%                                      90%

 

Sleep Apnea

62%                                      85%

 

Depression

Most Resolved                      57%

 

Quality of Life Improved

93%                                      95%

 

Common Complications

Staple Line Leaks 0.5%        N/A

 

Common Side Effects

Nausea, Digestive Issues      GERD, Gallstone

 

Full Recovery

4 to 6 Weeks                          4 to 6 Weeks

 

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Duodenal Switch vs. Gastric Sleeve: The Similarities

Duodenal switch and gastric sleeve have some similarities because the gastric sleeve actually began from a modification of the duodenal switch. The duodenal switch involves both a restrictive component (the stomach removal, which prevents overeating) as well as a malabsorption component (the rerouting of the small intestine, which reduces time in the stomach so your body can’t process all of the calories).

However, researchers and bariatric surgeons eventually started studying whether or not the restrictive component alone could promote weight loss. After several years of study, they found that for many, the restrictive component alone was enough, and so they turned it into its own bariatric surgery, known as the “Vertical Sleeve Gastrectomy,” or “Gastric Sleeve.”

That means gastric sleeve is, in many ways, simply a less extreme version of the duodenal switch.

Duodenal Switch vs. Gastric Sleeve: The Differences

There are very few differences between the restrictive component of the duodenal switch and the vertical sleeve gastrectomy. Most of the differences between the two procedures are related to the rerouting of the small intestine. However, this difference is significant, with both advantages and disadvantages. Differences include:

. Weight Loss – By adding the malabsorption component, the duodenal switch is able to support more weight loss than the gastric sleeve. Research has shown that the average duodenal switch patient will lose as much as 70% of their excess weight, on average, while gastric sleeve excess weight loss averages around 60% – good, but not to the degree of duodenal switch.

. Complications – The rerouting of the small intestine introduces a number of potential complications. Not only is the surgery more complicated for the surgeon (which could lead to surgical complications) but the new digestive tract can lead to increased flatulence, bloating, and diarrhea. These are far less common with gastric sleeve.

. Lifelong Dietary Changes – Similarly, the gastric sleeve has very few dietary restrictions because the digestive process is the same. Stomach removal can cause some food sensitivities, but generally, there are fewer foods that you cannot eat or vitamin deficiencies. But by reducing the amount of time food has to digest, the duodenal switch can lead to severe malnutrition without regular dietary supplements. You will also have to agree to lifelong blood tests to prevent any vitamin or mineral deficiencies.

Overall, the duodenal switch has a greater success rate than the gastric sleeve. It is considered the preferred option for severely obese patients that require immediate, rapid weight loss intervention.

However, the gastric sleeve provides most of the same weight loss benefits with fewer complications and fewer long term follow-ups and risk. For most patients, the gastric sleeve is a preferable choice as it can be converted to the duodenal switch if it proves ineffective. But some surgeons may recommend the duodenal switch, particularly for high-risk patients.

Comparison between Duodenal Switch and Gastric Sleeve Surgery

What is Gastric Sleeve Surgery?

Gastric Sleeve surgery also known as sleeve gastrectomy or vertical sleeve gastrectomy (VSG) is a weight-loss procedure that induces weight loss by restricting food intake. With this procedure, which is usually performed laparoscopically, the surgeon removes approximately 75-80 percent of the stomach.  This results in the stomach taking on the shape of a tube or "sleeve" which holds much less food.

What is Biliopancreatic Diversion with Duodenal Switch (BPD/DS)?

The Biliopancreatic Diversion with Duodenal Switch – abbreviated as BPD/DS – is a procedure with two components. First, a smaller, tubular stomach pouch is created by removing a portion of the stomach, very similar to the sleeve gastrectomy. Next, a large portion of the small intestine is bypassed.

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Comparing the procedure

How Gastric Sleeve is performed

Gastric sleeve surgery, also called the Vertical Sleeve Gastrectomy (VSG), is performed by removing a large portion of the stomach to create a long pouch that connects the esophagus to the small intestine. The pouch is stapled and the rest of the stomach is removed. Some surgeons take an additional step to reinforce the staple line, although whether that is effective is up for debate.

How Duodenal Switch is performed

The first step is sleeve gastrectomy in which about 80 percent of the stomach is removed, leaving a smaller tube-shaped stomach, similar to a banana. However, the valve that releases food to the small intestine (the pyloric valve) remains, along with a limited portion of the small intestine that normally connects to the stomach (duodenum).

The second step bypasses the majority of the intestine by connecting the end portion of the intestine to the duodenum near the stomach. A BPD/DS both limits how much you can eat and reduces the absorption of nutrients, including proteins and fats.

Comparing the Advantages and Disadvantages

Gastric Sleeve Advantages:

. Can lead to significant weight loss (average of 66% of excess body weight)

. Can lead to significant improvement of obesity-related health conditions

. Doesn’t use a foreign object (like the gastric band) and doesn’t reroute the digestive tract (like the gastric bypass)

. Short hospital stays approximately 2 days and recovery time due to minimally invasive procedure

. Limits the amount of food that can be eaten

. Causes significant changes to digestive organs and hormones that result in reduced hunger and increased metabolism.

. Permanent (won’t need more surgeries or readjustments, like the gastric band)

Duodenal Switch Advantages:

. You will lose up to 70% of your excess weight within a year

. Allows patients to eventually eat near “normal” meals

. Causes favorable changes in gut hormones to reduce appetite and improve satiety.

. Duodenal switch surgery will cure or improve your diabetes, sleep apnea, hypertension, and at least 12 other conditions.

. You will feel full sooner while eating

. Your body will absorb fewer calories from the food you eat.

Gastric Sleeve Disadvantages:

. Requires lifelong dedication to specific diet and exercise routines

. Permanent (cannot be reversed)

. Can lead to vitamin deficiencies

Duodenal Switch Disadvantages:

. Requires a longer hospital stay than the AGB or LSG

. Has a greater potential to cause protein deficiencies and long-term deficiencies in a number of vitamin and minerals, i.e. iron, calcium, zinc, fat-soluble vitamins such as vitamin D.

. Compliance with follow-up visits and care and strict adherence to dietary and vitamin supplementation guidelines are critical to avoid serious complications from protein and certain vitamin deficiencies.

. More frequent bowel movements.

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Comparing the Risks and Complications

Gastric Sleeve Risks and Complications:

. Leakage from the staple line – this is a rate but serious complication of the gastric sleeve surgery. The reported leak rate is between 0.7-3 percent. In Iran, we pay paramount attention to our surgical techniques to minimize all the complications.

. Stricture/stenosis - In the past, we had one stricture among our first 20 gastric sleeve procedures. We have not had any strictures within the past 5 years.

. Bleeding

. Blood Clot

. Heart Burn – This is a very controversial topic in bariatric surgery and the data from different centers is inconsistent. In our experience, most patients with heartburn before surgery see improvement of symptoms after surgery due to weight loss. Some patients may develop new heartburn, which is treatable with over-the-counter anti-acid medications, in most cases.

. Nutrient or vitamin deficiency

. Weight Regain

After two years, about 1 out of every 20 gastric sleeve patients have gained back some weight from their low point.

At 5 years, the average gastric sleeve patient regains as much as 50% of the weight they lost. Just as bad, the more weight you gain back, the more likely your health problems are to return.

The reasons for weight regain?

. Consuming calories in liquid form, such as protein shakes, pureed foods, smoothies, etc. Your new sleeve stomach works by making you feel full sooner when you eat. Since liquids don’t make you feel as full as solid foods, you’ll eat more and gain weight if you get your calories from liquids instead of solids.

. Overeating or eating the wrong things. This can stretch out the smaller gastric sleeve stomachs over time which will allow you to eat more and gain unwanted weight.

Remember, gastric sleeve is one of the best tools for weight loss, but it is only a tool. To avoid weight regain, you’ll need to eat the right foods and make the right lifestyle choices.

. 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. Gastric sleeve 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:

. Hard time getting dressed

. Uncomfortable to exercise

. Skin problems, such as rashes and 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.

. Digestive Issues

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% of patients.

Other potential digestive issues resulting from gastric sleeve surgery include:

. Indigestion (Dyspepsia)

. Gallstones

. Developing an intolerance to some food types

. Vomiting or nausea

. Vitamin deficiency

These digestive issues can often be addressed and fixed with diet and behavior changes.

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Duodenal Switch Risks and Complications:

Risks associated with BPD/DS include:

. Excessive bleeding

. Infection

. Adverse reactions to anesthesia

. Blood clots

. Lung or breathing problems

. Leaks in your gastrointestinal system

Longer term risks and complications of a BPD/DS may include:

. Bowel obstruction

. Dumping syndrome, causing diarrhea, nausea or vomiting

. Gallstones

. Hernias

. Low blood sugar (hypoglycemia)

. Vitamin deficiency/ Malnutrition

. Stomach perforation

. Ulcers

. Digestion issues

. Sagging skin

. Weight Regain

Who is a good candidate?

Is a gastric sleeve right for me?

The minimum requirements to qualify for gastric sleeve surgery include:

. A body mass index (BMI) of 40 or more, OR

. A BMI between 30 and 39.9 with a serious obesity-related health problem like diabetes, high blood pressure, sleep apnea, high cholesterol, joint problems, and many others.

Patients who qualify for gastric sleeve surgery usually:

. Are at least 80 lbs (36 kg) overweight.

. Are between 18 and 75 years old

. Have a history of failed weight loss attempts (example: failed diets)

. Thoroughly understand that the procedure is just a tool; your long-term success requires you to make significant diet and lifestyle changes.

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Is a Duodenal Switch right for me?

You may be eligible 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

How long does each procedure take?

Gastric sleeve

The operation can take between one and two hours, but this may vary between surgeons.

Duodenal Switch

The operation can take between three and four hours, but this may vary between surgeons.

What can I expect during recovery?

Gastric sleeve

During your gastric sleeve recovery, you can expect:

.Timeline: 4 to 6 weeks to full recovery

. Hospital Stay: 2 to 3 days

. Time Off Work: 1 to 3 weeks

. Pain: Same as experienced after any laparoscopic surgery, managed with medication

. Diet: Slow transition from clear liquids to solid foods

. Activity: Slow transition back to regular activity and exercise

. Challenges: Most side effects like nausea, digestive issues, and body changes go away over time or after adjusting diet/lifestyle habits.

Duodenal Switch

. 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.

Diet

Gastric sleeve

. Patient must eat three meals a day containing 600-800 calories per day (recommended for the first 24 months) and about 1000-1200 after that.

. There is no dumping or diarrhea.

Duodenal Switch

. Patients must eat three meals/day.

. Patients must strictly adhere to protein and vitamin supplements to avoid deficiencies. (Multivitamins, ADEK vitamins, Calcium, and Iron for Menstruating women).

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.

Comparing cost

Gastric sleeve

The cost of Gastric Sleeve in Iran is between $ 2700 – 3300.

Factors such as the surgeon’s location, credentials, and the type of facility where the procedure is being performed all impact the final cost.

Duodenal Switch

The cost of Duodenal Switch in Iran is between $ 3200 - 3700.

Factors such as the surgeon’s location, credentials, and the type of facility where the procedure is being performed all impact the final cost.

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