Duodenal switch vs gastric bypass: best procedure for weight loss

It’s easy to get all confused when trying to find the best possible weight loss surgery that is a perfect match for meeting your goals. There are many different procedures that involve bypassing or restricting your stomach and intestines. Duodenal switch and gastric bypass are one of them.  Duodenal switch vs gastric bypass – which of these procedures is more suitable for you?

 What you need to remember is that your health and safety are always crucial. Keep in mind that every weight loss surgery has its specific requirements, as well as positive outcomes and potential risks. In the article, you’ll read about the difference between gastric bypass and duodenal switch, so that you can choose the best surgery option with confidence and all the information you need.

Comparing two procedures: duodenal switch vs gastric bypass

The two procedures differ from one another, that’s a fact. Many patients think that the technique is different and focus on how much more weight they can lose. However, there is so much more to that. Remember that losing too much weight too much and too fast might not be the best solution to an obesity problem.

Both of these weight loss procedures are generally done laparoscopically and involve reducing the stomach size, by bypassing it or removing its big portion. They also both include bypassing some parts of the small intestine, which leads to a certain level of malabsorption. However, if you follow your dietary instructions during the post-op recovery period, you may avoid this problem in case of gastric bypass surgery. In the next article section, you’ll read about the main differences between these two surgeries and find out which one is safer and therefore recommended as a better option in your weight loss journey.

The main difference: surgical techniques

Gastric bypass (RYGB) is definitely less invasive. It’s also a gold standard for weight-loss surgery according to the American Society for Metabolic and Bariatric Surgery and the National Institutes of Health. Gastric bypass is a procedure in which your intestines’ anatomy changes. This change alters the path of the food you eat. How does it happen?

During the gastric bypass procedure, a small stomach is created. It is then directly connected to a piece of your small intestine. This way it can bypass the main part of your stomach. When it comes to numbers, a gastric bypass surgery reduces your stomach size by about 70% to 80%, and the small intestine is shorter by approximately 30%.

Duodenal switch (DS) on the other hand is the most invasive and complex procedure among all bariatric surgeries. Your stomach size is reduced by 75-80% and the surgeon bypasses much longer part of the small intestines – about 75% of it. This surgery is both restrictive and malabsorptive, and it’s considered the most complicated one.

The duodenal switch removes a major part of the stomach and most of the duodenum, which is the first part of the small intestine connected to your stomach. You must know that it leads to a much higher risk of malabsorption and other potential problems following this procedure.

Which one is more effective for weight loss?

When it comes to metabolic benefits, both surgeries are successful in the effective loss of unwanted weight. In the case of a gastric bypass, you will approximately lose 70-75% of your excess weight, while after the duodenal switch – a minimum of 80%, up to even almost all of it. It’s the highest amount of excess weight loss you can possibly achieve among all kinds of gastric procedures.

Weight loss may include muscle, water, and fat loss altogether. What you want to achieve however is fat loss exclusively. With a duodenal switch, you will able to lose extreme weight, that’s a fact. Keep in mind that this weight loss will also include losing your muscles too. With gastric bypass, on the other hand, this kind of side effect is preventable with a proper diet.

Recovery and complication rates compared

It needs to be emphasized that we know many fewer potential risks related to gastric bypass vs duodenal switch surgery. These complications in most cases include infections, blood clots, bowel obstruction, dumping syndrome, malnutrition, gastric pouch stretching, ulcers, and gallstones.

Duodenal switch is a newer procedure with a variety of complications that occur much more often. It’s still considered an experimental surgery that comes with more potential risks. Apart from the problems associated with gastric bypass, duodenal switch patients face risks that also include higher nutrition deficiency, leakage, hemorrhaging, protein malabsorption, and gastrointestinal side effects, just to name a few.

The major complication of duodenal switch is nutritional deficiency. It is going to affect micronutrients such as iron, vitamin B12, vitamin B1, folate, zinc, and calcium, as well as A, D, E, and K vitamins. As a result of this malnutrition, you can suffer from iron deficiency, anemia, osteomalacia, or osteoporosis.

A problem very specific to the duodenal switch is steatorrhea – pale, bulky, foul-smelling feces. It occurs because of abnormal fat contents in the stool, as a result of extreme malabsorption.

Duodenal switch vs gastric bypass: nutritional differences

Gastric bypass is a better choice if you consider nutrient deficiencies after the surgery because you only take supplements for a few months following the procedure. Duodenal switch bypasses much longer part of the small intestines, therefore the malabsorption risk is much higher. Less protein and fat are absorbed causing more nutritional deficiencies, so you have to use supplements for life. There is also a bigger risk of dumping syndrome in the case of duodenal switch surgery. Altogether it puts patients at much greater risk of malnutrition and vitamin deficiencies in the future.

Comparing long-term health benefits

You need to remember that when it comes to both of the surgeries, you will have frequent follow-up appointments with your doctor, a year up to two years following the surgery. During this time your physician will monitor the progress and overall health condition. You’ll have regular blood checks for nutrition and take daily supplements to prevent deficiencies.

In the case of a duodenal switch though these periodic appointments are going to take place for the rest of your life. The first year and a half up to two years, you are going to experience the most dramatic weight loss period. Also, the risk of long-term malnutrition will definitely be much higher.

Cost comparison between the duodenal switch and gastric bypass

The cost of a gastric bypass around the world is between 5-35K, while the price of the duodenal switch can range from 5-42K, so the cost of both procedures is comparable.

You should know that the overall cost of both surgeries depends on many different aspects, which include medical tests, pre-op care, the procedure itself, post-op care, and follow-up visits. The variety of prices is also related to other factors like country, clinic, and, last but not least, your bariatric surgeon. Note that the surgery cost is usually half of the overall price.

Choosing the best procedure for your weight loss goal

If you give priority to your health more than losing weight, bypass is a great option for you as a duodenal switch comes with many risks and side effects.

The duodenal switch may be considered a last resort weight loss surgery after other procedures failed, in patients with a BMI over 50. Some surgeons might recommend a duodenal switch vs gastric bypass if you suffer from ulcers because a pouch that is formed with bypass surgery is extremely small. For this reason, it’s almost impossible for ulcers to be found after gastric bypass surgery.

However, many surgeons will discourage you from undergoing a duodenal switch procedure. It’s still an experimental method and the most aggressive kind of weight loss surgery. Not enough studies show that it’s safe because of its complexity and many potential side effects. Last but not least, duodenal switch surgery type might also result in slightly higher perioperative mortality.

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Hedberg J, Sundström J, Sundbom M. Duodenal switch versus Roux-en-Y gastric bypass for morbid obesity: systematic review and meta-analysis of weight results, diabetes resolution and early complications in single-centre comparisons. Obes Rev. 2014 Jul;15(7):555-63. doi: 10.1111/obr.12169. Epub 2014 Mar 25. PMID: 24666623.

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