Bariatric Surgery Comparison: Gastric Sleeve vs. Duodenal Switch

Dr. Christopher McGowan
May 27, 2021

For decades now, the rate of obesity in the United States and around the world has continued to climb. According to the Centers for Disease Control and Prevention (CDC), a full 42% of Americans are considered obese, which is defined as a body mass index (BMI) of 30 or more. Even though many people make a valiant effort to lose weight, traditional weight loss methods—typically dieting and exercise—are rarely effective over the long run. The most promising alternative to diet and exercise for a lot of people is bariatric surgery, yet only a fraction of eligible people actually opt for surgery. Two popular surgery options are known as gastric sleeve and duodenal switch. 

What is Gastric Sleeve?

The term gastric sleeve is the common name for the bariatric procedure known as a sleeve gastrectomy. The main aim of the procedure is to reduce the amount of food (and thus calories) that can be consumed in a single sitting; over time, fewer calories consumed will eventually lead to the body burning fat stored for energy. The gastric sleeve procedure is a permanent reformation of the stomach, so it can’t be undone. Most people are able to lose 50% or more of their excess body weight within 1-2 years of the procedure.

The gastric sleeve procedure is done laparoscopically, which is a surgical method that involves a few small incisions in the abdomen; the surgeon then uses tools mounted to the end of the laparoscope to separate the stomach into two parts along the greater curvature. The larger section is removed, and the smaller section is formed into a banana-shaped sleeve that represents about 20% of the original stomach volume. The reduced stomach volume limits how much food can be eaten as well as causing the patient to feel full longer.   

What is Duodenal Switch?

Short for biliopancreatic diversion with duodenal switch (BPD-DS), the duodenal switch procedure is almost like an extension of gastric sleeve because the first stage of the procedure involves performing a sleeve gastrectomy. In fact, the procedure is essentially identical to a sleeve gastrectomy in terms of the way the stomach is bisected; just as in gastric sleeve, a banana-shaped stomach section is used to reduce stomach volume and promote weight loss. For patients who want or need a more aggressive approach to weight loss, however, the second phase of the duodenal switch can potentially help a person lose even more weight. 

Once the stomach has been transformed into a gastric sleeve, the second phase of the procedure can begin. As the name implies, a duodenal switch involves dividing the small intestines at the duodenum, the section of the small intestine where digestive juices are secreted into the gastrointestinal tract. One part of the small intestine connects the stomach to the rest of the digestive tract, though the shorter distance means that fewer nutrients can be absorbed by the small intestine. The second section of intestine connects the duodenum to an area on the small small intestine further down the line; this allows gastric juices to still be utilized by the digestive process.  

How Do Gastric Sleeve and Duodenal Switch Differ?

The biggest difference between the two procedures is simply that the duodenal switch contains the entire gastric sleeve procedure and then adds onto it. In a more comprehensive sense, though, the biggest difference is that the duodenal switch is more complicated and invasive. The gastric sleeve procedure is done laparoscopically with only a few incisions, but the duodenal switch requires all of those incisions plus additional incisions so that the surgeon can work with the small intestine. As with virtually all types of surgery, more incisions means more risk and longer recovery times. 

The goal of both surgeries is to limit calorie intake and promote weight loss by creating an ongoing caloric deficit. They both also achieve this through reduced stomach size via the newly formed gastric sleeve; as noted earlier, the smaller stomach size helps patients eat smaller meals and feel full after less food. The duodenal switch procedure, however, additionally involves another type of weight loss mechanism: reduced nutrient absorption. As most nutrient absorption happens in the small intestine, the rearrangement of the gastrointestinal tract in the duodenal switch causes fewer nutrients to be taken into the body. The combination of these two mechanisms has the potential to lead to even greater weight loss. 

What are the Pros and Cons of Gastric Sleeve?


  • Impressive Results: Patients who opt for gastric sleeve can lose upwards of 50% of excess body weight within 12-24 months after the surgery. 
  • Simple Procedure: Unlike some other bariatric surgeries, gastric sleeve is relatively simple and straightforward; this makes it less likely to cause complications.
  • Fewer Dietary Problems: Simply relying on a smaller stomach size means that there are fewer concerns with dietary side effects like vitamin deficiency. 


  • Irreversible: The surgery can’t be reversed. 
  • Complications: Though the gastric sleeve procedure is relatively safe, there are some possible complications from the surgery, including bleeding, esophageal irritation, and leakage through the stomach sutures. 
  • Recovery Time: The procedure usually requires an overnight stay in the hospital, and then full recovery and return to normal activities can take up to six weeks. 

What are the Pros and Cons of Duodenal Switch?


  • Excellent Results: The combination of reduced stomach volume and intestinal malabsorption makes the duodenal switch a highly effective means of weight loss; patients have been known to lose more than 70% of excess body weight within the first year. 
  • Improvement with Weight-Related Diseases: Conditions like type 2 diabetes, hypertension, sleep apnea, and heart disease all improve rapidly after the surgery.  


  • Irreversible: Like gastric sleeve, a duodenal switch procedure is permanent and can’t be reversed. 
  • Complications: As in gastric sleeve, the multiple incisions can cause a variety of complications. It is also possible to experience symptoms such as diarrhea, bloating, nausea, and gallstones.  
  • Involved Procedure: The multifaceted procedure is more complex and invasive; in addition to more potential complications, there are also simply fewer doctors who have the expertise to perform the procedure.   
  • Vitamin Deficiency: The malabsorptive element of the procedure can cause a lifelong need for certain vitamin and mineral supplements.   

Bariatric Surgery Alternatives

Both gastric sleeve and duodenal switch have a single digit percent chance of major complications, but, like any surgery, there are always risks. Even though laparoscopic surgery is considered minimally invasive, the required incisions can cause side effects like bleeding, inflammation, and infection. Moreover, most bariatric surgeries have lengthy recovery times, so it takes 4-6 weeks before you can return to your normal life. 

It is in light of these potential risks and complications that True You Weight Loss offers alternatives to standard bariatric surgery. We have several state-of-the-art, non-surgical procedures that can provide similar weight loss benefits without the risks of actual surgery. Endoscopic sleeve gastroplasty (ESG) is one example of a procedure that reforms the stomach into a similar banana-shaped sleeve as sleeve gastrectomy; in this case, though, the procedure is performed endoscopically and therefore requires no incisions or lengthy recovery times. 

Freedom is Waiting!

If you have tried traditional weight loss methods without much success, it may be time to consider a medical weight loss procedure like those offered at True You. Our highly trained staff is dedicated to helping you find the freedom from obesity that you’ve been seeking. If you’d like to learn more about our approach to weight loss or details about our offerings, contact us today to request a consultation.

Dr. Christopher McGowan
Dr. Christopher McGowan

Dr. Christopher McGowan, MD, a leader in endobariatrics, specializes in non-surgical obesity treatments and is triple-board-certified in Internal Medicine, Gastroenterology, and Obesity Medicine. Renowned for pioneering endoscopic sleeve gastroplasty (ESG) with over 2,000 procedures, his global influence and research contributions define him as a top expert.

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