Duodenal Switch vs Other Bariatric Surgeries

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Dr. Joshua Long

MD, MBA, FACS, FASMBS

Are you interested in bariatric surgery, and wondering if loop duodenal switch surgery (or SADI-S surgery) is right for you? The switch is the most powerful weight loss and type II diabetic treatment tool we have today. However, it’s not for everyone: after surgery, it requires that you adhere to a very strict vitamin and mineral regimen every day for the rest of your life to avoid malnutrition. It’s also a poor fit for some patients with certain health concerns.

Use this checklist, complete with explanations, to decide if the duodenal switch is right for you compared to the gastric sleeve or gastric bypass.

Duodenal Switch Surgery vs Gastric Bypass

Is Your BMI > 50?

Yes: SADI-S.
No: bypass or Sleeve
Explanation:
The switch is a powerful tool to combat “super obesity” (BMI > 50). After the bypass, patients routinely lose 100-200 pounds. However, for some patients, this may not be enough. The loop duodenal switch, in contrast to the gastric bypass, routinely helps patients lose 80-100% of their excess weight, meaning that it has more potential to help you if you suffer from super obesity.

It’s important to note that the SADI-S is still a viable tool for patients who don’t suffer from “super obesity.” But if you do need to lose more than 200 pounds to get down to your ideal weight, consider the switch.

Do You Struggle with Irritable Bowel Syndrome?

Yes: Gastric bypass or Sleeve.
No: SADI-S.
Explanation:
The switch can make issues of irritable bowel syndrome worse, by increasing the number and looseness of stools. This means more diarrhea for patients with irritable bowel syndrome. This is in contrast to the gastric bypass or the sleeve, which generally won’t worsen diarrhea.

Do you have severe reflux?

Yes: Gastric bypass.
No: SADI-S (or Sleeve).
Explanation:
Switch surgery may worsen reflux in up to 20% of patients, whereas the gastric bypass has actually been shown to resolve reflux conditions in more than 90% of patients.

Duodenal Switch vs Gastric Sleeve

Is Your BMI > 50?

Yes: SADI-S.
No: Sleeve gastrectomy.
Explanation:
Like the gastric bypass, the sleeve gastrectomy can help patients lose significant weight (55-70% of your excess weight). But if you’re suffering from “super obesity” (BMI >50), then this may not be enough.

SADI-S can help patients lose 80-100% of their excess weight, substantially more than the gastric sleeve. It is the most powerful (yet still safe) weight loss tool in modern medicine.

Do You Have Type II Diabetes?

Yes: SADI-S surgery (or gastric bypass).
No: Sleeve gastrectomy.
Explanation:
Duodenal switch surgery, compared to the sleeve gastrectomy, is much more effective at curing type II diabetes. SADI-S surgery leads to remission of type II diabetes in up to 98% of patients. If you’re suffering from diabetes, this surgery can help. If your BMI is <50 but you also suffer from type II diabetes, you may still wish to consider the switch if your insurance covers this operation.

Do You Struggle with Inflammatory Bowel Disease or Chron’s Disease?

Yes: Sleeve gastrectomy.
No: SADI-S.
Explanation:
Switch surgery can sometimes make existing bowel issues worse, and can also give some patients diarrhea. The sleeve gastrectomy generally doesn’t increase these symptoms and is a safer choice if you suffer from IBD or Chron’s disease.

Do You Suffer From Vitamin/Mineral Deficiencies?

Yes: Sleeve gastrectomy.
No: SADI-S.
Explanation:
Switch surgery can sometimes make certain pre-existing vitamin and mineral deficiencies worse, whereas the sleeve gastrectomy does not (the gastric bypass also worsens certain deficiencies, although to a lesser degree than the switch).

After SADI-S surgery, you’ll need to be extremely dedicated to taking vitamin supplements to avoid malnutrition, and even this may not be enough if you already suffer from baseline deficiencies.

Comparatively, the sleeve gastrectomy doesn’t usually worsen vitamin and mineral deficiencies. So patients who suffer from deficiencies already can have the gastric sleeve without significant risk of worsening deficiency if they take recommended vitamins. If you have questions about baseline vitamin deficiencies, please call or send a message to our office today.

Can You Consistently Commit to a Daily Vitamin and Protein Supplement Regime For Life?

Yes: SADI-S can be safely considered.
No: Sleeve gastrectomy (*may still have nutritional risk without committed vitamin supplementation).
Explanation:
Because the SADI-S can cause vitamin and mineral deficiencies, and after surgery your body won’t absorb as much protein and other key nutrients, you will need to be extremely dedicated to life-long supplementation in order to avoid malnutrition. You’ll need to take your vitamins every day, without fail, to avoid malnutrition; and make absolutely sure you get enough protein every single day. If you already know that that’s not realistic for you, then the gastric sleeve may be a better solution.

SADI-S vs Lap Band Surgery

Because of concerns about Lap Band complications and weight regain, we no longer perform Lap Band surgery at the BMCC. It is less safe and also less effective long-term than other bariatric surgeries.

However, if you were considering Lap Band surgery, the SADI-S surgery may be right for you.

Are You Considering SADI-S Surgery?

This bariatric surgery is the most powerful and yet safe weight loss tool in modern medicine. However, it’s not for everyone. If you have certain pre-existing issues, or you cannot commit to a lifetime of strict vitamin and mineral supplements, then the switch may not be right for you.

If that’s the case, you can learn more about the gastric bypass or sleeve gastrectomy, or just contact us today.

But if your BMI is over 50 and/or you have type II diabetes, you don’t suffer from bowel issues or reflux, and you can commit to a lifetime of vitamin and protein supplements, then the SADI-S can be an extremely powerful weight loss tool for you.

If you or a loved one has further questions or would like more information about the SADI-S surgery or other surgical or non-surgical weight loss solution, please check out our FREE ONLINE SEMINAR today.

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This page was medically reviewed by Dr. Joshua Long, MD, MBA, FACS, FASMBS. Dr. Long is a double-board-certified bariatric surgeon and bariatric medical director for Parker Adventist Hospital.
Full Bio: Dr. Joshua Long, MD, MBA, FACS, FASMBS
Page Updated: March 1st, 2020

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