There is no substitute for the Duodenal Switch  (DS) operation. The other easier procedures that are being presented as DS equivalent are untested, and unproven operations that in my opinion will fall short of the outcome patients expect. The coding definition of BPD/DS is as follows: A Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch) Please not that there are two anastomosis within the definition.

As a patient advocate and a surgeon who has seen a number of recent complications (significant bile reflux gastritis, inadequate weight loss, etc..) of these “Duodenal Switch” substitute procedures,   (SADI/SIPS/Loop)  I would recommend that any patient considering anything other than the anatomically accurate and proven standard DS procedure realize that they are being subjected to a procedure with an unknown long-term outcome other than what is published in a few studies with a very short-term follow-up. The weight loss of SADI/SIPS/Loop studies have only been measured in terms of months versus years. I would predict that for the majority of those patients, the long-term weight loss will be inadequate and further corrective surgery will be needed, either for inadequate weight loss or other complications such as bile reflux.