Why Isn't the Duodenal Switch More Popular?

Popularity of the duodenal switch has been suppressed on many fronts.  The ASMBS (the society of weight loss surgeons) is staffed and governed by surgeons that have spent their whole careers doing bypasses and willingness to change what they do is low, despite the tract record of gastric bypasses.  The surgery also involves dissecting anatomy that has important structure close by and many surgeons do not want to take the risk of being in this area.
In the right hands (a surgeon that focuses on duodenal switch) the complication rate is lower than gastric bypasses and the long term complication rate is drastically lower.

The duodenal switch otherwise known as the DS, is an excellent operation in the well selected patient that carries an overall low complication rate. The complication rate in terms of leaks is comparable to that of gastric bypass.  Certain patients with severe metabolic syndrome will benefit greatly from this opeation. DS is better at achieving overall weight loss for patients with BMI > than 50 and helping those patients get to a more "normal BMI". Also the DS is more resistant to weight regain which is far more common in gastric bypass patients. DS has potential issues or complicaitons such as protein and vitamin deficiencies. If you are a patient with high triglycerides and insulin dependent diabetes, and a high BMI, a DS procedure may be the right fit for you.