switch reduces this risk because it bypasses a smaller portion of the small intestine, but there is no long term information for the loop duodenal switch to fully and accurately compare. Malnutrition is an uncommon and preventable risk after duodenal switch. Qualifications The National Institutes of Health state that for patients who meet the following guidelines, weight loss surgery may be an appropriate measure for permanent weight loss: BMI of 40 or over BMI of 35 or over with obesity-related illnesses such as: Diabetes mellitus type 2 Coronary heart disease Sleep apnea Osteoarthritis GERD An understanding of the operation and lifestyle changes necessary following the surgery. Costs Compared with the other three generally accepted bariatric surgery procedures (gastric bypass, gastric banding and gastric sleeve), duodenal switch surgery is the most expensive procedure to perform due to its more complicated nature and longer operating times. Because it is more complicated and is performed less often than the other common procedures (lower demand), it is also performed by a relatively small percentage of surgeons which further drives up the price due to lack of competition. Patients without insurance (also called "self-pay" patients by most bariatric practices) can expect to pay an average of about $27,000 in the United States, although this varies widely across states and clinics. For example, surgical practices in the least expensive state (New Jersey) average about $24,000 while practices in the most expensive state (Nebraska) charge about $32,500. This surgery is also performed by some surgeons in Mexico at a much lower cost than in the United States. See also SADI-S surgery SIPS surgery References External links Duodenal Switch vs Normal Anatomy comparison tool Bariatrics Digestive system surgery sv:Sleeve gastrectomy