Concierge bariatric surgery · London
Duodenal switch and SADI-S, the most metabolically powerful bariatric surgery.
A sleeve gastrectomy combined with an intestinal bypass — the operation that produces the greatest weight loss and the highest diabetes-remission rates in modern bariatric surgery. Chosen only after an MDT decides it is the right one for you.
Why patients choose us
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A bariatric surgeon, a dietitian, an endocrinologist and a psychologist
A duodenal switch is never a solo procedure. The MDT sits around the same table before anyone books a theatre — and stays involved for life.
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The full menu, honestly compared
Sleeve, RYGB, OAGB, SADI-S, BPD-DS or a balloon — you see the trade-offs before you commit. The most powerful operation is not always the right one.
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Lifelong monitoring, not a discharge letter
Duodenal switch demands lifelong vitamin monitoring and protein targets. That plan is in place before you go to sleep — not something you Google afterwards.
Indicative pricing
What bariatric surgery costs privately in the UK.
Indicative ranges across our partner clinics. Send the details and we quote firm figures across the operations your MDT considers appropriate.
In short
A duodenal switch in our network: £16,000–£22,000, with lifelong follow-up included.
| Procedure | Indicative range | Typical stay | Recovery |
|---|---|---|---|
| Bariatric MDT consultation | £350–£600 | 60 min | Same visit |
| Sleeve gastrectomy | £10,000–£14,000 | 1–2 nights | Same admission |
| Roux-en-Y gastric bypass | £12,000–£16,000 | 2–3 nights | Same admission |
| OAGB (one-anastomosis / mini bypass) | £11,000–£15,000 | 1–2 nights | Same admission |
| SADI-S (single-anastomosis duodeno-ileal) | £15,000–£19,000 | 2–3 nights | Same admission |
| Duodenal switch (BPD-DS) | £16,000–£22,000 | 2–4 nights | Same admission |
| Intragastric balloon (endoscopic) | £4,500–£6,500 | Day case | 6–12 months |
Prices vary by clinic, by surgeon, by whether laparoscopic or robotic, by length of stay and by the package of MDT follow-up included. We come back with a firm quote within one working day.
The problem
The right operation, chosen by the right team, for the right patient.
Bariatric surgery is quietly one of the most mis-sold procedures in the private market — surgeons who only offer one operation, no dietitian for the lifelong bit, and no honest conversation about the alternatives. We fix all three before you commit.
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Not sure DS is right for you?
Sleeve, RYGB, OAGB, SADI-S, BPD-DS or a balloon — each has its place. We show you the comparison before anyone books a theatre.
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Worried about the follow-up?
Lifelong bloods, supplements and a dietitian who knows your case — that plan is written before your operation, not after.
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Want it done properly?
A named bariatric surgeon, MDT sign-off from dietitian, endocrinologist and psychologist, and a proper theatre — including for revision cases.
The journey
From MDT workup to lifelong monitoring — what happens, in order.
One team from first message to your tenth-year review — including the two-week prehab and the six-week diet progression.
Phase 1 · Before your operation
MDT workup and prehab
Phase 2 · Admission
Two to four nights in hospital
Phase 3 · After
Diet progression and follow-up for life
- 01
Before
MDT workup and eligibility
BMI, comorbidities, mental-health screen, endoscopy, bloods and a nutrition baseline. A named surgeon, dietitian, endocrinologist and psychologist all sign off.
- 02
Before
Prehab and a very-low-calorie diet
Two weeks of a liver-shrinking diet before surgery, plus vitamin loading and — where needed — sleep-apnoea and diabetes optimisation.
- 03
Before
Anaesthetic and consent
A detailed conversation with the anaesthetist. Consent covers leak, bleeding, ulcer, malnutrition and the lifelong follow-up you are signing up to.
- 04
Admission
Surgery — laparoscopic or robotic
Longitudinal sleeve gastrectomy, pylorus preserved, duodenum divided, small-bowel loop brought up. Common channel 100–150cm. 3–4 hours in theatre.
- 05
Admission
Recovery ward and first night
One to three nights in hospital. Sips of water on day one, walking within hours, dedicated bariatric nursing overnight.
- 06
After
Six weeks liquid, then soft, then normal
A staged diet with your dietitian: liquids, purees, soft textures, and finally normal-texture food by roughly week 8. Protein first, always.
- 07
After
Lifelong monitoring
Bloods at 3, 6, 12 months then annually. Vitamin ADEK, iron, B12, calcium, PTH and protein. Supplements are for life — not for the first year.
Typical end-to-end: 8–12 weeks from enquiry to surgery. Full diet transition: 6–8 weeks. Monitoring: for life.
When it helps
When duodenal switch or SADI-S is the right operation.
The situations where the extra power of DS or SADI-S is genuinely worth the extra follow-up burden — plus the one red flag that means treating something else first.
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Severe obesity (BMI ≥ 50)
The subgroup where BPD-DS or SADI-S consistently outperforms sleeve and RYGB for durable weight loss.
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Poorly controlled type 2 diabetes
Long-standing T2DM on insulin, especially with obesity — BPD-DS delivers the highest reported remission rates.
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Metabolic syndrome with BMI 40–50
Hypertension, dyslipidaemia and fatty liver alongside obesity — where maximum metabolic effect is worth the trade-off.
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Revisional bariatric surgery
Weight regain or inadequate loss after sleeve or RYGB — SADI-S is often the second-stage operation of choice.
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Failed non-surgical weight loss
A documented history of GLP-1 agonists, structured programmes and lifestyle change that have not achieved durable results.
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Ready for lifelong follow-up
The single non-negotiable — DS/SADI-S is only offered to patients who will attend annual bloods and take supplements for life.
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Age and comorbidity fit
Usually 18–65, with anaesthetic risk formally assessed. Older patients are considered case by case.
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Red flag: active eating disorder
Untreated binge-eating disorder, bulimia, alcohol-use disorder or unstable severe mental illness are absolute pauses — not the operation, first.
Procedure options
Duodenal switch is one of six operations on the table.
What each option actually involves — and which fits which patient. Weight loss, follow-up burden and reversibility all trade off differently.
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Sleeve gastrectomy
Stomach reduced to a narrow tube. Simpler, lower vitamin risk, ~50–60% EWL. The default first-line UK bariatric operation.
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Roux-en-Y gastric bypass
Small pouch plus a rerouted small-bowel limb. The most common UK bypass — ~60–70% EWL, strong reflux and diabetes control.
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OAGB (mini gastric bypass)
One-anastomosis bypass. Technically simpler than RYGB, similar weight loss, small bile-reflux risk debated by surgeons.
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SADI-S
Sleeve plus a single duodeno-ileal anastomosis. A modern DS variant — technically simpler than BPD-DS with similar power.
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Duodenal switch (BPD-DS)
Sleeve plus a two-anastomosis intestinal bypass with a short common channel. The most powerful metabolic operation — and the most demanding to live with.
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Modified DS (longer common channel)
A BPD-DS with a 150–200cm common channel to reduce malnutrition risk while keeping most of the metabolic effect.
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Intragastric balloon
A saline-filled balloon placed endoscopically for 6–12 months. Non-surgical, temporary, ~10–15% total weight loss.
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Endoscopic sleeve gastroplasty
Stomach folded and sutured endoscopically. No cuts, reversible in principle, ~15–20% total weight loss.
Our vetted UK network
A small panel of bariatric surgeons, we picked them.
Bariatric surgeons and dietitians across London, Manchester and Birmingham. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every bariatric team in our network.
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Bariatric surgeons with a documented DS/SADI-S caseload, not occasional cases
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A specialist bariatric dietitian involved from consultation to lifelong follow-up
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MDT sign-off — surgeon, dietitian, endocrinologist and psychologist — before booking
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Written lifelong monitoring protocol shared with you and your GP
Safety and long-term risks
What to plan for — honestly.
A duodenal switch is safe in experienced hands, but its long-term risk profile is different — micronutrient deficiency dominates. Knowing this list is part of the informed consent.
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Protein-energy malnutrition
The most feared long-term complication of DS. Protein targets (80–120g/day), regular albumin checks and dietitian input keep this rare — but it is real.
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Vitamin A, D, E and K deficiency
Fat-soluble vitamins are the DS Achilles heel. Lifelong supplementation and annual bloods are non-negotiable — night blindness and bone disease are avoidable.
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Iron and B12 deficiency
Common after any bypass. Oral supplements first, IV iron or B12 injections where absorption is inadequate.
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Calcium and bone health
Calcium citrate, vitamin D and PTH monitoring. DEXA scanning is offered periodically to detect early bone loss.
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Dumping syndrome
Less common after DS than RYGB but can occur. Small, frequent, low-sugar meals is the answer — not more medication.
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Anastomotic leak
The most serious early complication, ~1–2%. Detected by tachycardia, pain and imaging in the first days — the reason for inpatient observation.
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Marginal ulcer and gallstones
Smoking and NSAIDs are the main marginal-ulcer drivers. Gallstones develop in ~25% after rapid weight loss — some surgeons remove the gallbladder at the same time.
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Pregnancy timing
Wait 12–18 months post-op before conceiving — the window of rapid weight loss and nutrient flux is the wrong time for a baby.
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Red flags — call the same day
Persistent tachycardia, fever, severe abdominal pain, vomiting blood or unable to keep fluids down after discharge all warrant same-day contact.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever variant was performed — BPD-DS, SADI-S or a modified DS — the note keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the operation note before your dietitian review, just ask.
- 01 Header
Operation performed and variant
Which operation was done — BPD-DS, SADI-S, or a modified DS — and the length of the common and alimentary limbs.
- 02 Technique
Sleeve size, limb lengths, anastomoses
Bougie size for the sleeve, the length of the common channel, and how each anastomosis was constructed and tested.
- 03 Findings
Liver, adhesions, incidental findings
Notes on liver size after the pre-op diet, any adhesions, and any incidental findings such as hiatal hernia repaired at the same time.
- 04 Impression
Diet plan, supplements, follow-up
Read this first: the staged diet, the supplement prescription, and when your bloods and dietitian reviews are booked.
Recognised by major UK insurers
Cover for bariatric surgery varies by insurer and by policy — many corporate policies exclude it, some individual policies cover it where BMI and comorbidities meet threshold. We confirm cover before booking.
Frequently asked
Everything we get asked about duodenal switch and SADI-S.
Quick answers on candidacy, comparison with sleeve and RYGB, follow-up, and long-term risks.
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What is a duodenal switch and how does it differ from SADI-S?
BPD-DS combines a sleeve gastrectomy with a two-anastomosis intestinal bypass — a Roux limb from small bowel to duodenum plus a long biliopancreatic limb meeting at a short common channel. SADI-S uses the same sleeve but only one anastomosis, making it technically simpler with similar outcomes in most series.
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Why is duodenal switch considered the most powerful bariatric operation?
Because it combines two mechanisms — restriction from the sleeve and malabsorption from the short common channel. Excess weight loss averages 70–80% at five years, and type 2 diabetes remission rates exceed 85% in appropriately selected patients — higher than any other operation.
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Who is a suitable candidate for duodenal switch or SADI-S?
Typically adults with severe obesity (BMI ≥ 50), or with a BMI ≥ 40 plus poorly controlled type 2 diabetes or metabolic syndrome, who have failed non-surgical approaches and are prepared to commit to lifelong monitoring. The MDT decides — not the patient alone.
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How does it compare to sleeve gastrectomy and RYGB?
Sleeve is simpler, safer and has the lowest vitamin-deficiency risk, but averages ~55% EWL. RYGB is the most common UK bypass at ~65% EWL with strong reflux control. DS/SADI-S gives the most weight loss and diabetes remission, at the cost of the highest micronutrient risk and the most demanding follow-up.
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What supplements will I need after a duodenal switch?
Lifelong: a bariatric multivitamin, vitamin A, D, E and K, calcium citrate, iron, vitamin B12 and often zinc. Doses are guided by annual bloods. Skipping supplements is the single biggest cause of preventable harm after DS.
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What are the main risks and long-term complications?
Early: anastomotic leak (~1–2%), bleeding, chest infection. Long-term: protein-energy malnutrition, fat-soluble vitamin deficiencies, iron and B12 deficiency, calcium and bone loss, marginal ulcer, gallstones (~25%), kidney stones and, less commonly, dumping. Careful selection and lifelong follow-up keep these manageable.
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How long is recovery and when can I go back to work?
Two to four nights in hospital, two to four weeks off desk work, six weeks before heavy lifting or gym. Diet progresses from liquids to purees to soft to normal texture over roughly six to eight weeks — with a dietitian at every step.
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Can I get pregnant after a duodenal switch?
Yes, but wait 12–18 months after surgery until your weight stabilises and vitamin levels are steady. Pregnancy after DS is safe with proper monitoring, but it is a shared-care pregnancy — obstetrician, dietitian and bariatric team together.
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What if I regain weight later?
Some regain is normal. Significant regain triggers a return to the MDT: dietitian re-engagement, GLP-1 agonists, endoscopic revision of the sleeve, or — occasionally — surgical revision such as common-channel shortening.
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Is duodenal switch reversible?
The sleeve is not reversible. The intestinal bypass can be reversed or lengthened surgically if severe malnutrition develops, but reversal is a major operation in itself — the honest answer is to treat DS as permanent.
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