Just like the SADI-S the Duodenal Switch starts with creating a Sleeve Gastrectomy, though the Sleeve is slightly looser than tradition. The second step is the same as SADI-S in which the small bowel is divided and then reconnected further downstream. How it differs from a SADI-S though is in which a third step is performed to once again divide and reconnect the bowel. In this way it is similar to having a Gastric Bypass performed. The end result is in which digestion then occurs in the last part of the small bowel and this part is only about 6 feet long. Traditionally up to 20% of patients can have some nutritional issues. Dr. Peery leaves this last portion longer than was originally recommended. Yes this may result in slightly less weight loss but also results in significantly less nutritional issues and less loose stools.