Duodenal Switch as a Revision Surgery

Studies addressing Duodenal Switch as a revision surgery for other failed weight loss surgery procedures.


Laparoscopic conversion of adjustable gastric banding and vertical banded gastroplasty to duodenal switch.
Dapri et al. Nov-Dec 2009
PubMed Abstract

BACKGROUND: The aim of this retrospective consecutive study was to evaluate the feasibility, safety, and efficacy of the conversion of laparoscopic adjustable gastric banding (LAGB) and open vertical banded gastroplasty (VBG) into duodenal switch (DS) by laparoscopy.

METHODS: From November 2003 to February 2007, laparoscopic conversion into DS was performed in 1-step in 43 patients, 31 after LAGB and 12 after VBG. The reason for conversion was weight loss issues, such as insufficient excess weight loss (EWL) or weight regain. The mean interval from LAGB and VBG to conversion to the DS was 42.7 +/- 28.7 months and 172.2 +/- 86.9 months, respectively. The mean %EWL at conversion was 8.3% +/- 19.3% after LAGB and 20.8% +/- 30% after VBG.

RESULTS: The mean operative time was 205.8 +/- 44.8 minutes for LAGB and 210.9 +/- 53.7 minutes for VBG. No conversions to open surgery occurred. One patient in the LAGB group died on the third postoperative day of sudden death syndrome, as shown by the postmortem examination. Major complications occurred in 6.4% of patients with LAGB (1 hemoperitoneum and 1 ileoileostomy leak) and in 50% with VBG (1 sleeve gastrectomy leak with subsequent duodenoileostomy leak, 3 duodenoileostomy leaks, 1 pancreatitis, and 1 respiratory insufficiency). The mean hospital stay was 5.5 +/- 5 days for the LAGB group and 34.5 +/- 50.3 days for the VBG group. After a mean follow-up of 28 +/- 15.7 months for LAGB to DS and 43.5 +/- 6 months for VBG to DS, reoperations for late complications were required in 6 patients (20.6%) in the LAGB to DS group and in 5 patients (62.5%) in the VBG to DS group. Three patients (25%) died within 8 months after conversion of VBG. The 29 surviving patients (LAGB to DS) showed a mean %EWL and percentage of excess body mass index loss of (%EBMIL) 78.4% +/- 24.9% and 77.8% +/- 23.7%, respectively. The 8 surviving patients (VBG to DS) had a mean %EWL and %EBMIL of 85.1% +/- 20% and 85.8% +/- 18.7%, respectively.

CONCLUSION: According to these results, laparoscopic conversion of LAGB to DS seems feasible and effective, despite the 1 death. However, in our hands, laparoscopic conversion of VBG to DS had an unacceptable rate of complications and deaths.


Revision bariatric surgery: laparoscopic conversion of failed gastric bypass to biliopancreatic diversion with duodenal switch.
Gagner et al. Jun 2009
PubMed Abstract

With more than 40% failures of gastric bypass in Body Mass Index>50 kg/m2, a successful alternative has to be proposed. Laparoscopic conversion of failed Roux-en-Y gastric bypass to biliopancreatic diversion with duodenal switch is technically feasible, safe and can be performed in 1 or 2 stages. This revision surgery is the most effective treatment to date, and should also be proposed for failed vertical-banded gastroplasty, adjustable gastric banding and Magenstrasse and Mill procedure, as it may provide the most durable weight loss of all revision surgeries with acceptable morbidity. This may result in lesser degrees of hypoproteinemia, commonly seen after distal gastric bypass.


Laparoscopic conversion of failed gastric bypass to duodenal switch: technical considerations and preliminary outcomes.
Gagner et al. Nov-Dec 2007
PubMed Abstract

BACKGROUND: Weight loss failure after Roux-en-Y gastric bypass (RYGB) is a challenging problem facing bariatric surgeons today. Conversion from RYGB to biliopancreatic diversion with duodenal switch (BPD-DS) might provide the most durable weight loss of all revision procedures currently available. Revision to BPD-DS can be done laparoscopically in 1 or 2 stages and involves 4 anastomoses: gastrogastrostomy, duodenoileostomy, ileoileostomy, and jejunojejunostomy (to reconnect the old Roux limb). This study reports on our early outcomes after laparoscopic conversion from RYGB to BPD-DS.

METHODS: The data from all patients undergoing conversion from failed RYGB to BPD-DS were retrospectively reviewed. The data analyzed included age, body mass index, excess weight loss, method of gastrogastrostomy, and morbidity/mortality.

RESULTS: Twelve patients were identified for analysis. The mean age and body mass index before conversion was 41 years and 41 kg/m(2), respectively. Of these 12 patients, 4 (33%) had undergone revision surgery (lengthening of the Roux limb, resizing the gastric pouch, adjustable band on pouch, or distal gastric bypass) before conversion; 8 (66%) had obesity-related co-morbidities; 7 (58%) underwent conversion to BPD-DS in 1 stage. Most gastrogastrostomies were performed using the 25-mm circular stapler. No patient died and no leaks developed. One patient required laparotomy, and 4 developed stricture at the gastrogastrostomy. The patients lost a dramatic amount of weight after conversion to BPD-DS, with a mean body mass index and excess weight loss of 31 kg/m(2) and 63%, respectively, at 11 months postoperatively. All co-morbidities resolved completely with the weight loss.

CONCLUSION: Our preliminary results indicate that laparoscopic conversion to BPD-DS from failed RYGB is highly effective with an acceptable morbidity. Using a linear stapler to construct the gastrogastrostomy might reduce the stricture rate.


Duodenal Switch is a Safe Operation for Patients who have Failed Other Bariatric Operations
Keshishian et al. Oct 2004
PubMed Abstract
Full Article

BACKGROUND: The incidence of morbid obesity and its surgical treatment have been increasing over the last few years. With this increase, there has been a rise in the number of patients who have had less than desirable outcome after bariatric operations. We perform the duodenal switch (DS) in patients for whom other weight loss surgical procedures have failed, because of inadequate weight loss, weight regain or significant complications, such as solid intolerance or dumping syndrome.

METHOD: From November 1999 to March 2004, 46 revisional surgeries were performed at our institution. The data was prospectively collected and reviewed, based on a number of parameters. Operative details, perioperative morbidity, and results are reported.

RESULTS: 46 patients had their original bariatric surgical operation revised to DS. This resulted in complete resolution of their presenting complaints. The %EWL was 69% at the time of publication, with a mean lapsed time of 30 months. We had no mortality. Anastomotic leak occurred in 4 patients, 2 in our first 8 patients. We also noted that the majority of the patients were not aware of all the surgical procedures available to them at the time of their original operation.

CONCLUSION: In patients in whom gastroplasty, gastric bypass or both have failed to provide adequate weight loss, or worse have resulted in complications, DS can be performed as a safe revisional operation. The revision of other failed bariatric operations to DS results in both weight loss and resolution of the complications.