LOOP Duodenal Switch

I'm getting ready to book my OR date with Roslin as a revision to DS from RNY -- I'm one of those 'lightweights' that you mention -- though I haven't been to a seminar, etc. and I'm not clear on the specifics -- so I would appreciate you posting anything you find out after you 'grill' him -- education me too!

Thanks
Nannette

 Diana -
I saw Dr Roslin last night and asked him to clarify this revision / loop DS issue.  Here's what he told me.  

1- He will absolutely do an RNY to full DS revision,  He's done more of those full revisions than this Loop DS.  He presents it as an option of patients choice is what he told me.

2 - He's starting to offer the Loop DS as an option for RNY revisions based on the following:  Success of the procedure in Spain as a primary operation, as well as reduced risk for RNY to DS conversions based on fewer anastomosis points to revise.  

3- He's not offering it as a primary procedure, but feels that the reduced risk coupled with the success of the procedure in Europe makes it a reasonable option for revisions.

4 - The Loop DS does restore the pouch to a fully functioning stomach with pylorus.  It creates a short gut type small intestine but there is no Y-based common channel.

That being said, not sure how I feel about it.  For a revision I can see where it is a reasonable option to consider. and I respect his thought process, but for me I would want the full DS.

 Thanks for the info Joanne. :)

I also thank you for the update/clarification.

 I agree the intestines look problematic. However I do know that Dr. Roslin is Pro sleeve and pylorus preservation. He has done RNY to DS revisions, She is not fully explaining to us why he offered her this instead of the DS. I personally would ask a ton more questions and I would want to know WHY!

So thanks all for chiming in.

Dr. Roslin offered this as an option likely since he has done a couple of revisions recently a few full DS and others with this variation. THe option to still go to the full DS is an option it will however will  likely  mean longer operative time. 

Apparently the vague description kinda of stuck a cord. Apologies.

 I on the other hand do not want to mame a Great name.
Dr Roslin is fantastic + it is well deserved. He offered me ALL that he has to offer. BOB, Full DS or Loop Ds.  it is still ultimately my decision what to do with my body. I was less clear last night what this is. This option for loop DS was not offered to me back in MArch which is the last time I saw him prior to yesterday.

There is no reason to discontinue referring patients for revisions to Dr Roslin he will do whatever you request. 

 Reasons to consider the loop DS include( that were presented to me) but are not limited to :

1. its technically easier to perform this revision. 2. less mesenteric defects thus less chance for herniating into those areas. 3. similar weight loss curves that is stated in th video via a chart graphic. 4. the sleeve gastrectomy WILL be performed.  5. My understanding was to count from the ileocalve valve 225cm to perform the anastomosis to the proximal end of the duodenum and thus there is no bilopancreatic or ailmentary limb.

Hope that helps. Now I guess the real question is: do u really need to have 2 limbs or a common channel to have success? The answer obviously no one can answer and that is the issue that I have... not so much that it is new or rarely performed. 


This LOOP DS may very well become standard of care given that so many people w RNY will likley regain weight and want a revision.

How is that loop is intestine (other than the 225cm) NOT a billiopancreatic loop?  Is it not only carrying bile and pancreatic juices?

My understanding was that you were getting a 225cm combo alimentary + common channel with the rest as a biliopancreatic limb?

Please understand that I have great respect for Dr. Roslin...and I'm very glad to know that he would convert your pouch to a sleeve...but it seems to me that the pouch to sleeve conversion is the most difficult part and most risky part of the RNY to DS revision, so you aren't avoiding this - just having one less anastamosis further downstream, which yes, will speed things up a bit, but not that much, and will lower risk but not that much.
      I could see where keeping the pouch and doing this loop DS would really speed things up a lot and lower risk significantly, and I thought that was what he had proposed. This would definitely be lower risk surgically, but would leave you with the same problems you have now, just with more malabsorption to help with your weight. It didn't seem like a good trade off to me.
     Now, knowing that you would get a real sleeve and lose the pouch, it seems like a better wls, BUT with not much less risk than a real DS.
     So I still don't see the point, and given that longterm results are not known and so on, well, I know what I would do.

Larra

to larra
I hope this clarifies things... it is hard to consider DS or RNY without the limbs I know but here it goes. Actually I think that is what my issues was.

start with normal anatomy( so he will put it back together stomach yes, but for the intestinal this is only partially true ) then split at the duodenal fairly close to the stomach end.

then second part count from ileocal valve 225cm of intestine and at that point connect those 2 points together.  the so there are no limbs. no biliopancreatic no ailmentary. just a loop.  maybe the picture can explain it better.

Johanne do u have some inside number to Dr Roslin... cuz how did u get that info so fast.