Some heavyweight bariatric surgeons published a consensus view of when to use the DS as a second procedure. 29 surgeons contributed and the summary was written by surgeons, A.E. Merz,R.B. Blackstone,M. Gagner,A.J. Torres,J. Himpens,K.D. Higa,R.J. Rosenthal,A. Lloyd,E.J. DeMaria. You may or may not agree with their conclusions, but I think it is interesting how important they view the DS for revisions. They said it was increasingly more popular for revisions. This is the conclusion paragraph: "As a second-stage procedure, BPD/DS is most appropriate after sleeve gastrectomy (SG) for the treatment of super morbid obesity (96.7% agree) or as a subsequent operation for a reliable patient with insufficient weight loss after SG (88.5%). In a patient with weight regain and reflux and/or enlarged fundus after SG, Roux-en-Y gastric bypass is preferable and BPD/DS should be avoided (90%). BPD/DS should not be used prophylactically in patients with a history of jejunoileal bypass who are otherwise doing well (80.8%). Applicability of BPD/DS is limited by technical difficulty; 86.2% of experts would routinely recommend or consider the procedure if it were more technically feasible after failed bypass. No consensus was found on approaches to revision of BPD/DS for protein malnutrition."

Eliza, could you provide the reference for this article? Thank you!

Larra

I imagine it's this article, although I haven't read it yet.

Merz AE, Blackstone RB, Gagner M, Torres AJ, Himpens J, Higa KD, Rosenthal RJ, Lloyd A, DeMaria EJ. Duodenal switch in revisional bariatric surgery: conclusions from an expert consensus panel. Surgery for Obesity and Related Diseases. 2019 Mar 21.

Duodenal switch in revisional bariatric surgery: conclusions from an expert consensus panel

A.E. Merz^a,â?--, Email the author A.E. Merz , R.B. Blackstone^b , M. Gagner^c,d , A.J. Torres^e , J. Himpens^f , K.D. Higa^g,h , R.J. Rosenthalⁱ , A. Lloyd^h , E.J. DeMaria^j Published Online: March 21, 2019 https://doi.org/10.1016/j.soard.2019.03.009 Publication stage: In Press Uncorrected Proof

Thank you both!

Thanks for that

Thank you.

I find this to make sense, but interesting that I only recognize Michael Gagner and Rosenthal as being actual DS surgeons.

Himpins is a DS surgeon who works in Brussels. He performed the first DS in Europe in 2001.

Thank you both! Great answer.