Revision from bypass to DS switch... anyone else? I have to be sleeved first.

Hey, going through the revision process and wondering if anyone's gone through it. My bypass has to be made into a sleeve first and then a few months later they complete the DS. I would love to know of anyone has gone through it.

Hi Katie. There have been a number of people on this board that have had the RNY to DS revision but I've never heard about having to do the sleeve first and then go back and do the switch. What is your surgeon's reasoning for this? I know it's a complicated revision and only a few surgeons are experienced with this.

Hey, yes so in Ontario, they have changed it tonan2 part procedure Because of how long it takes.

Janet, this is actually common, but not done on all DS patients with an original surgery. Based on a patient's comorbidities, how much weight they need to lose, etc they can either do a straight DS or do it in three parts.

Normally the sleeve gastrectomy is performed first.

The second part of the procedure reroutes food away from the upper part of the small intestine, which is the natural path of digestion. This cuts back on how many calories and nutrients your body is able to absorb. The small intestine is divided and a connection is made near the end of the small intestine. This she has already had done, so they are sort of circling back.

The third part of the DS procedure changes the normal way that bile and digestive juices break down food. This cuts back on how many calories you absorb, causing still more weight loss. One end of the small intestine is connected to the duodenum, near the bottom of the stomach. It is a better revision approach to ensure more weight loss than the normal 20% that occurs with a normal revision.

But I'm so interested to know what they do... are they sleaving my pouch or connecting my out stomach?..

Typically they would put your stomach back together and then sleeve it (or maybe sleeve the remnant stomach and then graft it into the pouch - I would figure that techniques vary,) and undo the bypass, basically doing a total reversal of the RNY and sleeving it. Then they would do the switch part, which your surgeon seems to be doing as a second phase procedure - not a bad plan considering the length and complexity of the surgery; virgin DS's are still sometimes done in two stages in complicated cases.

I remember reading on Dr. Keshishian's site a few years ago he gave a detailed description of how he performed the procedure; look around in his backlog of blog posts to find it:

https://www.dssurgery.com/weight-loss-surgery/revisional-wei ght-loss-surgery/

https://www.dssurgery.com/?page_id=145

His revision page gives a brief description, but there was a much more detailed description in one of his blogs.

Normally they have to undo the original RNY gastric bypass surgery and put everything back into place, remove all the staples and sutures, and put your pyloric valve back into play. Then they have to go in and do the vertical sleeve gastrectomy, you will no longer have a pouch, you will have a sleeve. The last step is to perform the duodenal switch with biliopancreatic diversion.

Hi There:

I had a Gastric Bypass in 2017 and lost quite a bit of weight quickly then maintained. I spoke to my surgeon and decided to do the Duodenal Switch to lose the remaining weight. The surgery is done in 2 parts. You will first be converted to a Gastric Sleeve then 6-7 months later will have the Duodenal Switch. The time between your surgeries is to let your body heal. I had the first part last year and just a month ago completed the second part. The nutritional requirements and portions are different from the Gastric Bypass. I'm still on soft foods and working through some issues. Supplements and protein will be a central part of your diet.

Do you live in Canada. The only surgeons I have heard about doing the traditional Duodenal Switch in 2 parts are in Canada.

Yes, I live in Ontario Canada. The Duodenal Switch Surgery is still limited and to go from a RNY to Duodenal Switch is rare from what I've been told. They are very particular on the approval requirement. I've yet to meet anyone else who has done it.