Diana-

I am seeing all of these WONDERFUL PubMed articles, I was just wondering if you would please slip one in this post for the RNY to DS revision questions.

I know I have researched long & hard, but I will NEVER have ALL of the much needed information!!!


Thank You SO MUCH
-Jamie in Alaska

Well, this one is old, but it is from Dr. Keshishian, so I'm sure YOU have seen it:

http://www.dssurgery.com/about/publications/duodenal-switch- safe-operation.pdf

Yes, I have this one.... heck, I have printed it out, and given it to my PCP, and anyone els who shows the slightest bit of interest, I steer them towards this!!!!

Just curious, do you have anymore?  I do not want to pester you.
-Jamie

You should learn how to search on PubMed: www.ncbi.nlm.nih.gov, then use PubMed as the database for searching.  Here's a new one, but there are others to find (note that omentopexy means attaching the omentum in place, NOT removing it):
 

Surg Obes Relat Dis. 2010 Nov 10. [Epub ahead of print]

Duodenal switch with omentopexy and feeding jejunostomy-a safe and effective revisional operation for failed previous weight loss surgery.

Greenbaum DF, Wasser SH, Riley T, Juengert T, Hubler J, Angel K.

Abstract

BACKGROUND: As the number of weight loss operations has increased, the number of patients who have failed to maintain sufficient weight loss has also increased, providing a management challenge to the bariatric surgeon. Conversion to a duodenal switch with omentopexy and feeding jejunostomy was performed for these patients.

METHODS: Between September 2006 and January 2010, 41 revisional operations were performed at 1 institution and by 1 operating surgeon. The data were prospectively collected and reviewed for several parameters, including excess weight loss, mortality, and morbidity. These results are reported.

RESULTS: A total of 41 patients underwent conversion of their original bariatric operation to a duodenal switch with omentopexy and feeding jejunostomy. The initial operations had been gastric bypass in 32 patients, vertical banded gastroplasty in 5, and laparoscopic adjustable gastric banding in 4. The average excess weight loss was 54% in 31 patients at 6 months, 66% in 22 patients at 1 year, and 75% in 9 patients at 2 years. No patients died. The average hospital stay was 6.4 days. A total of 9 proven or suspected leaks (22%) developed. One was at the enverted staple line of a jejunojejunostomy that was diagnosed and treated the next day with little subsequent morbidity. The others were at the gastrogastrostomy or lateral gastric staple line and all occurred in conversions from gastric bypass. They were all ischemic type leaks and presented 5-11 days after surgery and closed relatively uneventfully with J-tube feedings and antibiotic/antifungal treatment. Other major complications included 1 pulmonary embolism (2%), 1 small bowel obstruction at the site of the feeding jejunostomy (2%), 2 stenoses (4%)-1 at the duodenoenterostomy and 1 in the body of the vertical gastrectomy. This gives a total major complication rate of 30%. A total of 3 patients required reoperation because of a jejunojejunostomy leak, small bowel obstruction, and stenosis at the vertical gastrectomy. No gastrogastrostomy leaks required surgical or radiologic intervention. One required revision for malnutrition, but otherwise the nutrition remained good.

CONCLUSION: Revisional surgery to a duodenal switch is a complex operation and carries a high potential for major complications. Nonetheless, it can be accomplished safely with good long-term results. Omentopexy, drainage, and feeding jejunostomy should be considered at surgery to treat the high potential for delayed ischemic leaks.