Duodenal Switch (DS) Revision Surgery
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Approximately 2-5% of Duodenal Switch patients may be candidates for revision weight loss surgery. As we become more adept at understanding the balance between weight loss and malnutrition, the number of patients requiring revision surgery after duodenal switch will likely decrease, but never be eliminated completely. The most common reasons for the revising Duodenal Switch include the following:
Some of the clearest issues requiring surgical correction after Duodenal Switch are nutritional deficiencies caused by malabsorption and excessive weight loss, both of which often occur simultaneously. As with most things, timing plays a significant role in success. As time goes on, the malabsorptive effect of Duodenal Switch decreases as the intestine becomes increasingly efficient at absorbing protein and other nutrients. Therefore, revising the Duodenal Switch should not be done too early in patients who experience malabsorptive complications, rather, conservative therapy should be attempted prior to revision surgery, allowing sufficient time for the absorptive abilities of the intestine to increase. If enough time is not allowed and revision surgery is performed too early, patients risk regaining excessive weight after the intestine has increased its absorptive abilities. Treating malabsorptive complications resulting from Duodenal Switch most often require adding intestinal length or elongation. Elongations of the common limb are possible utilizing the biliopancreatic limb, to attain specific results. A relatively common elongation procedure requires elongation of the alimentary and common limbs, providing additional surface area for protein, starch and fat absorption. Increased fat absorption abilities in turn increases ones ability to absorb fat soluble vitamins such as vitamin-D. Treating excessive weight loss and protein malnutrition with revision procedures after Duodenal Switch, simultaneously increase a patients ability to absorb fat soluble vitamins. The easiest revision procedure that increases both alimentary and common limb length involves a single connection to the small intestine; this is also known as entero-enterostomy and by some, the "kissing-X." The "neuro-endocrine brake" effect, generally enables patients to maintain some level of weight loss. The neuro-endocrine brake effect is also responsible for weight loss after Ileal Trasposition surgery. Instances where calcium and iron malabsorption occur following Duodenal Switch, Ileal Transposition may be used as a means of intestinal elongation to treat these conditions. When Ileal Transposition is used in these cases, unlike a conventional Ileal Transposition, the Ileal Transposition can be done at the level of the duodenum, without having to re-connect the duodenum; after Duodenal Switch this is not an easy task. High Duodenal Ileal Transposition may only utilize a segment of the alimentary limb to perform the transposition. The rest of the alimentary limb is used for a "Parallel Ileal Transposition" at the level of the biliopancreatic limb. The Parallel Ileal Transposition joins the flow of food that resulted from the High Duodenal Ileal Transposition performed above. This restores calcium and iron absorption without entirely reversing the Duodenal Switch procedure. There are some occasions where patients experience inadequate weight loss or weight regain after initial weight loss with Duodenal Switch. With the assumption that non-surgical weight loss attempts have been made and failed, there are two theoretical approaches to solve this problem,
While the results of these two revisions vary, reductions in stomach size seem to generate superior results over shortening the length of the common limb in North America. Next: Metabolic Bone Disease >> Previous: Vertical Sleeve Gastrectomy (VSG) Revision Surgery << This information has been provided by Dr. John Husted. To learn more about Dr. Husted, please visit http://www.johnhustedmd.com/. |
