Duodenal switch is a safe operation for patients who have failed other bariatric operations.
BACKGROUND
The incidence of morbid obesity and its surgical treatment have been increasing over the last few years. With this increase, there has been a rise in the number of patients who have had less than desirable outcome after bariatric operations. We perform the duodenal switch (DS) in patients for whom other weight loss surgical procedures have failed, because of inadequate weight loss, weight regain or significant complications, such as solid intolerance or dumping syndrome.


METHODS
From November 1999 to March 2004, 46 revisional surgeries were performed at our institution. The data was prospectively collected and reviewed, based on a number of parameters. Operative details, perioperative morbidity, and results are reported.


RESULTS
46 patients had their original bariatric surgical operation revised to DS. This resulted in complete resolution of their presenting complaints. The %EWL was 69% at the time of publication, with a mean lapsed time of 30 months. We had no mortality. Anastomotic leak occurred in 4 patients, 2 in our first 8 patients. We also noted that the majority of the patients were not aware of all the surgical procedures available to them at the time of their original operation.


CONCLUSIONS
In patients in whom gastroplasty, gastric bypass or both have failed to provide adequate weight loss, or worse have resulted in complications, DS can be performed as a safe revisional operation. The revision of other failed bariatric operations to DS results in both weight loss and resolution of the complications.
Keshishian
Ara
A
Department of Surgery, Delano Regional Medical Center, 1205 Garces Highway, Delano, CA 93215, USA. Keshishiana@gr-ds.com
Zahriya
Karin
K
Hartoonian
Teny
T
Ayagian
Chris
C
D000328:Adult; D015904:Biliopancreatic Diversion / Q000379:methods; D005260:Female; D015390:Gastric Bypass; D015391:Gastroplasty; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D012086:Reoperation; D017211:Treatment Failure; D015431:Weight Loss