title: Total gastrectomy for complications of the duodenal switch, with reversal.
abstract: BACKGROUND
  Duodenal switch (DS) is one of the most effective techniques for the treatment of morbid obesity and its related co-morbidities, with mortality rates of <1%, but with 9.4% morbidity rates (6.5% due to leaks). We present our experience with 9 patients operated with a DS, who later underwent total gastrectomy (TG) for complications of the sleeve gastrectomy.
  
  
  METHODS
  From 1994 to March 2006, 846 patients underwent the DS. 9 patients (1%) underwent TG; 5 were due to gastric leak at the angle of His, 2 were related to leakage at the doudeno-ileal anastomosis (DIA), 1 was for stenosis of the gastric sleeve, and 1 for a gastroparesis. In 3 cases, the DS was the second bariatric operation. Full restoration of bowel anatomy was attempted in all patients.
  
  
  RESULTS
  TG has been the final solution for gastric complications of the DS in 9 (1%) of our 846 patients. In all cases, bowel anatomy has been restored, and there was no mortality. Postoperative courses have been difficult and hospital stays have been long in all patients (mean 4.5 months; range 1-10 months), with several episodes of re-do surgery after the TG. The actual BMI and %EBMIL are acceptable.
  
  
  CONCLUSIONS
  TG successfully treated all 9 cases with life-threatening complications and difficult reinterventions after DS, without mortality. Restoration of bowel anatomy was done in all cases, with good final results.
authors.affiliation: Servicio de Cirugía General, Hospital Virgen de los Lirios, Alcoy, Alicante, Spain. serra_car@gva.es
authors.forename: Carlos
authors.initials: C
authors.lastname: Serra
authors.forename: Aniceto
authors.initials: A
authors.lastname: Baltasar
authors.forename: Nieves
authors.initials: N
authors.lastname: Pérez
authors.forename: Rafael
authors.initials: R
authors.lastname: Bou
authors.forename: Marcelo
authors.initials: M
authors.lastname: Bengochea
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects*; D015904:Biliopancreatic Diversion; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*