title: Revision of the duodenal switch: indications, technique, and outcomes.
abstract: BACKGROUND
  Duodenal switch (DS) operation combines both restrictive and malabsorptive components and has become an accepted operation in selected patients with morbid obesity. Complications develop in some patients, which are refractory to dietary supplementation. We report a series of 33 patients who required partial revision of the DS.
  
  
  METHODS
  During the 10-year period after September 1992, 701 patients had DS operation performed; of these, 33 (5 men and 28 women) patients required revision. Revision was performed by side to side enteroenterostomy 100 cm proximal to the original anastamosis. Outcomes measures reviewed include postoperative complications, nutritional parameters, and weight change.
  
  
  RESULTS
  Revision was performed a median of 17 (range 7 to 63) months after DS. Indications for revision included protein malnutrition (n = 20), diarrhea (n = 9), metabolic abnormalities (n = 5), abdominal pain (n = 3), liver disease (n = 2), emesis (n = 2), and gastrointestinal bleed (n = 1). Median body mass index at the time of revision was 28. Median serum albumin was 3.6 g/dL and improved to 4.0 g/dL postoperatively (p = 0.01). Complications occurred in 5 of 32 patients (15%) and included wound infection (n = 2), respiratory failure (n = 1), gastrointestinal bleed (n = 1), and small bowel obstruction (n = 1). There was no perioperative mortality. During a median followup period after revision of 39 months, the median weight gain was 18 pounds. Three patients requested repeat operation because of weight regain.
  
  
  CONCLUSIONS
  Patients requiring revision of DS for malnutrition can be corrected by a technically simple procedure, but they are at considerable risk for complications. Although many patients are anxious about regaining their weight after reversal, they can be reassured that substantial weight gain is unlikely.
authors: Department of Surgery, University of Southern California, Los Angeles, CA 90033, USA.
authors: Nahid
authors: N
authors: Hamoui
authors: Brandon
authors: B
authors: Chock
authors: Gary J
authors: GJ
authors: Anthone
authors: Peter F
authors: PF
authors: Crookes
mesh_terms: D000328:Adult; D000368:Aged; D015904:Biliopancreatic Diversion / Q000009:adverse effects / Q000379:methods*; D004386:Duodenum / Q000601:surgery*; D005260:Female; D006801:Humans; D008286:Malabsorption Syndromes / Q000209:etiology / Q000601:surgery; D008297:Male; D044342:Malnutrition / Q000209:etiology; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation