title: Conversion to modified duodenal switch for relieving intractable dumping syndrome and constipation after laparoscopic Roux-en-Y gastric bypass.
abstract: BACKGROUND
  Dumping syndrome is not infrequent after laparoscopic Roux-en-Y gastric bypass and could result in dreaded complications, such as hypoglycemia or syncope. Those patients who failed medical therapy and diet modification, regarded as intractable dumping syndrome, may be considered as candidates for revisional surgery. Herein, we make a video presentation of laparoscopic revisional procedure for intractable dumping syndrome with unsatisfactory weight loss.
  
  
  METHODS
  A 32-year-old, morbidly obese woman (initial body mass index, 53.3 kg/m(2)) presented with dumping syndrome 17 months after initial laparoscopic Roux-en-Y gastric bypass. She underwent nutritional counseling, strict diet modification, and medication treatment but failed. In addition, the patient complained of worsening constipation and insufficient weight loss (body mass index, 36 kg/m(2)). Laparoscopic revisional procedure with modified duodenal switch was conducted to relieve her intractable condition.
  
  
  RESULTS
  The procedure took 260 min without any intraoperative complication. Blood loss was 100 mL The patient had an uneventful postoperative course and the postoperative hospital stay was 5 days. The uncomfortable symptoms relieved successfully after the revisional surgery.
  
  
  CONCLUSIONS
  Though long-term follow-up is warranted to draw a definite conclusion, modified duodenal switch with pyloric restoration and shortening bowel length remains an acceptable revisional procedure to relive intractable dumping syndrome and constipation in our patient successfully.
authors.affiliation: Bariatric and Metabolic International Surgery Center, No. 1, Yi-Da Road, Jiao-Su Village, Yan-Chao Distinct, Kaohsiung City, 824, Taiwan.
authors.forename: Chih-Kun
authors.initials: CK
authors.lastname: Huang
authors.forename: Ming-Yu
authors.initials: MY
authors.lastname: Wang
authors.forename: Ming-Che
authors.initials: MC
authors.lastname: Hsin
authors.forename: Po-Chih
authors.initials: PC
authors.lastname: Chang
mesh_terms: D000328:Adult; D003248:Constipation / Q000601:surgery; D004377:Dumping Syndrome / Q000601:surgery*; D004386:Duodenum / Q000601:surgery; D005260:Female; D015390:Gastric Bypass / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation