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Hypertrophy of Small Bowel and Weight Gain Years After Duodenal Switch

Posted On : August 21, 2015

Duodenal switch (DS) operation results in the highest success rate of all weight loss surgical procedures. Patients, over time, will experience some weight gain many years after DS procedure. There are a number of suspected mechanisms that may be responsible for the weight gain:

1-Ageing may slow the metabolism and the activity down.

2-Over time patients may not be as adherent to healthy dietary and lifestyle changes as they may have been immediately after surgery.

3- Hypertrophy of the alimentary and common channels over time increases in surface area f allowing greater caloric absorption leading to increased weight gain.

It has been demonstrated in bowel resection studies, as well as rat studies, that the nutrient stimulated regions of small intestine increase villus height and total weight, crypt depth and proliferation as well as wall thickness, as an adaptation to compensate for the loss of absorptive capacity in the resected bowel. This observation may be applied to DS procedure as seen in histological slides from a patient who had to have an operation done requiring bowel resection. The segment of the bowel resected included the junction of the biliopancreatic, common and alimentary limbs.

Screen Shot 2015-08-20 at 2.09.29 PM
Side by Side comparison of Biliopancreatic and the Alimentary limb

22 responses to “Hypertrophy of Small Bowel and Weight Gain Years After Duodenal Switch”

  1. Very interesting,, and rather disturbing news for us DSers who are many years out …

    btw, how far out from his/her DS was the patient whose slide sections were reviewed?

  2. I had a bpd/ds in July of 2001. At that time my surgeon told me I would never gain my weight back. I started at 350 lbs, 5’5″ tall, bmi 58. My height is the same, but now I weigh 175 lbs. Muy lowest weight after surgery was about 4 years after, at 135 lbs. People told me I was too thin. I have very dense bones and they account for a good percent of my weight. I still also have lots of excess skin on my arms, thighs, belly, which I’m sure isn’t helping, trying to get back to a lower weight. I thought I would never have to “diet”again, but that wasn’t true. What are the options for someone like me? Is a second surgery called for to reduce the stomach, or shorten the intestines again? I don’t want my health to be at risk like it was before I had the ds.

    • I cannot speak for other surgeons. Any surgery, including the duodenal switch operation can be physiologically undergone to result in weight gain. It is important not to forget and appreciate that since 2001 when he had your surgery, until now we are all 15 years older. There is a certain amount of slowing of metabolism that takes place over time.

      With regards to the specific questions off indication for revision weight loss surgery as I discussed this on our website, he can divide this into to set of criteria. Those patients that are having complications of the origin weight loss surgery and those that have gained weight and or or having comorbidities off the obesity but they have not gained significant weight. You have describe a weight loss of approximately 175 pounds. This is an excellent weight loss.

  3. I had a virgin lap DS in 2009 at age 26 with 2 subsequent internal hernia repairs. I returned to the ER a couple of weekends ago with severe abdominal pain. CT scan showed thickening and inflammation near my alimentary limb and common channel. Exploratory surgery showed that the lower anastamoses had become a floppy, “amorphous blob” and that the appearance of my intestines were consistent with that of someone who had been experiencing intermittent transient intussusceptions. My alimentary limb was shortened 50cm and common channel was shortened by 20cm. My surgeon here on the East Coast (a reputable bariatric surgeon) said he’d never seen hypertrophy like that in a DS’er. I began researching the topic and stumbled upon this post. Do you know what would cause this in a patient like me who has been compliant with diet and supplements? I’m terrified of going through this again in another 7 years. Is there anything I can do to prevent this from happening? It’s interesting to me that there are so few documented cases of this happening.

    • Hello
      The hypertrophy of the mucosa is seen, and described as it is noted in the blog. In my years of experience is primary and revision patients Hypertrophy is noted on the common and the alimentary limb. Intussusception however is more common when the bowel to bowel anastomosis is done in a fashion where the direction of the propulsion forces the bowel into each other. This is common when some surgeons for technical reasons doing the DS Laparoscopically, connect the bowel in this fashion.

    • I am going through this exact thing now..did they go in and revise some things? And if so did your extra weight come off

      • Shortening of the common and alimentary limb for more weight loss is only justifiable if the lengts were too long to begin with. The risk of shortening of the bowel legnth is malnutrtion complcations that may not be justifiable for minimal weight loss.

  4. I had switch only 3 months ago. Did well up to the point where I started eating 800 calories a day. Now I’m gaining 4 pounds a week. I walk 1 to 2 miles a day plus upper body resistance exercises 5 days a week. The doctor says its nor safe to go back to my 500 calories but I’m not going to eat 800 and get right back where I was

  5. I had my DS in 2003 and have gained all my weight back, how do I find out if my sleeve has stretched, or anything is wrong? CT, EGD? I was also told I would never have to diet again 🙁

    • WAs the DS done with the lengths of the bowel tailor made for your bowel length? has the volume of the food consumed gone up? Any other surgeries since DS, any hormonal changes since DS?
      All these questions have to be investigated.
      The short answer is yes a lot can be done- see your surgeon for answers, and planning what to be done next.

  6. I had BP/DS in 2003. Started at 353 and only got down to 192. I’m now up to 230. For the past year, I’ve suffered with severe constipation, which isn’t typical since I was accustomed to very loose stools for 14 yrs. Foods that would normally give me diarrhea now do nothing for me. It’s as if my body is back to what it was before surgery. I’m now on 3rd wk of keto but don’t think that’s the right answer due to all the fat consumption. I have lost 12 lbs but I think that’s just water weight. Especially since I’m doing 20 carbs or lower. My original surgeon retired about 2 mos after my surgery, so I don’t really have another Bariatric surgeon who understands BP/DS. Is the original surgery from then the same as the DS today?

    • Hello, Some things have change other have not. It depends who the surgeon was. There are many factors that may contribute to inadequate weight loss of even weight regain. Should see a bariatric surgeon for evaluation.

  7. Do the initial malabsorption rates (20% of fats, 60% of protein, 60% of complex carbohydrates, but 100% of simple carbohydrates) change and increase years after surgery?

  8. Hello I had a BPD/DS in 2005 and I have gained significant weight gain. Is there a revision where they can re do my sleve? I’m really afraid of continuing to gain weight.

  9. Hi. I had modified duodenal switch in 2018 I am almost 4 years out. I’ve started gaining weight back and yes I do eat a little more then I did starting. I feel hungry all the time now. I don’t drink very much as I don’t get thirsty. It seems though when I try to drink more cause I know I’m supposed to drink more. I retain water. Am I lacking some kind of nutrients or something. I’m 49 now. My parathyroid is messed up my iron is low last labs my zinc was down my potassium was hi my b12 was high. I’ve not taken anything with potassium in it nor any extra b12 supplements. The only meds. I take now is metoprolol, xarelto, low dose aspirin, zinc, iron pill and vitamin c. I also have Afib. My stool is loose most all the time. I feel bloated most all the time. Is there any advice you can give please. Thank you.

    • Hello it’s important to clarify what modified duodenal switch is. Are you referring to SIPS and SADI? If so, I do not do the SIPS and SADI routinely because of the complications of the weight gain and inadequate weight loss.
      As for the nutritional and lab-related issues, you should follow up with your surgeon who performed the operation. You can also reach out to our office for a consultation if you have your operative reports and recent labs available for review.

      • Idk which one it is. Everyone I talk to says they are the same. My surgery was where they cut most of the stomach off then cut the small intestine off and pulled up 3m of the small intestine up and sowed it back on.

  10. Idk which one it is. Everyone I talk to says they are the same. My surgery was where they cut most of the stomach off then cut the small intestine off and pulled up 3m of the small intestine up and sowed it back on.

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