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1-818-812-7222 Office Hours: Monday and Wednesay 8:00 AM to 5:00 PM
10 Congress St., Suite #405
Pasadena, CA 91105

Results for : "Vitamin A"

Small Intestine

September 25, 2016 10:27 am

The small intestine is a long tubular organ that is approximately 460-1000cm in adults. It is divided into three sections, Duodenum, Jejunum, and Ileum. The surface area is greater than one might think due to the folds, villi, and microvilli. The surface area is approximately 30 square meters. Most of human digestion and absorption takes place within these three sections of small intestine.

Keshishian master-normal-anatomy-with-text
Keshishian master-normal-anatomy-with-text

The diagram of normal anatomy absorption in the small intestine is pictured to the right.  It is color coded based on the area of the digestive tract the absorption takes place. You may also view here: master-normal-anatomy-with-text

Overview

Length: 22 ft. (6.7 m)

Width: 1 inch

pH: neutral or slightly alkaline (5-7)

  • Steps:
    1. Neutralization in stomach, where enzymes act to breakdown food
    2. Digestion through greater breakdown with help of bile and pancreatic juices
    3. Absorption through assimilation of digested food, vitamins, and salts. Nutrients are taken into the bloodstream via specialized epithelial cells to the liver through the hepatic portal vein.

Duodenum

Length: 1 ft. (0.30 m)

pH~ 5

  • Main site of breakdown
  • C shaped turn with 4 parts: superior, descending, inferior, ascending
  • Mixes food (now in form of chyme) with bile and other digestive juices
  • Passes chyme through duodenojejunal flexure which contains suspensory muscle to widen the duodenal angle and increase movement.

Jejunum

Length: 8.2 ft. (2.5 m)

pH~ 6

  • Coiled, vascular tube that contains a thick intestinal wall
  • The wall contains epithelial projections called intestinal villi
    • Smaller projections in the villi, called microvilli work to:
  1. project specialized transport cells called enterocytes
  2. increase surface area
  3. allow more absorption

Ileum

Length: 11.5 ft. (3.5 m)

pH~ 7

  • Less vascularized and thinner intestinal wall
  • Absorbs nutrients that preceding sections of the gut did not
    • particularly works with vitamin B12 and bile salt absorption
  • Connects to the colon through the ileocecal valve for further breakdown.

The following are Member Exclusive documents.  Please be aware of your terms of use of these items.

Click for: Duodenal Switch Absorption & Anatomy (1.2 MB)

Click for:RNY Absorption Anatomy (1.1 MB)

References:

  1. Campbell NA, Reece JB, Mitchell LG. Biology. 5th ed. Benjamin-Cummings Pub Co. 1999-2002; 802-805.
  2. Ovesen L, Bendtsen F, Tage-Jensen U, Pedersen NT, Gram BR, Rube SJ. Intraluminal pH in the stomach, duodenum, and proximal jejunum in normal subjects and patients with exocrine pancreatic insufficiency. Gastroenterology. 1986; 90(4): 958-62.
  3. Stevens C. E., and Hume, I. D. 1995.Comparative Physiology of the Vertebrate Digestive System. 2nd ed. New York: Cambridge University Press.
  4. Schmidler C. Anatomy and Function of the Digestive System. Healthpages.org. 2016.

Duodenal Switch

August 24, 2016 5:45 am

Buyer Beware ! There are a lot of look alike and counterfeit “Duodenal Switch” procedure being performed. A recent online chat discussion clearly demonstrates the point that just because a patient is told that they had the duodenal switch operation this is not necessarily the case.

In our practice, we always warn our patients of not comparing notes and their outcome to others. I perform the Duodenal Switch procedure  the way it was described by Dr. Hess, making the common and alimentary lengths as a percentage of the total length of small bowel. This is why our patient population has very little nutritional, and gastrointestinal issues compared to others. Unfortunately when a patient is given a disproportionately long Common channel and/or Alimentary channel the patient will have inadequate weight loss. Alternatively, when patients are  given a shorter alimentary channel in proportion to the total bowel length, significant nutritional deficiencies can arise. In a shorter alimentary channel situation patients have to consume higher doses of vitamins and nutrients to keep their laboratory values normal.

I have repeatedly raised the issues to clearly distinguish the single anastomosis procedures from Duodenal Switch operation.

One of the unfortunate problems is the lack of clear guidance given to the patients. It is not uncommon, when I do second opinion consultation with patient who were given generic gastric bypass post op protocol and instructions after their duodenal switch operation. This clearly shows lack of fundamental understanding of the practice performing these procedures and it is carried onto the patient.

 

Exercise Benefits & Events

August 09, 2016 2:25 pm

Exercise and it’s benefits for body, mind and weight loss can’t be over emphasized. Everyone can benefit from some form of exercise whether it be a brisk walk, chair exercises, exercise bands, aquatics, running, hiking or biking. As a family we try to exercise often and attempt to participate in at least one event a month or so.  These types of events tend to keep us more accountable and motivated.  The group atmosphere, energy and vibe only add to the experience. Listed below are some of our favorite exercise events.  We will update this list and add to it.

Physical Benefits:

  • Weight loss and maintenance can be a benefit of exercise. It also improves muscle function and strength.
  • Improves Type 2 Diabetes and Metabolic Syndrome
  • Reduces some Cancer Risk
  • Improved Cardiovascular Health
  • Improved “Good” cholesterol
  • Strengthens and improves Bone Health
  • Living longer
  • Improved Sleep

Mental Health Benefits:

  • Reduce Stress
  • Boosts Endorphins
  • Helps with Anxiety
  • Improved Self Confidence
  • Being in the Great Outdoors and Sunlight (increases Vitamin D)
  • Prevent Cognitive Decline
  • Sharpen Memory and Cognitive Function
  • Help with Addiction
  • Increase Relaxation

One important key note is to pay close attention to hydration with exercise, not only with fluids but electrolytes as well. Exercise increases fluid loss due to sweat and increase circulation to muscle.  You need to increase fluid intake to compensate for these losses.

Exercise events by the month:

June

The Los Angels River Ride is one of our families favorites.  Great ride for a great cause.

August

Luau 5K walk and fun run This is a fun family activity as they have a kids run and lots of activities.  It is also in Griffith Park which is a beautiful and treasured location.

September

The Prudential 401K Run is to promote saving for retirement and is a FREE event at the beautiful Rose Bowl

October

The Aloha Run brings a little Hawaiian feel to the fall.

JDRF One Walk fighting Type I Diabetes

November

City of Hope’s Walk for Hope 

December

Santa to the Sea (must bring a gift for a child)

Varying months depending on location:

Race for The Rescues

Walk from Obesity

Step Out Diabetes Walk

Get your Rear in Gear to fight Colon Cancer

CicLAvia a Los Angeles area quarterly biking event.

Diet Soda, Diabetes and Weight Loss Surgery

June 14, 2016 7:02 pm

Our practice has long discouraged the consumption of diet soda and carbonated sugary beverages for anyone, but especially our weight loss surgical patients. These products’ detrimental effects on bone health, gut microbiome, increase appetite, diarrhea, inhibited weight loss and regain shouldn’t be ignored. In addition, in the situation of limited space post Bariatric surgery, a WLS patient needs nutrient rich, protein foods. These beverages provide no nutritional value.

soda cans
soda
Stevia
Stevia

In addition, these products are also not recommended for non-WLS patients. Oral health, peak in insulin levels, increase weight gain, increased Type 2 DM, and diarrhea are also issues that can effect patients in addition to the above issues.

Our practice, as well as a recent article on Medical News Today Written by Jon Johnson, encourages people to:

“Saying goodbye to diet soda

Soda, whether regular or diet, is a dietary waste. Sodas have little nutrients, and have a long list of side effects. For people with diabetes, diet soda has been associated with weight gain and symptoms of metabolic syndrome. Some sweeteners in diet soda even cause sugar and insulin spikes in the blood.”

We encourage the use of Stevia, which is a natural sweetener, instead of other artificial sweeteners. Stevia is a herb type plant with leave that can be used for sweetening. It has been used for many years in other countries and cultures. It contains Magnesium, Potassium, zinc, Vitamins A, B3 and C as well as fiber.

A past blog post on Carbonated Beverages and Weight loss Surgery .

Probiotics and Prebiotics

May 26, 2016 1:59 pm

Probiotics and Prebiotics are an important part of our overall general and gastrointestinal health. The gastrointestinal (GI) tract is a large, muscular tube that allows the digestion of food. The intestinal lining of the tract plays a role in absorbing vital nutrients and acts as a barrier for the macromolecules and microorganism from circulation. Our GI system is exposed to many bacterial agents that undergo fermentation in the mucosa. The type of fermentation carried out in the gut is greatly influenced by the types of bacteria found in the lumen.

The GI microflora is an elaborate ecosystem consisting of neutral and beneficial bacteria whose balance impacts overall health. This microenvironment consists of about 400 different bacterial species that make up approximately 100 billion organisms in the gut. The flora functions in nutrient consumption, vitamin production, detoxification, hormone activity, and other regulatory processes. Abnormal microbial balance or colonization results in dysbiosis, where the deviant nature of bacteria may become pathological (7). Dysbiosis is a contributing factor to many degenerative and chronic diseases.

Prebiotic and probiotic-rich food sources. Source: www.urerovhor.gffu.net
Prebiotic and probiotic-rich food sources. Source: www.urerovhor.gffu.net
Effect of dysbiosis on the body.
Effect of dysbiosis on the body. Source: Qsota Medical, Gastroenterology.

Benefits of Probiotics and Prebiotics:

Our bodies are full of both good and bad bacteria. Probiotics contain live bacteria and yeasts, whose activity is beneficial when present in appropriate amounts (11,12). These helpful microorganisms regulate the body’s systems in several ways:

  • Gastrointestinal: Probiotics work to reduce infectious diarrhea, specifically types identified by antibiotic use (1). Certain strains enhance stool consistency and bowel movement frequency. Probiotics have also proven effective in alleviating bloating and gas found in irritable bowel syndrome (9). Further studies suggest that specialized strains aid in milder forms of ulcerative colitis, an inflammatory bowel disease. A recent Russian study suggested eradication of SIBO and IBS using a combination of Bifidobacterium bifidum, Bifidobacterium longum, Bifidobacterium infantis and Lactobacillus rhamnosus, called Florasan-D available in Russia. These findings were presented at the 2015 Gut Microbiota for Health World Summit in Barcelona, Spain by Elena Polouektova, MD, a researcher at I.M. Sechenov First Moscow State Medical University.
  • Weight Loss: A clinical study (8) revealed reduced body fat in patients who consumed yogurt (probiotic source), although there were no observed changes in weight. Another study, published in the 2011 European Journal of Clinical Nutrition (6), found that subjects who consumed fermented milk that contained a specific bacterial strain observed abdominal fat and weight loss, when compared to subjects drinking a control.

 

  • Immunity: Although the clinical implications of this evidence are still being studied, it has been found that immune response strength is greatly improved through certain strains of probiotics (2,4). They have also been shown to lighten hypersensitivity reactions and normalize added mucosal dysfunction.

 

  • Other Uses: Bacteria also reside in the mouth. Probiotics play an essential role in oral health, where they reduce throat infection, bad breath and periodontal disease, a gum infection (5). There have been claims that probiotics lower the effects of some skin conditions, prevent colon cancer, lower blood pressure and cholesterol, and alleviate anxiety and depression (3). Future studies are working towards the consistency of these claims.

Probiotics regulate the movement of food through the digestive system. They help replace unwanted bacteria and maintain the mucosal microenvironment to avoid dysfunction. Prebiotics are fiber compounds that move through the GI tract undigested. Prebiotics are important in stimulating probiotic growth and maintaining a stable environment for their optimal activity (13). The best way to get all the powerful benefits of probiotics is through consuming foods that are prepared by bacterial fermentation. Supplements are also available. Previous blog regarding probiotic supplements here. Previous blog regarding probiotics, C.Diff and Hyperoxaluria here.

 

Written by: Mariam Michelle Gyulnazaryan & Dr. Ara Keshishian

References

  1. Bowen, J. M., Stringer, A. M., Gibson, R. J., Yeoh, A. S., Hannam, S., & Keefe, D. M. (2007). VSL# 3 probiotic treatment reduces chemotherapy-induced diarrhoea and weight loss. Cancer biology & therapy, 6(9), 1445-1450.

 

  1. Chiang, B. L., Sheih, Y. H., Wang, L. H., Liao, C. K., & Gill, H. S. (2000). Enhancing immunity by dietary consumption of a probiotic lactic acid bacterium (Bifidobacterium lactis HN019): optimization and definition of cellular immune responses. European journal of clinical nutrition, 54(11), 849-855.

 

  1. Foster, J. A., & Neufeld, K. A. M. (2013). Gut–brain axis: how the microbiome influences anxiety and depression. Trends in neurosciences, 36(5), 305-312.

 

  1. Isolauri, E., Sütas, Y., Kankaanpää, P., Arvilommi, H., & Salminen, S. (2001). Probiotics: effects on immunity. The American journal of clinical nutrition, 73(2), 444s-450s.

 

  1. Krasse, P., Carlsson, B., Dahl, C., Paulsson, A., Nilsson, A., & Sinkiewicz, G. (2005). Decreased gum bleeding and reduced gingivitis by the probiotic Lactobacillus reuteri. Swedish dental journal, 30(2), 55-60.

 

  1. Merenstein, D., Murphy, M., Fokar, A., Hernandez, R. K., Park, H., Nsouli, H., … & Shara, N. M. (2010). Use of a fermented dairy probiotic drink containing Lactobacillus casei (DN-114 001) to decrease the rate of illness in kids: the DRINK study A patient-oriented, double-blind, cluster-randomized, placebo-controlled, clinical trial. European journal of clinical nutrition, 64(7), 669-677.

 

  1. Myers, S. P. (2004). The causes of intestinal dysbiosis: a review. Altern Med Rev, 9(2), 180-197.

 

  1. Omar, J. M., Chan, Y. M., Jones, M. L., Prakash, S., & Jones, P. J. (2013). Lactobacillus fermentum and Lactobacillus amylovorus as probiotics alter body adiposity and gut microflora in healthy persons. Journal of functional foods, 5(1), 116-123.

 

  1. Prantera, C., & Scribano, M. L. (2009). Antibiotics and probiotics in inflammatory bowel disease: why, when, and how. Current opinion in gastroenterology, 25(4), 329-333.

 

  1. Reid, G., Jass, J., Sebulsky, M. T., & McCormick, J. K. (2003). Potential uses of probiotics in clinical practice. CLINICAL microbiology Reviews, 16(4), 658-672.

 

 

  1. Rolfe, R. D. (2000). The role of probiotic cultures in the control of gastrointestinal health. The Journal of nutrition, 130(2), 396S-402S.

 

  1. Sanders, M. E. (2008). Probiotics: definition, sources, selection, and uses. Clinical Infectious Diseases, 46(Supplement 2), S58-S61.

 

  1. Schrezenmeir, J., & de Vrese, M. (2001). Probiotics, prebiotics, and synbiotics—approaching a definition. The American journal of clinical nutrition, 73(2), 361s-364s.

Financing and Cash Options

March 19, 2016 10:40 pm

Insurance benefits can be complicated and difficult to obtain for weight-loss surgical procedures. Investing in your health and yourself can still be an option through financing or cash options. We offer competitive cash options for weight loss surgery. Please contact our office, either by phone 818-812-7222 or our online form, for information regarding cash options.

For those traveling from out of the local area, please see our dedicated Travel Information page and map of patients who have traveled.

Cash Option

Paying out of pocket for your weight loss surgery can be a very stressful process, but we make it as easy as possible for you.

In order to make the process easier, we will assist you throughout the process. Pricing for each procedure depends on many variables, health status and history. Our staff will walk you through all of the costs associated with the procedure that best suits your needs and health status. We are confident that when you compare our costs and benefits with those of other providers you will agree that Dr. Ara Keshishian and Central Valley Bariatric offers a great value and comprehensive program.

Keep in mind that the price of our procedures includes the following:

  • Pre-Operative Consultation
  • Post-Operative Appointment
  • Facility Fees
  • Surgeon Fees
  • Anesthesia Fees
  • IV Therapy
  • Member Exclusive Information and Blogs

Additional cost, not covered are:

  • Pre-Operative labs, EKG and surgical clearance*
  • Post-Operative prescription medications
  • Protein Shakes and Vitamins
  • Airfare
  • Hotel & Transportation
    * Pre-Operative labs, EKG, and surgical clearance are necessary prior to your arrival to ensure you are healthy enough for surgery! This is usually covered by your medical insurance.

Prices vary according to surgery performed and payment method. Please schedule a consultation to find out your exact pricing. The weight loss surgical procedures that we offer are:

  • Duodenal Switch
  • Revision to Gastric Bypass to Duodenal Switch
  • Revision to other Weight Loss Surgeries
  • Sleeve Gastrectomy
  • Revision of Sleeve Gastrectomy to Duodenal Switch
  • Other options

Please keep in mind that the cost of surgery can be tax-deductible. The IRS does allow the deduction of weight loss programs, including surgery when medically necessary. Follow this link for more information: https://www.irs.gov/publications/p502/ar02.html (click on weight loss programs). Note that the cost of surgery must exceed 7.5% of your adjusted income. Other costs designated by the IRS, including weight loss surgery prep programs, health insurance premiums, postoperative visits, smoking cessation programs, and other delineated costs, may help you meet this requirement. Please consult with your accountant for further details.

Category :

Revisional Weight Loss Surgery*

March 19, 2016 8:27 pm

revision-ad-3

Each weight loss surgical procedure has a different short and long-term result, as well as unique and long-term complications. Patients who have had complications or ill effects as a result of weight loss surgery may require other procedures to correct the original operation. These types of operations are called revisional weight loss surgical procedures. In the last 18 years, Dr. Ara Keshishian has performed more than 500 revisions from other Weight Loss Surgeries such as RNY Gastric Bypass, Adjustable Gastric Band, and Sleeve Gastrectomy to Duodenal Switch on patients who have come from all over the United States and other countries. He first published his data on Revisional Weight Loss Surgery in 2004.

 

CONTACT US TODAY

Conditions that may require Revisional Weight Loss Surgery include:

  • Inadequate weight loss.
  • Weight regain after initial weight loss.
  • Dumping syndrome.
  • Solid intolerance.
  • Marginal ulcers.
  • Nutritional deficiencies, including vitamins, minerals, etc.
  • Anemia.
  • Significant bowel dysfunction (constipation, diarrhea, malodors flatulence).
  • Significant gastroesophageal reflux disease.
  • Infection involving implanted devices (ports or bands).
  • Erosion or slippage of the adjustable band.
  • Partial resolution of the comorbid conditions or recurrence of the comorbid conditions after initial or partial resolution.
  • Stricture (narrowing at the site of bowel anastomosis).

Animation of Revision of Gastric Bypass to Duodenal Switch

The goal of the revisional weight loss surgery is to:

  • Correct the problem that brings a patient under our care, including the correction of any of the above outlined conditions.
  • Make the revisional weight loss surgery a definitive procedure. This will be discussed further with each type of procedure that we revise.
  • Accomplish the primary goal of the weight loss surgical procedure, which is maintenance of the weight in a favorable range and resolution of the patient’s comorbid conditions.
  • Revisional Weight Loss sSurgery should have acceptable risk as a surgical intervention.

The majority of patients seeking a revisional weight loss surgery are those who experienced an acceptable short-term outcome after the initial weight loss surgical procedure. They may have lost the weight only to gain it back, or experienced inadequate weight loss. There are also certain patients who have had ill effects from their primary operations, including ulceration and stricture in the case of a Roux-en-Y gastric bypass, and slippage or erosion in the case of an adjustable gastric banding. While there are some patients who have been able to lose the weight and keep it off, this comes at the expense of near constant nausea and frequent episodes of vomiting. It has been our experience that the failure of primary weight loss surgical procedures is quite frequently blamed on the patient, which is usually not the case. In the majority of cases, a less than ideal outcome of a weight loss surgical procedure can be traced back to a procedure itself. A similar circumstance would involve a patient trying a number of blood pressure medications to find the one that works best. Even the best possible outcome may be inadequate for the patient and his or her particular conditions.

The causes of failure of primary weight loss surgical procedures may be:

Cause
  • Dilated pouch stoma
  • Fistula (gastro-gastric, gastro-enteric)
  • Marginal ulcer
  • Significant nutritional deficiency including iron deficiency anemia
  • Stricture
  • Excessive diarrhea or debilitating malodorous flatus
  • Significant protein calorie malnutrition
  • Gastric bypass revisions are indicated for any of the above conditions
  • Significant nutritional deficiency including iron deficiency anemia
  • Excessive diarrhea or debilitating malodorous flatus
  • Significant protein calorie malnutrition
  • Slipped Band
  • Erosion of the Band
  • Port problem including flipped port or infection
  • Inadequate weight loss
  • Incomplete resolution of co-morbidities
  • Revision of a lap band may be indicated for any of the above conditions

Each one of the surgical procedures will be discussed in great length with the rationale for the recommended revisional weight loss procedure.

Sleeve Gastrectomy

The popularity of Sleeve Gastrectomy has increased the number of people who have had this procedure. However, in certain circumstances the weight loss might be inadequate or a person might experience regain following Sleeve Gastrectomy. The procedure for converting a Sleeve Gastrectomy to Duodenal Switch can be achieved to maximize weight loss and/or regain.

Roux-en-Y, Gastric Bypass

Roux-en-Y Gastric Bypass is a procedure in which a small stomach pouch is created and connected to a limb of small bowel in which a deliberately small opening is made. The purpose of the small pouch and the small opening is to restrict the amount of food that a patient can eat in any given setting and to purposefully delay the emptying of the pouch to give the patient a longer period of feeling full.

Complications of the Roux-en-Y gastric bypass include dumping syndrome, marginal ulcer, cases of persistent nausea and vomiting with solid intolerance, inadequate weight loss, and weight regain. In our opinion, the best option for cases of Roux-en-Y gastric bypass in need of revision is the Duodenal Switch operation. Adjustable gastric banding (Lap Band) placement as a revisional weight loss surgery for a primary Roux-en-Y may only be considered for patients who have experienced an initial success of weight loss followed by weight regain. This should, however, only be used for those not experiencing dumping syndrome, marginal ulcer, or reflux disease, as it can potentially get exacerbated by placement of the band on top of a gastric pouch.

Adjusting the length of the common channel, or alimentary limb, allows a revisional weight loss surgery to be tailored to the patient’s needs. An example would be if a patient is experiencing persistent nausea and vomiting and seeks the revision of a failed gastric bypass to a Duodenal Switch. If a patient seeks the revision of Roux-en-Y for persistent nausea and vomiting while experiencing adequate weight loss, a relatively long common channel and alimentary limb (percentage based) will be set for the patient, thus preventing any further weight loss while correcting the persistent nausea and vomiting problem.

In contrast, a patient seeking the revision of a failed gastric bypass to a Duodenal Switch due to inadequate weight loss and/or weight gain will have a relatively shorter common alimentary channel (percentage based) in order to maximize the amount of weight loss. In our opinion, revising a failed gastric bypass, from a proximal to a distal Roux-en-Y, is an extremely poor choice in the majority of the patients, as the distal gastric bypass has the worst nutritional safety profile of all the known surgical procedures.

Adjustable Gastric Banding
Lap Band, Realize

Adjustable gastric banding is a restrictive procedure in which a very small pouch of the stomach is created and partitioned solely by the placement of a ring that can be adjusted by the addition or removal of sterile saline through a port.

In the majority of cases, the reason for inadequate weight loss may be related to inadequate adjustments or unrealistic patient expectations in regard to the anticipated weight loss. All of the published reports to date identify the amount of weight loss to be approximately 50% of the excess body weight, and patients that have a large amount of weight to lose may never attain adequate weight loss to resolve their comorbid conditions.* This may be an example of patients having attained the weight as expected by the surgery, yet experiencing a less than ideal weight loss surgical procedure for their general health condition to include their excess weight and their comorbid conditions. The majority of the patients that had adjustable gastric banding being inadequate weight loss or significant reflux disease in the presence or absence of hiatal hernia. It is our recommendation to have this procedure conversed to Duodenal Switch.

Duodenal Switch

Duodenal Switch operation is the primary weight loss surgical procedure that we perform. It is a hybrid operation in which a banana-shaped stomach is created. Additionally, two parallel limbs of small bowel are created to carry down the ingested food separately from juices from the liver and pancreas. No small bowel is removed. This limits the amount of absorption of calories and nutrition thus magnifying the amount of weight loss.

The most common reason for revision or reversal of the Duodenal Switch operation in our experience has been 1) inadequate weight loss, and a distant second) significant diarrhea. In the case of inadequate weight loss, greater than 80% of the patients in our experience have had dilated stomach which has rendered itself easily to a re-gastrectomy with excellent results. Very few patients have benefited from shortening of the common channel.

The revision/reversal of the Duodenal Switch operation for significant amounts of loose bowel movements and malodorous flatus is easily accomplished by creation of a side-by-side anastomosis.

In fact having extensive experience with revision of weight loss surgical procedures it is our opinion that from a technical perspective, revision or reversal of Duodenal Switch operation is technically the safest and easiest of all the other surgical procedures.

*https://www.dsfacts.com/pdf/agb-long-term-results-1506834076.pdf

Are you a candidate for Revisional Weight Loss Surgery? Contact our office here.

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