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Revision or Reversal of the Duodenal Switch

Posted On : September 08, 2012

A significant portion of my practice involves the revision of the Gastric bypass and Adjustable Gastric Banding procedures to the Duodenal Switch operation. The re-operations are necessary to correct the complications that have been caused by these procedures. There are also instances of required revisions due to inadequate weight loss or weight regain. Our website contains detailed information regarding reasons for revision and the reversal of weight loss surgical procedures. I think it is important to mention that these complications are very common and almost never have anything to do with the patient’s behavior.

Duodenal switch operations may also require reversal or revision. The general reasons for a revision or reversal of the Duodenal Switch is the same as for all weight loss surgical procedures and include a variety of reasons. The reversal or revision of the Duodenal Switch operation is one of the simplest revision surgeries that I perform.

Let’s review a few facts about Duodenal switch.

Reversal of Duodenal Switch
Duodenal Switch anatomy

The Duodenal Switch procedures has two components:

1.) The sleeve gastrectomy

2.) The separation of the biliopancreatic secretions from the food to limit its absorptions.

Clearly, the portion of the stomach that has been removed cannot be reintroduced to the abdominal cavity. The second part of the operation can, however, be easily “undone.

The assumption is that the bowel needs to be divided again and re-anastomosed to reconstitute its continuity. This revision or reversal of the Duodenal Switch operation is done by simply creating a new connection between a new anastomosis, located between the biliopancreatic limb, and the alimentary limb.

If a complete reversal is needed, then the connection is made just distal to the ligament of Treitz. Ligament of Treitz is the transition point between the duodenum and Jejunum. This single anastomosis is safe and simple to perform and does not involve removing the previous staple lines.

If a partial revision is needed, or the common channel needs to be lengthened, then the anastomosis is made further proximal to the junction of both the alimentary limb and the biliopancreatic limb, but distal to the ligament of Treitz to allow for increased absorption of the calories and nutrientsIn my opinion, the revision and reversal of the Duodenal Switch operation is, from a technical perspective, the simplest of all revisional weight loss surgical procedures.

In my opinion, the revision and reversal of the Duodenal Switch operation is, from a technical perspective, the simplest of all revisional weight loss surgical procedures.

11 responses to “Revision or Reversal of the Duodenal Switch”

  1. Both my daughter and I had DS surgery. Mine in 2003, my daughter around 2005. Both done by Pacific Laparoscopy in San Francisco. I have done ok. I am able to take my supplements. My daughter has been plagued with malabsorption issues, severe anemia requiring multiple emergent blood transfusions, severe vitamin and mineral deficiency. She is interested in a revision. At 5’8″ she weighs less than 110 lbs. in my opinion, this would be a necessary operation. I would be paying out of pocket. Can you tell me the approximate cost?

  2. Hi Dr/Team

    What is the data from full reversal to revision (also sharing the length CC was extended to. I am a DS patient, 17 years in. My concerns are now for my future as to how my body will be impacted especially on effects which are not noticed straight away. I am aware the negatives are weight gain. However if I take on board new life lessons and address that then what does it look like for me to have a reversal vs a revision. Please know the toiletry habits and flatulence at times are unbearable for me – how do these look under both options.

    Thanks
    Manisha

    • Hello, the reversal or revision is based on the actual labs, weight loss, health condition now. This disucssion should be had with your surgeon with your weight history, labs, health condition at hand.

    • Hello
      In our experience majority of the GI-bathroom issues are caused by dietary choices. In the handful of the cases that we have revised due to purely GI issues that have no identifiable food correlation, the result has solved the GI issues with weight regain.

  3. I need help!!! I had the duodenal switch done back in 2007 and from then until now it seems my health has gotten worse and my doctors can’t figure out why, I am having blood issues that even the blood specialist doctor at Penn blood disorder center can’t figure out and this all started after my duodenal switch and I also have read that people that had a full cut from rib cage to belly button have been having scare tissue problems with tissue forming around a major organ and some cases the people are dieing before the doctors can figure out why they have any health issues they cannot figure out. I have doctors telling me they DON’T THINK that’s the problem but I hate when doctors say I don’t think it is when I do everything they think it was only not to be what they think. I need a doctor that is going to at least look at what I think it might be only because that’s when this problem started. Can someone please help because I don’t want to be one of them people that they can’t figure out what’s wrong health wise until it’s to late😢

  4. I need help!!! I had the duodenal switch done back in 2007 and from then until now it seems my health has gotten worse and my doctors can’t figure out why, I am having blood issues that even the blood specialist doctor at Penn blood disorder center can’t figure out and this all started after my duodenal switch and I also have read that people that had a full cut from rib cage to belly button have been having scare tissue problems with tissue forming around a major organ and some cases the people are dieing before the doctors can figure out why they have any health issues they cannot figure out. I have doctors telling me they DON’T THINK that’s the problem but I hate when doctors say I don’t think it is when I do everything they think it was only not to be what they think. I need a doctor that is going to at least look at what I think it might be only because that’s when this problem started. Can someone please help because I don’t want to be one of them people that they can’t figure out what’s wrong health wise until it’s to late😢

  5. I would like more information on reversal. I think I am about 10 years out since surgery. The malabsorption is a huge health problem for me. My esophagus hurts despite taking 2 prilosecs a day. I have 4 hernias now, Three large incisional from the surgery and 1 hiatal. I look pregnant they are so big. My organs are seared together with scar tissue and my surgeon states no one should do any further surgery in me. I have esophageal cramps daily and during the night while I sleep. I have them even though I have not eaten. I am showing signs of kidney and liver disease, deficient in A E Zinc, Iron, Calcium and vitamin D. I barely have the energy to work let alone bathe. I have chronic headaches and burning pain in my gut all day. I have begun throwing up more as well. Water sometimes makes me nausceous. I feel if I could just have the absorption part of my intestine back, I could get better. Is that a possibility?

    • Hello, The short answer is yes. However, the complexity and the risk associated with it depend on where it was done and who did it. Single anastomosis duodenal switch is drought with complications that are not discussed openly. We do revise them.

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