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.
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.
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?
Hello, Please contact our office by completing the form https://www.dssurgery.com/contact-forms-new/ and our office staff will contact you.
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.
How much weight regain occurred after revision?
I do not have a specific weight regain number; the concern, however, is the return of the comorbidities that occur with varying degrees of weight gain.
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😢
As a weight loss surgical patient with health issues, your first contact person would the weight loss surgeon who did your operation.
He has retired and I can’t find any doctor in my area that will even look at me because they say they don’t and will never do the DS surgery because of the complications.
Contact our office, and the staff will help coordinate a telehealth if you wish.
https://www.dssurgery.com/contact-forms-new/
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😢
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?
Several issues are raised in your question. All these concerns need to be studied and addressed. A common theme may be a conversion to the gastric bypass to address the reflux and the weight gain. The problem with the gastric bypass is the lack of durability of the weight loss.
Can you get a revision after having a single astmosis deuodenal switch?
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.
21 Years ago I had a duodenal switch, in the past several years my weight has increased substantially. Is a revision something that could assist me with my weight?
Hi, you and are looking for the same question if there is a revision to the ds. I had my ds 20 years ago. I went from 315 to 180 I am 5’4. I am now I’m at 233. We should get to know one another.
Hello, weight gain after the duodenal switch may be due to several reasons. 1- Was the bowel length done as a percentage of the total length or just a random standard setting? What was the start weight? What was the lower weight? How old is a patient? Any significant change in the volume of the food? Are there any other surgeries since the duodenal switch? Any metabolic (thyroid, adrenal, infertility issues), any pregnancy since then? In a Female patient, any pregnancy, hysterectomy, Depo shot, or Norplant type of birth control, etc…
The point that I am trying to make is that the short answer from an anatomical perspective is “Yes.” It is possible to provide a surgical solution for weight gain after the Duodenal switch. However, a workup is needed to explain why substantial weight was regained.
I had my DS in 2001. My highest weight was 285lbs and I got down to 140lbs. I had bowel problems but been on the FODMAP diet which has improved the problem 90%. Two years ago I fell and suffered a head concussion. Since then I’ve gotten down to 114lbs and been unable to regain any of it. I’ve been working with my primary, who is familiar with surgery, but nothing works. I’ve even tried scheduling meals every 2 hours. I’m 74yrs now and wonder if a revision would be appropriate for me.
Hello, Weight loss years after DS is very uncommon. There are other than DS-related reasons why some patients experience malnutrition and weight loss, including Covic infection and not being vaccinated; a low protein diet, high fiber, high carbohydrate, high-fat diet, and a diet rich in artificial sweeteners will all cause or contribute to weight loss. I strongly recommend that you get in touch with your bariatric surgeon for further advice. Revision of a DS for malnutrition is a relatively straightforward and simple operation, where a single “kissing X” anastomosis reverses the physiology of the DS and will improve the nutritional status and result in weight gain.
Can you have a revised DS to aid in the regaining of weight?
The short asnwer is yes. The long asnwer is what is contributing to the weight regain?
Can you have a revised DS to aid in the regaining of weight? I had DS surgery in 2020 and want to know if there is a revision option?
Hello, Revision of a DS is possible. Work up would be 1- What procedure was done and where, 2-Upper GI to evaluate the stomach size, 3- Complete lab work, 4- Complete physical exam, and then formulate the surgical options if possible. Recommend seeing the original surgeon.
Hello, Where was the surgery done? is this DS or SIPS/SADI procedure. They are not the same and the weight gain is much more common with the SIPS SADI, and rarely seen with the primary two ansatamosis DS. https://www.dssurgery.com/weight-loss-surgery/compare-procedures/duodenal-switch-compared-sadi/
I had a DS 19 years ago, after decades of not being able to solve a thyroid issue, which caused me to keep gaining weight despite proper diet and exercise. The DS moved my weight from 250 to 123 lbs, which stayed like that for 9 years. Then a colonoscopy prep messed up my biome so badly I lost the ability to function well. This has gone on for 10 years: I have had tons of issues, I’ve spent years in bed, nearly died, and now have gone on TPN after not being able to gain weight despite months of trying. The original common channel is 125 cm long. Should it be revised to twice, or to three times its length? Would three times its length cause me to become obese again?
Hello,
The common reversal for malnutrition is to double or completely reverse the duodenal switch component. this decision is based not only on the weight but also on the laboratory studies, micro and macro nutrition levels, other health conditions (osteoporosis)
Your surgeon should be contacted to review your operative records, labs, and current health status and then proceed with a plan.
Thank you so very much for your reply. Also for your illustration of the two versions of revision. Much appreciated!
Hello, first off thank you for any info you can provided. Here is my surgery histroy
2018: Duodenal Switch (DS)
2020with pyloroplasty
end of 2020-start of 21hernia repair
*first year after ds was great then a flip switched and since then ive delth with chronic nausea, vomiting, kidney stones, malnutrition, and fatigue.Muscle mass loss, inability to hold down any oral intake at times. mutiple instances of anemia and electrolytes so bad hospitalization was required, sometimes for days.
Then all, including, intake my body rejected. Had some tests done and surgery in 2022 was for a Blind loop correction and at that time my dr lengthen my common channel from 150cc to 400cc. It failed
→ Attempted to fix severe malabsorption from multiple aspects, my surgeon has a lot of different departments all working together but symptoms persisted: nausea, vomiting, nutritional deficiencies etc etc but i was able to sustain oral intake enough to get by.Until
June this year. By time I got admitted to te hospital i could barely walk: had surgery to Repair of stomach sliding into esophagus (similar to hiatal hernia repair)
→ Continued severe nausea, vomiting, and pain. Required TPN for nutrition. It started June second, i returned to work july 31st on tpn but a lower time and formula. able to hold down about 400 calories orally a day. Then around Aug 3rd my body rejected absolutely everything again. Admitted on the 8th. my esophagus had mobility issues out of no where. when i would swallow instead of sending it towards my stomach it would spasm and send it back to my mouth. Also, an adhesion caused my stomach to twist and it was almost obstructed. This was aboutto be my 6th surgery. my dr said he knew in a few months he would end up having to revise my ds to bypass so he was going to fix my twisted stomach, do the revision, dilated my esophagus and place a g tube.This happened last Wednesday.
I advanced t protein shakes after a few days and my dr suspected i had an obstructions at the end of tjhe intestine into my small pouch but thankfully it started clearing. Got released from the hospital yesterday the 28th on tpn, g tube for my meds and liquid only diet. I am struggling getting past 20oz of protein and water combined I know its been only a day but im terrified of an obstruction
another surgery and going back to the hospital. Home health for my central line, which i had since june so whatever. but also now getting it for the G tube plus physical therapy because of muscle loss and inability to move much. I know thats a lot of history thank you if you got to this point. My question is do you know of anyone who has the ds revised to bypass. my kind of complications and had a full/good recovery?