Duodenal switch after gastric bypass? 206lb with health issues.

Question

I have a gastric bypass in 2009 I was 243 and i when down to 168 and gain like 20 pounds in 2012 I got pregnant and gain some weight right now I'm 206 and have some healthy issues again like diabetes and fatty liver i was wonder if I'm a candidate to do a duodenal switch

Jay Roberts, DO, FACOS, FASMBS · Answer

yes you are a candidate for duodenal switch after gastric bypass as long as your bmi is greater than 35. I have done many bypass to DS conversions. It is without question the most effective procedure for weight loss after weight regain following gastric bypass. The procedure is performed laparoscopically (not open) even if your initial bypass was done open.

Alejandro Lopez, MD, FACS · Answer

Duodenal switch, in my personal opinion, is the best procedure for weight loss. This doesn't mean that it is the best procedure for all the patients, because not everyone needs it to meet their goals. Gastric bypass is the gold standard procedure, and all procedures need to be compared with it, this doesn't mean that it is the best procedure either. 
To suggest one or other procedure, we need to study each patient. For revision surgery is even more important to know why the last procedure failed. 
In my personal experience the efficiency between DS versus Distal Gastric Bypass in a revision coming from a Gastric bypass, in terms of weight loss is the same. The big difference is the risk reported in multi center studies, which is to present a serious complication, such as leaks. The % of this complication is as follows: 
Revision from gastric bypass to a Distal Gastric Bypass is 5% to 8% and if it were revision from bypass to DS, the risk increases to 15% and we can find other cases that report 20% of risk to present a leak. 
In our practice is important first to see why the procedure failed, and after that, if it is necessary, suggest the best revision procedure with good results and without high risks. When the patient agrees to have a revision surgery to a Distal bypass, we always review the size of the gastric pouch and the size of the anastomosis and in some patients, we need to reconstruct the gastric pouch and the anastomosis. Distal Bypass means to make shorter the commune limb, similar to DS, leaving 200 to 250cm distance and very long biliar limb. This change will increase the malabsorption allowing the patient to stop regaining weight and lose more weight. 
It is important for this patients (with Distal bypass) or with a DS, to have a very close follow up with the physician and nutritionist to prevent complications of some nutritional deficiencies.
 We receive many cases with this situation, a failed bypass. To whom first surgery was covered for the insurance, but the revision is not covered.

Pablo Garcia, MD - Account Suspended · Answer

Thanks for asking,  as long as your bmi is greater than 35, yes you are a candidate for duodenal switch after gastric bypass. How ever it is important to consult your health physician first, and maybe have some general tests done before making any decisions. Hope I was helpful to you,Regards.

Duodenal switch after gastric bypass? 206lb with health issues.

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