Is ok to have the ds 4 years later after the gastric sleeve?

The DS is the ideal operation if your weight loss after sleeve as been inadequate or if the weight has come back. I usually require patients to wait at least one year before doing the duodenal switch. Waiting longer will not have any affect. I have converted gastric bypasses 10+ years post op to duodenal switch and had fabulous outcomes. hope this helps. 

Actually I have a full video actually explaining this on my YouTube channel (@D SandyMartinez)
Hello! The short answer is an absolute YES. In fact, converting a Gastric Sleeve to a Duodenal Switch (or its modern, single-loop version, the SADI-S) is one of the safest and most successful revision procedures we perform.
Four years post-op is a very common timeframe for patients to seek a revision due to weight regain or a weight-loss plateau. Here is why this is a great medical option for you:
1. You already have "Step One" completedThe traditional Duodenal Switch is actually a two-part surgery: Part 1 is creating a Gastric Sleeve, and Part 2 is the intestinal rerouting (the "switch"). Since you had the Sleeve 4 years ago, you already have the stomach portion done! To help you lose the remaining weight, a surgeon simply needs to go in and add the intestinal bypass part to give you that powerful malabsorptive boost. (Note: If your sleeve has stretched over the last 4 years, your surgeon may also "re-sleeve" or tighten it during the procedure).
2. It re-ignites your metabolic engineThe Gastric Sleeve is purely a restrictive tool (portion control). By adding the DS component, we introduce malabsorption (changing how your body absorbs calories and fats). This is exactly what your body needs to break through a 4-year plateau and get back on track.
3. Consider the SADI-SAs an IFSO-recognized surgical team, we frequently perform the SADI-S procedure for sleeve revisions. It offers the same massive weight-loss power as the traditional DS, but it only requires one intestinal connection instead of two. This makes the surgery faster, safer, and lowers the risk of long-term nutritional complications.
The Only Exception:The only reason a surgeon might advise against this is if you have developed severe Acid Reflux (GERD) over the last 4 years. If you suffer from bad reflux, converting your sleeve to a Gastric Bypass (Roux-en-Y) is a much better, safer option.
Your next step: I highly recommend consulting with a board-certified bariatric surgeon. They will likely order an Upper GI series or an Endoscopy to check the current size and health of your 4-year-old sleeve, and rule out any severe reflux before clearing you for the DS.
You are in a great position to reach your ultimate health goals. Best of luck on your revision journey!
Warmly,
Dr. Sandy Martinez

Hello, 
Yes! It is perfectly adequate  to consider a revision from the sleeve to a DS 4 years out if you did not lose enough weight and/or are regaining.   Your surgeon may decide to redo your sleeve too. We perform a barium swallow x ray to check the sleeve as part of the pre op tests and decide if a resleeve is needed to optimize results. 

DS is a good option for inadequate weight loss or weight regain after gastric sleeve.  I only offer this option in highly compliant patients as the consequences of non-compliance after the DS is severe vitamin/mineral deficienies that can lead to permanent disabilities.  There is a lot of upkeep with the DS so you need to really do your research before making this decision.  
Good luck!
Dr Houston

I agree with all of the answers above.  Beware of a surgeon that tells you that you need a gastric bypass after your sleeve.

Duodenal Switch is a great choice for revisional surgery after sleeve gastrectomy.
This can be done laparoscopically.  This requires usually one night stay after surgery, and the return to work will be about the same as your sleeve. 

Hello.
Thank you for your time, question and photos.
The Duodenal Switch after gastric sleeve is the best options for those patience who didn't reach the expected weight loss or weight regain. I would recommend you to visit a certified bariatric surgeon to discuss the best option for youGod bless you, and good luck on this journey.
Dr.Pablo Garcia