Duodenal Switch Conversion: A Viable Option When Sleeve Gastrectomy Fails

By Stephen G. Boyce, MD, FACS, FASMBS, Bariatric Surgeon, New Life Center for Bariatric Surgery

Vertical Sleeve Gastrectomy, in which approximately three-fourths of the stomach is removed and a narrow gastric tube is created, is the most popular bariatric surgical procedure in the United States. It is considered a quicker, less complicated surgery than gastric bypass, the long-time “gold standard” for bariatric surgery. Sleeve gastrectomy restricts food intake, but the intestines are not removed or bypassed during the procedure.

While sleeve gastrectomy is effective for many people, there will be patients who don’t lose adequate weight or the sleeve fails. Among the options patients may consider when a sleeve gastrectomy fails is to re-sleeve, or convert to the Duodenal Switch procedure.

Duodenal Switch (DS) is a natural option, since Sleeve Gastrectomy is actually part of the Duodenal Switch procedure. In the procedure, the first part of the small intestine is divided to bypass pancreatic and biliary drainage. The advantage is that the DS significantly limits the amount of fat absorbed from the diet.

The patients that benefit the most are those with a BMI (body mass index) of more than 50, who are severe diabetics. The DS provides the most weight loss, the lowest risk of weight regain, and the best resolution of diabetes. However, Duodenal Switch makes up only a small fraction of the bariatric procedures performed in the United States because it is a very complex surgery that most surgeons have limited experience with, and it has a higher risk of nutritional problems (click here to learn more about the DS).

As one of the few bariatric surgeons in the United States who perform Biliary-Pancreatic Diversion with Duodenal Switch, I have created a unique program at New Life Center for Bariatric Surgery in Knoxville, for training bariatric surgeons from around the country in the Duodenal Switch surgical techniques. The surgeons’ staffs also learn protocols for managing and monitoring DS patients from our experienced multidisciplinary team.

Interest in the conversion of Sleeve Gastrectomy to Duodenal Switch is growing, as evidenced when I was asked to discuss the topic at the American Society for Metabolic and Bariatric Surgery (ASMBS) annual meeting this past summer. The information was well received and participants were particularly interested in the special protocols for taking care of a Duodenal Switch patient.

It is encouraging to see the number of bariatric surgeons who are coming to Knoxville to receive further training about the Duodenal Switch procedure. It can be a viable second step solution for patients who need further weight loss and/or a resolution of their diabetes.

Thanks for reading!
Your Bari Life Team

Questions for Dr. Boyce? Email [email protected]!

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