Conversion and Revisional Surgery: Duodenal Switch

Duodenal switch (DS) and its modifications, including modified duodenal switch (MDS), stomach intestinal pylorus-sparing surgery (SIPS), and single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S), offer greater weight loss and resolution of metabolic syndrome than more commonly performed bariatric procedures [1]. Therefore, when patients have inadequate weight loss or weight regain following laparoscopic adjustable gastric banding (LAGB), vertical sleeve gastrectomy (VSG), or Roux-en-Y gastric bypass (RYGB), conversion to DS is a veritable and enticing option that offers the greatest likelihood of sustained weight loss. Though DS may optimize weight loss in these patients, these procedures confer a higher risk of frequent bowel movements, diarrhea, and deficiencies of protein and micronutrients. When symptomatic and extreme, these adverse effects require surgical revision. This chapter reviews the evidence and techniques for revision of other bariatric operations to DS as well as techniques to modify the DS when complications such as malnutrition arise.