Conversion of Sleeve Gastrectomy to Duodenal Switch

The sleeve gastrectomy (SG) is now the most commonly performed weight loss surgery in the United States. However, non-responder rates after SG may be as high as 50%. Revision to biliopancreatic diversion and duodenal switch (BPD/DS) after inadequate results following a SG offers a number of unique advantages. As compared to resleeve or conversion to Roux-en-Y gastric bypass, BPD/DS offers superior weight loss and has the highest rates of comorbidity resolution. Despite early reports, complication rates with minimally invasive BPD/DS are similar with other bariatric operations, when performed by experienced surgeons. Furthermore, revision to BPD/DS from SG avoids placing a staple line or anastomosis in a previously violated and scarred tissue plane. For these reasons BPD/DS may be a superior option for revision surgery after inadequate results from a SG.