Purpose: Significant controversy exists regarding concomitant proximal gastric transection during revision of failed gastric banding. We demonstrate the safety and efficacy of duodenal switch after failed gastric banding for super-obesity (BMI >50kg/m2) and describe variations in technique for these unique patients.
Methods: Retrospective review of perioperative and intraoperative data for patients with previous gastric band revised to duodenal switch.
Results: Sixteen patients with average BMI 56.1 kg/m2 underwent removal of gastric band with intended revision to duodenal switch. Staging and sequence of revision was determined by intraoperative findings and patient-specific factors. Revisions during band removal included: standard DS with sleeve (DS, n=2), sleeveless loop-duodenoileostomy (S-Loop DS, n=6), sleeveless DS (S-DS, n=6), sleeve alone (n=1) and one aborted revision.
Sleeveless procedures had less blood loss than DS with sleeve (32cc vs 150cc, p<0.05). Operative time was shorter for S-Loop DS than S-DS (4.2 vs 5.6 hours, p<0.05). There were no mortalities, one readmission for postoperative pancreatitis (S-Loop DS) and one postoperative duodenoileostomy leak treated with percutaneous drainage (S-DS). Four patients had a second stage for additionally weight loss. At 1-year three patients achieved BMI <40 kg/m2: standard DS, S-Loop DS with staged sleeve and S-Loop DS revised to RY reconstruction. At 1-year, average BMI after sleeveless procedures was 43.5 kg/m2.
Conclusions: In experienced centers, duodenal switch after failed gastric band is a safe treatment for super-obesity when staging is individualized for the patient. Sleeveless duodenal switch procedures still result in significant weight loss while allowing for staged sleeve and additional results.
