Gastric Band Revision to Duodenal Switch

Background: Duodenal switch is a choice of revision when patients fail to lose or regain weight after bariatric surgery. This study aims to evaluate the effectiveness and safety of duodenal switch as a secondary operation for patients who presented with insufficient weight loss or weight regain after failed laparoscopic placement of an adjustable gastric band (LAGB) as primary procedure.Methods: A retrospective study was performed on nine patients who underwent BPD/DS revision procedures that were considered for patients who had failed to attain 25% excess weight loss (%EWL) at the end of 3 years. All patients were evaluated preoperatively and postoperatively by the multidisciplinary team.Results: The initial mean body weight before LAGB was 132 ± 4.5 kg and had decreased to 125 ± 19 kg after LAGB, for a %EWL of 18%. The body weight decreased further after BPD/DS to 89.5 ± 11 kg after 6 years. The total weight loss calculated from the period before BPD/DS to years after BPD/DS was 35.5 kg and corresponded to an additional %EWL of 55%. After LAGB and subsequent band removal plus BPD/DS resulted in a total weight loss of 42.5 kg with a %EWL of 71.2% (52.2%, 61.5%, 75.3%, 74.4%, 72.3% and 71.2% at six, respectively. These results show that patients unsuccessfully treated with LAGB still responded well to BPD/DS.Conclusion: Revision of LAGB to BPD/DS provides significant additional weight loss. However, complications and malnutrition can develop after the conversion, and further research is needed for evaluating safety.