Duodenal switch without gastric resection after failed gastric restrictive surgery for morbid obesity

Several surgical treatments have been proposed for patients in whom gastric restrictive operations have failed. The aim of this study was to analyze the effectiveness and safety of duodenal switch (DS) with restoration of normal gastric capacity in such patients.

Between May 2001 and May 2003, 11 DS with restoration of normal gastric capacity were performed without other gastric procedures in patients who had had previous gastric restrictive operations which had failed because of inadequate weight loss or weight regain. Data were collected and follow-up was 2 years for all patients.

At the original operation, mean BMI was 47.3 (range 38-53) kg/m2, and mean age was 42 years. 7 of the 11 patients (63.6%) had previous vertical banded gastroplasty, and 4 of the 11 (36.4%) had previous laparoscopic adjustable gastric banding. Mean percentage weight regain and mean BMI at the time of DS were 92.1% and 44.6 (range 35-53) kg/m2 respectively. After the second operation, mean BMI at 6 months was 35.4 kg/m2, at 12 months 31.7 kg/m2 and at 24 months 28.6 kg/m2. The % excess weight loss was 41.1 after 6 months, 56.6 after 12 months and 69.6 after 2 years. There was minor morbidity and no mortality.

After this experience, we suggest that patients with failed gastric restrictive operations (weight regain or inadequate weight loss) may undergo DS with restoration of normal gastric capacity. This second operation proved to be safe and effective.