Conversion from Duodenal Switch to Single Anastomosis Duodenal Switch to Deal with Postoperative Malnutrition

• Published in: Obesity surgery 2021, Vol.31 (1), p.431-436
• Main Authors: Baltar, Javier, Martis-Sueiro, Aurelio, Pardo, María, Santos, Fernando, Sartal, Maria Isabel, Crujeiras, Ana B., Peinó, Roberto, Seoane, Luisa María, Bárcena, María, Bustamante, Manuel
• Format: Article
• Language: English
• Subjects: Alcohol abuse; Anastomosis, Surgical; Biliopancreatic Diversion; Diabetes Mellitus, Type 2 - surgery; Duodenum - surgery; Gastrectomy; Humans; Laparoscopy; Malnutrition; Malnutrition - etiology; Medicine; Medicine & Public Health; New Concept; Obesity, Morbid - surgery; Postoperative period; Surgery; Weight Loss
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-020-05047-5

Background Duodenal switch (DS) is considered one of the most effective bariatric techniques for long-term weight and comorbidity control. After these operations, some patients may get severe complications related to malnutrition and a few of them may need surgical revision. Lengthening the common channel (CC) is usually the solution: changing the Roux anastomosis or with a side-to-side anastomosis (kissing X). We propose that when simplified construction of the DS is used, conversion to single anastomosis DS (SADI-S/OADS) is an easy and safe choice. Objectives To evaluate the safety and effectiveness of conversion from DS to SADI-S in cases of malnutrition. Methods We report three patients with severe malnutrition after a DS at 9, 74, and 84 months. One of them had also liver failure related to alcohol abuse and malnutrition. Laparoscopic reoperations included a new ileo-ileal anastomosis and takedown of the Roux-en-Y anastomosis with the aim of lengthening the CC. Results All three patients were successfully converted by laparoscopy. After a median follow-up of 54.6 months [32–76 months], all of them had moderate weight regain and returned to normal biochemical nutritional parameters. Two patients with type 2 diabetes (T2DM) before DS had complete remission before conversion; one of them had recurrence of T2DM after conversion. The patient with liver failure improved significantly after conversion. Conclusions Conversion from DS to SADI-S/OADS is a simple operation with excellent results in resolving malnutrition in those patients. However, weight regain and recurrence of comorbidities may arise.