Revisional Surgery: Second-Stage Duodenal Switch

The goal of this chapter is to give a comprehensive overview of selection criteria, surgical technique and operative outcomes of standard Bilio-Pancreatic Diversion with Duodenal Switch (BPD-DS) as a second-stage procedure for failed Sleeve Gastrectomy (SG). The importance of vitamin supplementation and long-term clinical and metabolic follow-up is also emphasized. 90-day major complication rate of 2-stage DS is around 5%, not significantly different from single-stage BPD-DS. Following second-stage DS, excess weight loss increases from 39 ± 17% after SG to 75 ± 18% at 1 year, 80.2 ± 17% at 2 years and 80.2 ± 18% at 3 years. Remission rate for Type 2 Diabetes (T2D) increases from 59% after SG to 94% and remission of hypertension increases from 42 to 77%. In addition, second-stage DS is highly effective in controlling patients with T2D on insulin, with a remission rate of 80% (from 15% after SG). Strong metabolic changes explain the excellent 10-years outcomes of single-stage BPD-DS, with a remission rate for T2D over 90%. Side-effects and nutritional risks, including an 8% readmission rate for protein de-nutrition after single-stage BPD-DS at 9 years is also discussed. Overall, second-stage BPD-DS offers the most effective weight loss and metabolic option in patients with SG failure who are willing to commit to long-term follow-up and vitamin supplementation.