Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1002_Библиотеки_им_академика_М_И_Перельмана

Despite the limited acceptance as a primary procedure, BPD-DS and SADI-S/ OADS should be seen as the natural rescue procedure in sleeved patient, since the gastric step of these two techniques has already been done, saving operative time and minimizing the risk of complications related to the SG itself. However, the bar­iatric community in general still seems to opt more frequently for conversion to gastric bypass, considered a less technically demanding procedure. Nonetheless, the greater technical simplicity attributed to the emerging SADI-S/OADS surgery com­pared to classic BPD-DS can provide a broader acceptance of duodenal switch sur­gery as a suitable revisional option after failed SG in the following years.

Therefore, the purpose of this chapter is to discuss duodenal switch surgery, either by two- or one-anastomosis, as a safe and feasible option to rescue patients undergoing SG and failure in obesity disease control.

Nevertheless, the variable rates of post-sleeve WR do not mirror the percentage of revision surgery, since not all patients identied as WR will need an interven­tional procedure. In a short-term case series of 500 morbidly obese patients who underwent primary SG, 26 individuals (5.2%) required revisional surgery due to poor weight loss (n=8) or WR (n=18). In this study, poor weight loss was dened by a percentage of excessive weight loss (%EWL) of less than 50% after 1year, and WR was dened as a regain of at least 30% of lost weight or a regain of 20% of weight from the nadir [21]. Another case series also applied the %EWL as a param­eter to proceed with a rescue procedure after SG.Of a total of 1300 patients, 36 (2.2%) required reoperation due to failure in weight control, dened by a %EWL below 50% after 1year. In this study, both IWL and WR were included in the same denition [22]. In a long-term case series of obese patients undergoing SG, 4 (2.2%) of 182 patients eligible for the study underwent BPD-DS as a second-stage procedure due to IWL before reaching the endpoint. In this cohort, 114 patients (62.6%) reached 10years of follow-up, and the WR, expressed as an increase in weight≥25% from the nadir, occurred in 10.4% of patients [23]. And nally, a retrospective analysis of a prospective cohort assessed long-term outcomes of 168 patients undergoing SG.After 8years of follow-up, 116 patients still had only the index procedure and had an average EWL of 67%. Of the remainder, 29 lost follow­up, and 23 (13.7%) patients underwent revisional surgery for WR (n=14; 8.3%) or for severe reux (n=9; 5.3%) at a mean time elapsed since the initial procedure of 50 months. Of these 14 patients, 5 went to duodenal switch surgery and 1 to SADI-S/OADS [24].

The ASMBS Revision Task Force established a nomenclature for reoperative surgery into conversion, corrective, and reversal procedures [27]. Obviously, the sleeve cannot be subjected to a reversal procedure, since 70–80% of the stomach is removed. On the other hand, there are several corrective procedures that can be applied to the sleeve: re-sleeve, banding, seromyotomy, and axis realignment, among others.