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Duodenal Switch Conversion: a Viable Option when Sleeve Gastrectomy Fails

Vertical Sleeve Gastrectomy, in which approximately three-fourths of the stomach is removed and a narrow gastric tube is created, is the most popular bariatric surgical procedure in the United States. It is considered a quicker, less complicated surgery than gastric bypass, the long-time “gold standard” for bariatric surgery. Sleeve gastrectomy restricts food intake, but the intestines are not removed or bypassed during the procedure.

Although sleeve gastrectomy can enable rapid weight loss after surgery, it is a relatively new procedure and the risk of weight regain long term is not known.

“While sleevBoyce Steve Headshot - smallere gastrectomy is effective for many people, there will be patients who don’t lose adequate weight or the sleeve fails,” explains bariatric surgeon Stephen Boyce, MD, FACS, FASMBS, of New Life Center for Bariatric Surgery in Knoxville, Tennessee.

“Among the options patients may consider when a sleeve gastrectomy fails is to re-sleeve, or convert to the Duodenal Switch procedure,” says Dr. Boyce.

Duodenal Switch (DS) is a natural option, since Sleeve Gastrectomy is actually part of the Duodenal Switch procedure. In the procedure, the first part of the small intestine is divided to bypass pancreatic and biliary drainage. The advantage is that the DS significantly limits the amount of fat absorbed from the diet.

“The patients that benefit the most are those with a BMI (body mass index) of more than 50, who are severe diabetics,” says Dr. Boyce. “The DS provides the most weight loss, the lowest risk of weight regain, and the best resolution of diabetes.”

However, Dr. Boyce says Duodenal Switch makes up only a small fraction of the bariatric procedures performed in the United States. “It’s a very complex surgery, that most surgeons have limited experience with and it has a higher risk of nutritional problems,” says Dr. Boyce.

Dr. Boyce is one of the few bariatric surgeons in the United States who perform Biliary-Pancreatic Diversion with Duodenal Switch. Dr. Boyce has created a unique program at New Life Center for Bariatric Surgery in Knoxville for training bariatric surgeons from around the country in the Duodenal Switch surgical techniques. Their staffs also learn protocols for managing and monitoring DS patients from the multidisciplinary team at the New Life for Bariatric Surgery.

Dr. Boyce was recently invited to discuss the conversion of Sleeve Gastrectomy to Duodenal Switch at the American Society for Metabolic Bariatric Surgery (ASMBS) annual meeting in Miami. The educational event draws top-tier bariatric professionals from the U.S. and beyond.

“It was an honor to be asked to present at the ASMBS meeting,” says Dr. Boyce. “The information was well received. The participants were particularly interested in the special protocols for taking care of a Duodenal Switch patient.”

Dr. Boyce is encouraged by the number of bariatric surgeons who are coming to Knoxville to receive further training about the Duodenal Switch procedure. “It can be a viable second step solution for patients who need further weight loss and/or a resolution of their diabetes.”

About Dr. Stephen Boyce
Stephen G. Boyce, MD, FACS, FASMBS, is a pioneer and educator in bariatric surgery. Since 1989 he has performed more than 4,000 weight-loss surgical procedures. Dr. Boyce has special training in laparoscopic surgery and holds a Masters Certification in Bariatric Surgery. His practice, the New Life Center for Bariatric Surgery in Knoxville, Tennessee, was one of the nation’s first Centers of Excellence.

Dr. Boyce is a nationally –known bariatric educator. He and his New Life staff have trained surgeons and bariatric practices from across the United States in weight loss surgical techniques and protocols for managing patients. Dr. Boyce has also presented his techniques and results at national and international meetings of bariatric surgeons.

Dr. Boyce is the Medical Director of the Tennova Center for Surgical Weight Loss at Turkey Creek Medical Center in Knoxville. It is a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) and the only accredited Level 1 facility by the Bariatric Surgery Center Network (BSCN) Accreditation Program for the American College of Surgeons (ACS) in the East Tennessee region.

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