Gastric sleeve revision to Duodenal Switch by Dr. Ungson at MBC

Gastric sleeve revision to Duodenal Switch by Dr. Ungson at MBC

Hi, I’m Nina and welcome to Mexicali Bariatric Center. Today I will talk to you about revisions from the Gastric Sleeve to Duodenal Switch (DS) performed by board certified surgeon Dr. Gilberto Ungson. I wanted to share two cases that we had last month that are very interesting. In the first case a lady with a BMI in her mid 40’s contacted us. She had a sleeve done several years ago but it wasn’t very successful, she was sure she was eating too much because her sleeve was too big. So she was considering having her sleeve redone and then having a DS portion done as well. We scheduled her and it was agreed that the day before surgery we would check her sleeve to determine if in fact it needed to be received* or not.

Same day we had a lady scheduled that had a band converted to a sleeve. She knew she could only eat very little, she was sure her sleeve was small but she had lost very little weight and in fact, she started to regain some of it. She knew she needed the second part, she needed the malabsorption of the DS. Again, we rechecked her sleeve to make sure we were doing the right thing.

The ladies came in the day before surgery and we do case number one. After the X-Rays we confirmed that indeed her sleeve was very big, it had bulges at the top and at the bottom. Basically she had a sleeve that could hold two or three times what a tight sleeve should hold. We decided she needed to have her sleeve redone and at the same time have a DS. At that point we thought that if she had a tighter sleeve, a regular one, she might have been successful. In the second case, the lady with the low BMI, her sleeve was very tiny, very nice...so we stuck to the plan to do the DS part.

The day of surgery the first lady goes in and the doctor resleeved her, but when he starts doing the DS part he needs to measure in order to determine the lengths of the limbs. He found out that the lady had very long intestines way over the average. The doctor knew at that point that even with a tight sleeve she most likely wouldn’t have been successful. She needed the malabsorption, therefore she was happy to decide to have both parts done and not stay just with the resleeving. The second lady comes in and again the doctor starts measuring and again, this lady had very long intestines. This means that these two ladies could absorb more fat, more carbs, more calories basically. This was a lady that was eating very small portions but this wouldn’t work for either of them. We were happy that they scheduled for a second part and we are very sure they are going to be very successful.

I was very excited about all of this so I asked the doctor “how can we know if a patient’s intestines are too long? Is there a test, an X-ray or something to determine if they need a DS from the get-go and not need to wait until a sleeve fails”. Sadly the answer was no. There’s no not-invasive procedure to determine the length of the intestines. Only at the time of surgery when the doctor is measuring will he know how long they are. Nevertheless, that is good information to have for the patient to consider a malabsorptive procedure like the Duodenal Switch or the bypass. Do you notice that when you eat small portions you still won’t lose weight? Do you think you need something more? That’s something to consider.

I hope this helps and hope to see you soon.

What are my options for lap-band revision surgery?

Options for lap-band revisions

Hi everyone, I’m Nina. Welcome back to Mexicali Bariatric Center. I’m going to talk to you about revision surgery, specifically those for lap-bands. There are many reasons why someone would want to have a possible revision from their original surgery. Most of the times is lack of weight loss or weight regained, sometimes is because a patient started to have technical problems with their bands. We are a revision center with doctors specialized in revision surgery, and there are some procedures we recommend the most.

First let me tell you what we longer do because of poor long term results for our patients. We are no longer relocating bands. Years ago, when somebody had a slipped band, we used to go in and put the band back in place and stitch it back where it’s supposed to be. But invariably over 90% of the time the band would slip again and would have to be removed. So that wasn’t even a short term solution since sometimes that took about a year to happen. Another thing we would be doing is that when someone wanted to have their band removed and wanted another lap-band, we would go ahead and do it, sometimes a larger one, sometimes a newer one… but then again, the results were not very good. In a short to medium term the band was usually removed. We are not comfortable with that.

The options that we do recommend that are long term solutions is revising from your band to the sleeve, DS or gastric bypass. We do these revisions laparoscopically and in a single procedure. The only reason we wouldn’t do it in a single stage is in the case of an eroded band. In those cases the protocol is to remove the band, let the stomach heal somewhere between 6 months and a year, and afterwards the patient can consider another weight loss surgery like sleeve, DS or bypass. Certainly in some cases the risk is higher, so the patient needs to evaluate that plus the cost, his needs and then move forward. But it can be done. Having said that, the other cases we do them 100% of the time in a single procedure. If you find that you are being told that there's a 30% chance or a 50% chance of not having it done in a single procedure, you might consider visiting a Revision Center where doctors are highly experienced in revision surgery. We have been doing them for a very long time and revision for lap-bands are the ones we do the most.

Lets start off with the revision from band to sleeve. Some doctors recommend that if you already failed in a restrictive procedure like the lap-band do not go to a restrictive one like the gastric sleeve. They would recommend to go to a malabsorptive procedure. There are many patients, though, that after failing with the band do very good with the sleeve. So when patients contact us wanting us to decide for them and tell them what to do, we can only make recommendations and encourage them to analyze why the band didn’t work for them. If, lets say, you lost 100 lb or 150 lb and then started to have technical problems, i.e. a leak in your port, or it suddenly is too tight or too loose and afterwards you regained weight, you can conclude that just cutting portions is not enough for you. If you limit your food intake it will be enough to lose weight. So then a restrictive procedure would be a good option. Now, it is very important to be honest moving on. Were you following the guidelines? If you did but you did not get the results you were hoping for, then most likely another restrictive procedure would not be very helpful, you most likely need a malabsorptive one.

If you are going for the sleeve in your revision surgery because you think this procedure is enough for you, you still need to have a good effective sleeve. We redo many of them so we know some are done very irregularly (some of them are too big), so have it done at a place where they know how to do revision surgeries, it's not the same thing. Some times we find that they just go around the band's scar tissue, so patients end with a bulge on the top that holds a lot of food, you must pay attention to that. But if you have your sleeve done appropriately, that should be enough for you.

There are some other patients that know that just cutting food portions is not enough. Sometimes when we go over what they have been eating it really isn’t very much. After analyzing their calorie intake and exercise done, it is very obvious that they need something else. Is just the way people are and some patients need the help of a malabsorptive procedure. There are some revision surgery options like the gastric bypass or the duodenal switch. Either of them is a very good option and both are safely done in a single procedure and by laparoscopy.

These procedures are the ones we truly believe will help you lose weight and keep for long term success.

Hope to see you soon.