Duodenal switch with omentopexy and feeding jejunostomy--a safe and effective revisional operation for failed previous XXXX surgery.

@entity1 @entity353 @entity63 @entity2478 @entity1151 @entity3147 @entity850 @entity1744
BACKGROUND: As the number of @entity353 operations has increased, the number of @entity1 who have failed to maintain sufficient @entity353 has also increased, providing a management challenge to the bariatric surgeon. Conversion to a duodenal switch with omentopexy and feeding jejunostomy was performed for these @entity1 . METHODS: Between September 2006 and January 2010, 41 revisional operations were performed at 1 institution and by 1 operating surgeon. The data were prospectively collected and reviewed for several parameters, including excess @entity353 , mortality, and morbidity. These results are reported. RESULTS: A total of 41 @entity1 underwent conversion of their original bariatric operation to a duodenal switch with omentopexy and feeding jejunostomy. The initial operations had been gastric bypass in 32 @entity1 , vertical banded gastroplasty in 5, and laparoscopic adjustable gastric banding in 4. The average excess @entity353 was 54% in 31 @entity1 at 6 months, 66% in 22 @entity1 at 1 year, and 75% in 9 @entity1 at 2 years. No @entity1 died. The average hospital stay was 6.4 days. A total of 9 proven or suspected leaks (22%) developed. One was at the enverted staple line of a jejunojejunostomy that was diagnosed and treated the next day with little subsequent morbidity. The others were at the gastrogastrostomy or lateral gastric staple line and all occurred in conversions from gastric bypass. They were all @entity63 and presented 5-11 days after surgery and closed relatively uneventfully with J-tube feedings and antibiotic/antifungal treatment. Other major complications included 1 @entity1151 (2%), 1 @entity1744 at the site of the feeding jejunostomy (2%), 2 stenoses (4%)-1 at the duodenoenterostomy and 1 in the body of the vertical gastrectomy. This gives a total major complication rate of 30%. A total of 3 @entity1 required reoperation because of a @entity2478 , @entity1744 , and @entity850 at the vertical gastrectomy. No @entity2478 required surgical or radiologic intervention. One required revision for @entity3147 , but otherwise the nutrition remained good. CONCLUSION: Revisional surgery to a duodenal switch is a complex operation and carries a high potential for major complications. Nonetheless, it can be accomplished safely with good long-term results. Omentopexy, drainage, and feeding jejunostomy should be considered at surgery to treat the high potential for delayed @entity63 leaks.
