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.