Conversion to Modified Duodenal Switch for Relieving Intractable Dumping Syndrome and Constipation After Laparoscopic Roux-en-Y Gastric Bypass
Open accessAbstract
Background Dumping syndrome is not infrequent after laparoscopic Roux-en-Y gastric bypass and could result in dreaded complications, such as hypoglycemia or syncope. Those patients who failed medical therapy and diet modification, regarded as intractable dumping syndrome, may be considered as candidates for revisional surgery. Herein, we make a video presentation of laparoscopic revisional procedure for intractable dumping syndrome with unsatisfactory weight loss. Methods A 32-year-old, morbidly obese woman (initial body mass index, 53.3 kg/m(2)) presented with dumping syndrome 17 months after initial laparoscopic Roux-en-Y gastric bypass. She underwent nutritional counseling, strict diet modification, and medication treatment but failed. In addition, the patient complained of worsening constipation and insufficient weight loss (body mass index, 36 kg/m(2)). Laparoscopic revisional procedure with modified duodenal switch was conducted to relieve her intractable condition. Results The procedure took 260 min without any intraoperative complication. Blood loss was 100 mL The patient had an uneventful postoperative course and the postoperative hospital stay was 5 days. The uncomfortable symptoms relieved successfully after the revisional surgery. Conclusions Though long-term follow-up is warranted to draw a definite conclusion, modified duodenal switch with pyloric restoration and shortening bowel length remains an acceptable revisional procedure to relive intractable dumping syndrome and constipation in our patient successfully.
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Approximately 24% of patients who underwent surgical re-intervention because of refractory severe post-Roux-en-Y gastric bypass hypoglycemia received a gastric bypass reversal and approximately 9% had gastric pouch restriction.
“As shown in Table 5, approximately 24% of patients who underwent surgical re-intervention because of refractory severe post-Roux-en-Y gastric bypass hypoglycemia received a gastric bypass reversal (66,103,106-113) and approximately 9% had gastric pouch restriction (66,114,115).”
From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [113]
The Abstract (p. 1) describes one patient who underwent conversion to a modified duodenal switch for intractable dumping syndrome. Our copy gives no patient totals or percentages for bypass reversal or gastric pouch restriction; searches for those procedures and the claimed 24% and 9% found no supporting passage. (LLM, conf=0.77)
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Cited by
Sorted by citations
International consensus on the diagnosis and management of dumping syndrome
Scarpellini, E., Arts, J., Karamanolis, G., Laurenius, A., Siquini, W., Suzuki, H., Ukleja, A., van Beek, A. V., Vanuytsel, T., Bor, S., et al. (2020) · Nature Reviews Endocrinology · doi:10.1038/s41574-020-0357-5 · Cited by 247 · see citing works
van Beek, A. P., Emous, M., Laville, M., & Tack, J. (2017) · Obesity Reviews · doi:10.1111/obr.12467 · Cited by 288 · see citing works
“(113) Case report N = 1 Laparoscopic conversion to modified duodenal switch • Dumping symptoms resolved • No complications were reported”
BackgroundRoux-en-Y gastric bypass reversal: a systematic review.
Shoar, S., Nguyen, T., Ona, M. A., Reddy, M., Anand, S., Kuwari, M. A., & Saber, A. (2016) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2016.02.023 · Cited by 70 · see citing works
“For patients with dumping syndrome resistant to medical treatment or diet modification, surgical revision has been proposed as a beneficial option (44-45).”
BackgroundMid-term outcomes of gastric bypass weight loss failure to duodenal switch
Surve, A., Zaveri, H., Cottam, D. R., Belnap, L. P., Medlin, W., & Cottam, A. (2016) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2016.03.021 · Cited by 49 · see citing works
“[28] present their experience with a patient who had inadequate weight loss and dumping syndrome after RYGB and underwent surgical revision to modified DS with immediate resolution of he dumping syndrome.”
BackgroundMasclee, G. M. C., & Masclee, A. (2023) · Clinical and Experimental Gastroenterology · doi:10.2147/ceg.s392265 · Cited by 32 · see citing works
“76 Apart from a possible target of therapy as a delay in gastric pouch emptying, slowing the esophageal passage of food to the gastric pouch is also reported to be a target for intervention in dumping syndrome.”
BackgroundBazarbashi, A., Dolan, R. D., McCarty, T., Jirapinyo, P., & Thompson, C. (2021) · Surgical Endoscopy · doi:10.1007/s00464-021-08731-4 · Cited by 16 · see citing works
“This is a notable benefit of endoscopy, where efficacy and safety of surgical revision methods for treatment of intractable dumping syndrome remain variable [7, 9, 10, 29].”
BackgroundLinke, K., Schneider, R., Gebhart, M., Ngo, T., Slawik, M., Peters, T. T. A., & Peterli, R. (2020) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2020.04.009 · Cited by 15 · see citing works
Dumping syndrome : Update on pathophysiology, diagnosis, and management
Tack, J. F., Raymenants, K., de Bruaene, C. V., & Scarpellini, E. (2024) · Neurogastroenterology & Motility · doi:10.1111/nmo.14962 · Cited by 12 · see citing works
Liu, B., Yang, X. H., Guo, L., Zhang, J., Zhou, X., Yi, R., & Zhao, X. (2019) · Journal of Food Quality · doi:10.1155/2019/9781914 · Cited by 7 · see citing works
“Clinical observation shows that constipation can cause body weight loss [19], and a previous study showed that mice with induced constipation can also lose weight and that constipation in animals can cause slow weight gain or weight loss [20].”
[Dumping syndrome: Diagnostics and therapeutic options].
Seyfried, F., Wierlemann, A., Bala, M., Faßnacht, M., & Jurowich, C. F. (2015) · PubMed · doi:10.1007/s00104-015-0047-3 · Cited by 4 · see citing works
Is duodenal switch the preferred option after failed Roux-en-Y gastric bypass?
Himpens, J. (2016) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2016.04.010 · Cited by 3 · see citing works
Mera-Carreiro, S., Bernaldo-Madrid, B., Rodríguez-Carrillo, C., Esteban-López-Jamar, J. M., Marcuello-Foncillas, C., Pérez-Ferre, N., Ramos-Levi, A. M., Matía-Martín, P., & Rubio-Herrera, M. (2025) · Frontiers in Endocrinology · doi:10.3389/fendo.2025.1662911
Dumping syndrome after bariatric surgery
Emous, M. (2019) · doi:10.33612/diss.106406421
Diagnosis and Treatment of Dumping Syndrome After Gastric Bypass for Morbid Obesity
Ganga, R., Zorrilla-Núñez, L. F., Menzo, E. L., Szomstein, S., & Rosenthal, R. J. (2024) · Springer eBooks · doi:10.1007/978-3-031-70004-0_21
- Authors
- Huang, C.-K., Wang, M.-Y., Hsin, M.-C., & Chang, P.-C.
- Affiliations
- E-Da Hospital (TW)
- Corresponding author
- Chang, Po-Chih
- Venue
- Obesity Surgery
- Published
- 2015-02-21
- Volume
- 25
- Issue
- 5
- Pages
- 946-946
- ISSN
- 0960-8923 (ISSN-L)
- 1708-0428
- OpenAlex
- W2016720169
- Cited by
- 15
- References
- 0
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 1 · 2021: 1 · 2020: 2 · 2019: 2 · 2016: 4 · 2015: 2
- FWCI
- 2.02
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Obesity Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- MeSH terms
- Adult, Constipation, Dumping Syndrome, Duodenum, Female, Humans, Obesity, Morbid, Laparoscopy, Postoperative Complications, Reoperation, Gastric Bypass
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