Background

Malnutrition and liver failure after Duodenal switch (DS) are possible and undesired complications, often conservatively treated. However, in specific cases, surgical revision may be necessary. This study aims to describe outcomes achieved by two bariatric surgery centers and initially address effectiveness and safety of revisional surgical procedures to resolve these complications.

Methods

A retrospective chart review was performed in two bariatric surgery centers from 2008 to 2021. Patients who required revisional surgery to treat malnutrition and/or liver failure refractory to nutritional and total parenteral nutrition intervention after duodenal switch were included. No comparisons were performed due to the descriptive nature of this study.

Results

Thirteen patients underwent revisional surgery, mean age was 44.7, 53.8% were females, mean preoperative BMI was 53.7; mean time between DS and revisional procedure was 26.5 months, 69.1% of patients underwent TPN, 7% (1 patient) developed hepatic encephalopathy, 1 patient presented with ascites, pleural effusion, renal insufficiency, undergoing reoperation after revisional procedure due to a perforated ileal loop. Mortality rate was 0%; all patients regained weight after the revisional procedure and mean total protein and albumin blood levels 12 months after surgery were 6.3 and 3.6 g/dl.

Conclusions

While refractory malnutrition and/or liver failure are rare among patients post DS, if underdiagnosed and untreated can lead to irreversible outcomes and death. All revisional procedures included in this study resulted in improvement of the nutritional status and reversal of liver failure, with low complication rates.