Reversal - Takedown 

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Reversal on gastric bypass and DS/BPD surgery

People researching gastric bypass surgery or duodenal switch surgery should realize that despite what some might tell them, these procedures PERMANENTLY change the configuration of your digestive system and can be complex to reverse!

Although lay people refer to undoing a weight loss surgery as "reversal", medical providers generally call it a "takedown".  Takedown on gastric bypass is not an easy task but quite often, is necessary because of complications or repercussions of surgery such as hypoglycemia, malnutrition etc and in many cases, insurance will cover a takedown.   In the takedown on the gastric bypass, the separated small pouch is re-attached to the bypassed stomach - this establishes a more normal digestion and gives the patient the same effect of the old Vertical Banded Gastrectomy (VBG). What makes the surgery more complex is that there is likely some necrotic tissue in the small bowel which they also, at the time of takedown, remove. A takedown on a gastric bypass looks similar to the graphic below.

In the UK, take-downs are routinely done, 1-2 years after a gastric bypass and I've known many takedown patients in the USA, who felt immediately better upon waking up after their surgeries and are still living an active and happy life today.  Because there still is restriction on what a person can eat, despite how some surgeons try to scare patients away from takedowns (in the USA), I have never known a patient to gain much or any weight after a gastric bypass takedown because there is still restriction on what they can eat.

There is no way to reverse a Duodenal-Switch surgery because in this surgery, the stomach is 80 to 90%, reduced to a small pouch and the excess is removed from the body.  However, they can revise a Duodenal Switch surgery by lengthening the amount of small bowel connected (called the "common channel"), so as to effect better absorption... this revision procedure has often saved a life.  Duodenal Switch surgery is no longer done often, in the USA due to the high rate of malabsorption and malnutrition in patients.  Last I checked less than 25% of surgeons did the duodenal switch and that number is probably less now.  The Duodenal Switch was a modification of the old Bileo-pancreatic diversion or (BPD) invented by Dr Scopinaro in the 1960's.

As Dr Flancbaum stated in his book, DOCTOR'S GUIDE TO WEIGHT LOSS SURGERY, the Duodenal switch or DS procedure creates permanent structural changes in the digestive tract.  Dr Terry Simpson of Phoenix, AZ, a WLS Surgeon who used to do the Duodenal Switch surgery until, in the 1990's he stopped doing that procedure in favor of the Adjustable Lap Band, agrees.  "It's like remodeling your house. We can take down parts of it but basically it's not reversible."  Dr Simpson added at a recent seminar "Some people ask 'can't you just take the staples out?'  (like you can unstaple your newspaper!)" 

Additionally, few WLS surgeons care to do reversals for various reasons among which I suspect, would be admitting that a percentage of patients become ill after WLS,  although often when asked by pre ops about reversal 'just in case' they assure the pre op that reversal is easy and say that they would do it. "But," say many, "I've never had to do one of these." 

The patient may end up thinking that reversals are never needed but there is definitely strong evidence to the contrary.  And many WLS surgeons say they have never done a reversal, not because it wasn't needed but because they had chosen to not become involved in reversals.   According to one nurse who lived in the UK, some hospitals outside the United States, takedown gastric bypass surgery after a year or two, in order to avoid long term vitamin deficiencies.  At the hospital my DH stayed after his third stroke, I found out there is an entire floor dedicated to patients with gastric bypass repercussions...

Dr Elliot Goodman, an excellent highly skilled bariatric surgeon, located in NYC, does reversals and revisions.

To find who does reversals and revisions in your area, it's a case of calling different surgeons until you find one who is willing.  If your WLS is causing illness, it's worth doing.


A Doctor's Guide to Weight Loss Surgery by Flancbaum, MD

Dr Terry Simpson - Dr. Simpson Web Site  Dr Simpson has also done reversals and revisions.

Phone numbers of other docs who have done reversals

Dr. Miles Weaver in Pittsburgh, PA 1-866-579-6759 click on option 4 hospital office
regular office number is: 412-359-6668

Dr. Huse, in Carmel Indiana. 317-814-4590

Dr. Kuhner in Marshfield, Wisconsin 1-800-782-8581

As I understand, Dr Davis in Houston (the surgeon featured on "BIG MEDICINE" TV show) also does takedowns on gastric bypass.