CONVERSION OF GASTRIC BYPASS (RYGB) TO ILEAL INTERPOSITION Long Version

Revisional Surgery for Failed Gastric Bypass: Conversion to Ileal Interposition

The worldwide highest frequency of performing Roux-Y Gastric Bypass (RYGB), encounters increased demand for revision for either failure of maintaining adequate weight loss or weight regain.

The reason of failure to maintain weight loss or weight regain after sufficient weight loss might be in two different ways:

1. Patient Related (Eating Disorders, Eating Malhabitus etc.)
2. Procedure Related
a. Gastro-gastric Fistula
b. Gastric Pouch Enlargement
c. Anastomotic (Gastrojejunostomy) Enlargement

Revision Options for Failed Gastric Bypass
1.Endoscopic Interventions (Stomphx etc.)
a. Endoscopic plication of pouch walls
b. Endoscopic plication of G-J Anastomosis
2.Gastric Pouch Resections and re-shaping
3.Gastro-Jejunal Sleeve Resection
4.Take down G-J and Re-anastomose
5.Take down the Jejunojejunal anastomosis and distal re-anastomose
6.Conversion to normal anatomy and then to sleeve gastrectomy
7.Conversion to Biliopancreatic Diversion
8.Conversion to Duodenal Switch
9.Conversion to Ileal Interposition

The former revision methods between 1-6 may offer partial and short term benefit for weight management and metabolic control. However Biliopancreatic Diversion and Duodenal Switch are the most powerfull revisions for failed gastric bypass. At the same time duodenal switch is technically the most difficult and advanced procedure.

Ileal Interposition Surgery
Ileal Interposition is a new approach to metabolic surgery. A distal 1.7 m ileal (the last part of small intestines) segment is prepared and placed at the very proksimal part of small intestines. When the distal ileal segment is interposed after stomach, the raw food enters directly to the very most distal part of the small intestines and stimulates a strong GLP-1 secretion. This hormonal stimulation is more stronger than BPD or BPD/DS and forms an hormonal satiety called "ileal brake". By this hormonal stimulation, patients experience extreme feeling of satiety leading to strong caloric restriction. Besides apetite supression, strong GLP-1 effect (The Ileal Brake effect), also provokes the activity of beta cells at pancreas and stimulates GLUT-1 and GLUT-2 receptors at muscle cells, which results as promt resolution of insulin resistance.

Ileal Interposition is purely a "non-malabsorptive" procedure. In other words, non of the patients has to use vitamin or mineral pills after one year. Short term (6-8 months) low dose (one a day) multivitamines are used to support the extreme satiety related oral intake insufficiency. After 6-8 months majority of patients stop taking these supps.


The patient was a 35 years old female. Previous RYGB was performed at 2009 with 43 kg/m2 BMI. Her lowest BMI was 24.5 kg/m2. She gained more than 30 kg at last 7 months with an increase of 10 in BMI.
BMI prior to revision was 34.5 kg/m2. After 6 months she had reached to 24 kg/m2 and preserving the weight loss without any medication so far.

Ileal Interposition may be a powerful alternative to Duodenal Switch without any malabsorption. Ileal Interposition may be a safe and effective option for patients who are aware of life-time supplementation.

The short version of this video is presented as "video presentation" at IFSO 2013 World Congress at Istanbul, TURKEY.

DiaSurg Metabolic Surgery Team is an experienced and skilled surgical team mainly focused on Duodenal Switch and Ileal Interposition. Especially for revision of failed RYGB and Mini-Gastric Bypass procedures, we recommend durable and effective solutions.

Tugrul Demirel M.D.
Bariatric-Metabolic Surgeon
DiaSurg Metabolic Surgery -- Istanbul/TURKEY

www.diasurg.com