Duodeno-enteral omega switches - more physiological techniques in metabolic surgery

Abstract

Introduction: In bariatric surgery, still new surgical techniques are developed. On the one hand, the Roux-en-Y gastric bypass (RYGB) is one of the most common procedures used. However, many patients experience dumping syndrome or pain due to bile reflux. On the other hand, revisions after gastric banding are frequent and may be technically challenging.

Aim: To create a new bariatric procedure counterbalancing the drawbacks of conventional RYGB, also suitable as a redo option after gastric banding.

Material and methods: To diminish the complication rate and pathophysiological disadvantages in reoperations after gastric banding, we primarily combined a gastric plication (GP) with a single anastomosis duodeno-ileal omega switch (DIOS), bypassing 2/3 of the total bowel length. Further on, in patients with lower body mass index we combined a GP or LSG and laparoscopic sleeve gastrectomy with a duodeno-jejunal omega switch (DJOS), performing an end-to side anastomosis after 1/3 of the total bowel length.

Results: The DIOS and DJOS techniques restrict food intake and bypass the duodenum and part (DJOS) or the whole (DIOS) jejunum. Restriction is achieved either through gastric plicature or conventional sleeve gastrectomy.

Conclusions: Similar bariatric and metabolic effects to proximal RYGB are expected in the case of DJOS, or to a conventional duodenal switch when performing a DIOS procedure. Performing a gastric plicature will reduce the risk of gastric leak when revising patients after failed gastric banding.

Keywords: Roux-en-Y gastric bypass; SADI-S; bariatric surgery; biliopancreatic diversion; gastric plication; laparoscopic sleeve gastrectomy.

Photo 1

Gastric plication before the second layer of 3-0 V-Loc™ sutures is applied. The Biosyn 3-0 single sutures can also be used technically as holding sutures

Figure 1

Diagram of a duodeno-jejunal omega switch with gastric plication (DJOS-GP, A) and a duodeno-ileal omega switch with gastric plication (DIOS-GP, B)

Figure 2

Diagram of a duodeno-jejunal omega switch with sleeve gastrectomy (DJOS-SG, A) and a duodeno- ileal omega switch with sleeve gastrectomy (DIOS-SG, B)

Photo 2

Duodenoenterostomy with 3-0 V-loc™ continuous sutures creating a double-layer anasto mosis on the back side

Photo 3

Final aspect of a gastric plication combined with a duodenoenterostomy