Duodenal switch: Fully stapled technique

Abstract

Background: Duodenal switch and single anastomosis modifications continue to gain greater interest among bariatric surgeons. Limiting factors to adoption include concerns around the nutritional management, patient compliance and follow-up, and the technical challenge of the operation. The majority of techniques offered currently use a hand-sewn duodenoileostomy. This approach is limited by the steep learning curve as well as longer operating times.

Objectives: We present a video demonstrating the fully stapled technique for duodenoileostomy and ileileostomy. We offer technical pearls around the technique, specifically focused on maintaining a widely patent anastomosis, open biliopancreatic limb, safe duodenal dissection, and correct loop orientation.

Methods: Laparoscopic fully stapled duodenoileostomy for duodenal switch and single anastomosis modification.

Setting: Community hospital, single institution, 3 surgeons.

Conclusion: Triple staple offers a reproducible and safe technique for the duodenoileostomy and specifically for construction of a Roux or loop anastomosis in duodenal switch.

Keywords: Bariatric surgery; Duodenal switch; Malabsorption; Metabolism.