Recently, we have noted that numerous of our gastric bypass patients have gained weight and complained of increased hunger between meals. This was prevalent when eating refined carbohydrates. We studied glucose tolerance testing. We found a very high incidence of reactive hypoglycemia. As a result, we have begun to preform opeations such as the duodenal switch, where the pyloric valve is preserved.

The purpose of this video is to show the technique of the laparoscopic duodenal switch. Important aspects are an appropriated sleeve that we titrate over a 38 bougie and oversew, a separate dissection of the pylorus with adequate length of about 5 cm, and a minimum common channel of 125 cm. The duodenal enteral anastomoses is handsewn in two layers.

We have perfomed 36 ds operations this year, with 30 being on super morbidly obese patients without mortality.

We believe that rapid emptying of the non valved gastric bypass leads to reactive hypoglycemia and weight gain after the first year. It is our contention that preservation of the pyloric valve, the thinest area of the gi tract, will provide for better long term outcomes. This operation does not need to be severely malabsorbtive. We conclude that pyloric preservation will become a standard priciple in bariatric surgery in years to come.