The biliopancreatic diversion with duodenal switch combines restriction and malabsorption. Excessive diarrhea, weight loss, or malabsorption are late complications that can be indications for revision. This video involves a 39 year old white female who had previously undergone an uncomplicated laparoscopic DS. Her initial BMI was 50, and her common channel was made 80cm with an alimentary limb of 260cm. After three years her BMI was 27, but she struggled against deficiencies of the fat soluble vitamins and iron (though not protein) despite maximal supplementation and compliance.

Our mutual plan was to functionally reverse her severe malabsorption with a laparoscopic jejuno-ileostomy, making a stapled anastomosis between the proximal alimentary and biliopancreatic limbs with mesenteric closure. The operation required three 12mm ports and one 5mm port.

Intraoperatively, limb lengths were slightly longer than expected. Hospital stay was two nights. Recovery was rapid, with significant improvement in vitamin and iron levels, and without excessive weight regain. Frequency of bowel movements was significantly reduced.

Late malabsorptive complications of the DS procedure can be managed laparoscopically. Functional reversal of malabsorption can be achieved with proximal jejuno-ileostomy.