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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.

and Jehovah's Witness. She had a prior gastric banding which was removed and then had a sleeve. She had lost weight well but regained to her current BMI. After extensive dietary counseling and follow up,a revisional procedure was offered. Part of the preoperative workup included esophagram and upper endoscopy. After review of the available data with the patient, a single anastomosis duodenoileostomy with partial gastrectomy was offered. The video shows the technical details of the procedue.

Biliopancreatic diversion with duodenal switch is primarily a malabsorptive procedure. It consists of a combination of sleeve gastrectomy and biliopancreatic diversion (Obes Surg 8, 267–82, 1998; World J Surg 22, 947–54, 1998), and it can be performed in two steps (Surg Obes Relat Dis 7, 703–8, 2011). A Roux-en-Y limb is anastomosed to the first part of the duodenum at one end and to the transected small bowel some 75–100 cm proximal to the ileocecal valve at its other end. The mechanism of weight loss after duodenal switch is double: 1. Sleeve gastrectomy ensures restriction in the amount of calories taken by the mouth. 2. The functional shortening capacity of the small bowel reduces the absorption capacity of the latter since the exchange surface is smaller. Moreover fat can only be digested once the biliary and pancreatic juices are mixed with the food, which obviously occurs only quite distally. Different types of laparoscopic duodenoileostomy and jejunoileostomy are described in this chapter. The chapter is finally written to allow the reader to perform the laparoscopic duodenal switch step by step.

loop from the angle of Treitz), with an end-to-side gastrojejunostomy, followed by another loop for the enteroanastomosis with the alimentary limb (100‐120 cm) of the first omega loop. Both anastomoses are tested with methylene blue solution, and the limb connecting them is transected to establish the Roux-en-Y. For the simplified laparoscopic duodenal switch, the omega loop begins at the ileocecal valve, from which the ileum is measured to 100 cm, plus an additional to 200 cm from that (150 cm for patients with a body mass index 50 kg/m 2 [super obese] and 200 cm for patients with a body mass index 50 kg/m 2 [morbidly obese]), with the intention of having fewer possible nutritional complications in the morbidly obese patients. The omega-shaped loop is connected with the duodenum as a duodenoileostomy, and a second loop is made, connecting the ileum measured at 100 cm to the bileopancreatic limb of the first omega loop to create the enteroanastomosis. As with the gastric bypass approach, both anastomoses are tested with methylene blue solution, and the limb connecting them is transected to establish the Roux-en-Y.