Metabolic duodenal switch proposal of a modification for metabolic surgery

The duodenal switch was described in 1998. Its popularity increased after Michel Gagner's first laparoscopic case in 2000.

The surgical anatomy of the duodenal switch is much better and appealing for the surgeon. One of the important points of this technique is that it makes it possible to maintain the pylorus.

This technique is associated with less restriction than gastric bypass and avoids the dumping syndrome associated with RYGBP. On the other hand, duodenal preservation avoids the calcium and iron deficiencies associated with RYGBP.

The main complications of the duodenal bypass are nutritional, using 250 cm as the alimentary limb and 100 cm as the common channel. The hardest part of the surgery is the intestinal part. For this reason, it is important to measure the entire length of the bowel. Dr. Kawahara explains that in his experience 50% of the entire bowel should be used as the alimentary limb and 25% as the common limb".

In Dr. Kawahara’s experience a common limb longer than 150 cm is required to avoid malnutrition. Our results show a 100% remission rate in DM2 and any kind of malnutrition at 6 years.

Dr. Kawahara advocates for the use of the duodenal switch rather than RYGBP for treatment of sleeve gastrectomy failure. His team now apply this technique with no exclusions and with no malnutrition.