title: Duodeno-enteral omega switches - more physiological techniques in metabolic surgery.
abstract: BACKGROUND
  In bariatric surgery, still new surgical techniques are developed. On the one hand, the Roux-en-Y gastric bypass (RYGB) is one of the most common procedures used. However, many patients experience dumping syndrome or pain due to bile reflux. On the other hand, revisions after gastric banding are frequent and may be technically challenging.
  
  
  OBJECTIVE
  To create a new bariatric procedure counterbalancing the drawbacks of conventional RYGB, also suitable as a redo option after gastric banding.
  
  
  METHODS
  To diminish the complication rate and pathophysiological disadvantages in reoperations after gastric banding, we primarily combined a gastric plication (GP) with a single anastomosis duodeno-ileal omega switch (DIOS), bypassing 2/3 of the total bowel length. Further on, in patients with lower body mass index we combined a GP or LSG and laparoscopic sleeve gastrectomy with a duodeno-jejunal omega switch (DJOS), performing an end-to side anastomosis after 1/3 of the total bowel length.
  
  
  RESULTS
  The DIOS and DJOS techniques restrict food intake and bypass the duodenum and part (DJOS) or the whole (DIOS) jejunum. Restriction is achieved either through gastric plicature or conventional sleeve gastrectomy.
  
  
  CONCLUSIONS
  Similar bariatric and metabolic effects to proximal RYGB are expected in the case of DJOS, or to a conventional duodenal switch when performing a DIOS procedure. Performing a gastric plicature will reduce the risk of gastric leak when revising patients after failed gastric banding.
authors: University of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
authors: W Konrad
authors: WK
authors: Karcz
authors: Department of General and Visceral Surgery, University of Freiburg, Freiburg, Germany.
authors: Simon
authors: S
authors: Kuesters
authors: Department of General and Visceral Surgery, University of Freiburg, Freiburg, Germany.
authors: Goran
authors: G
authors: Marjanovic
authors: Department of General and Visceral Surgery, University of Freiburg, Freiburg, Germany.
authors: Jodok M
authors: JM
authors: Grueneberger
keywords: Roux-en-Y gastric bypass; SADI-S; bariatric surgery; biliopancreatic diversion; gastric plication; laparoscopic sleeve gastrectomy