700 Obesity Surgery, 15, 2005 © FD-Communications Inc. Obesity Surgery, 15, 700-702 A simplified technique to perform the duodeno-enter- al anastomosis in the duodenal switch is presented. A linear stapled duodeno-jejunal side-to-side anasto- mosis is performed. The technique is easy and rapid to perform, avoids passing an anvil through the mouth of the patient and is safe for the patient, with satisfactory short-term results. Key words: Duodenal switch, stapled anastomosis, side- to-side anastomosis, morbid obesity Introduction Duodenal switch is a bariatric procedure with some advantages for selected patients when compared to gastric bypass. It provides excellent weight loss 1-3 with less volume restriction than gastric bypass, which makes a modification of eating habits unne- cessary. 2 The preservation of the gastric antrum and pylorus avoids dumping syndrome, and the absence of a bypassed stomach allows endoscopic access to the whole organ. The technique can be performed with acceptable morbidity and mortality rates, 3,4 and many groups are performing it laparoscopically with good results. The Achilles’ heel of the duode- nal switch is the duodeno-intestinal anastomosis, from which most of the severe complications origi- nate, with a failure-rate between 1.2% and 5%. 5-7 We present a technique to perform this anastomosis easily, based on the application of the linear endo- scopic stapling device. Surgical Technique After devascularization and resection of the greater curvature of the stomach, the first portion of the duo- denum is dissected. The continuation of the greater curvature of the stomach is devascularized from the pylorus down to the division line, which is placed approximately 4 cm from the pylorus. The right side or the lesser curvature of the duodenum is scarcely touched, aiming to preserve its whole vascularization. The duodenum is sectioned with the linear stapler Endo-GIA Universal ® 60, blue cartridge (3.5 mm) (United States Surgical, Tyco Healthcare Group LP, Norwalk, CT, USA). The distal duodenal stump is not oversewn. We perform a variant of the duodenal switch similar to that described by Larrad et al 8-10 for the Scopinaro’s procedure, i.e. the intestinal division is performed 50 cm distal to the ligament of Treitz to ensure a long alimentary limb. The distal end of the jejunum is brought up antecolic, to be anastomosed to the proximal end of the duodenum. This ascended loop is placed under the sectioned proximal duode- num at right angles, and an opening is made into each of the structures with the harmonic scalpel. The lin- ear stapler device endoGIA Universal Roticulator ® Modern Surgery: Technical Innovation “Right-Angled” Stapled Latero-lateral Duodeno- jejunal Anastomosis in the Duodenal Switch Andrés Sánchez-Pernaute, MD, PhD; Elia Pérez-Aguirre, MD, PhD; Luis Díez-Valladares, MD, PhD; Alvaro Robin, MD; Pablo Talavera, MD; Miguel Angel Rubio, MD, PhD; Antonio Torres García, MD, PhD, FACS III Department of Surgery, Hospital Clínico San Carlos, Madrid, Spain Reprint requests to: Andrés Sánchez-Pernaute, MD, PhD, Servicio de Cirugía III, 7ª planta, ala Norte, Hospital Clínico San Carlos, c/Martín Lagos s/n, 28040 Madrid, Spain. Fax: + 91 330 3183; e-mail: asanchezp.hcsc@salud.madrid.org