Background

A possible cause for nutritional complications after duodenal switch may be due to the variability in total bowel length (TBL). Most surgeons performing this procedure use a pre-determined standard length for all patients without measuring TBL. In recent years, we began performing TBL measurements in all patients with 40% of the TBL used as the length for the common channel. At our institution, we have seen a significant decrease in reoperation and nutritional complications since implementing this practice. Thus, we present the practice of using TBL measurements to evaluate the common channel length during a reoperative single anastomosis duodenal switch.

Methods

A case study is presented of a 56-year-old male with who underwent a single anastomosis duodenal switch in 2020. Postoperatively, he lost over 140 pounds and was suffering from severe diarrhea and protein calorie malnutrition. We returned to the operating room approximately 1 year later for a robotic small bowel resection with lengthening procedure.

Results

A video of a small bowel resection with common channel lengthening procedure is presented. The patient tolerated the procedure well and there were no complications. His symptoms significantly improved, and his protein calorie malnutrition has resolved.

Conclusions

Since becoming our standard practice, reoperations and nutritional complications have substantially decreased by using TBL measurements to calculate the common channel length. Surgeons should consider using TBL measurements to calculate common channel length in single anastomosis duodenal switches.