Background

Duodenal Switch is a proven and effective bariatric operation with excellent weight loss and comorbidity resolution. As an alt-absorptive procedure, this approach carries risk of significant nutritional deficiency, including protein calorie, fat soluble vitamin, and mineral malnutrition. The roux bypass portion of the operation is amenable to revision to address these complications. Revision approaches included divided limb lengthening, kissing anastomotic limb lengthening, as well as complete reversal. This video discusses the indications for limb length revision, demonstrates the divided limb lengthening technique, and reviews the underlying clinical reasoning behind increasing both total alimentary limb length and common channel to recapture absorption.