Laparoscopic duodenal switch for pathologic duodenogastric reflux: initial experience.

Duodenogastric reflux (DGR) is barely responsive to medications and antireflux fundoplication is not able to control the gastric symptoms. Duodenal switch (DS) preserves the physiologic food transit while creating an effective Roux-en-Y diversion to duodenal juice. However, it never enjoyed great popularity, perhaps due to the invasiveness of the open approach. The paper reports our initial experience with laparoscopic DS. Preoperative assessment, surgical technique, and outcomes are described. Normalization of DGR was demonstrated by preoperative and postoperative 24-hour bilimetry and pH-multichannel intraluminal impedance. The procedure was completed under laparoscopy in all the cases with a mean operative time of 165 minutes. Mean blood loss was 200 mL. No patient required admission to the intensive care unit. Initial experience with laparoscopic DS encourages continued use of the minimally invasive approach. A meticulous preoperative evaluation is essential to place a correct indication.