腹腔镜十二指肠切除术

A Swedish Laparoscopic Duodenal Switch
The SOFY-procedure

                               
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Introduction:
The laparoscopic duodenal switch is a standard procedure for morbid obesity with excellent results concerning weight loss, maintenance of weight and resolution of comorbidities.
Different variations of the procedure are described in the literature with variable lengths of the limbs and anastomosis techniques.
At Torsby Hospital in Sweden, a regional bariatric center, duodenal switch operations have been performed since 2010.
Inspired by the gastric bypass technique according to publications by Hans Lönroth from Gothenburg, a novel procedure for duodenal switch has been developed: The SOFY Duodenal Switch. The name refers to the chronology of performing the anastomoses: Starting as an Omega-loop, Finished as roux-en-Y.

Method:
The SOFY Laparoscopic Duodenal Switch procedure is illustrated in a videopresentation.

Results:
The main issues of the SOFY Duodenal Switch are the way how to create the duodenoileal anastomosis (DIA), the arrangement of the common channel (CC), the alimentary limb (AL) and the biliary limb (BPL) and the construction of CC-BPL anastomosis.
The sleeve gastrectomy is performed as a standard procedure with the division of the duodenum 3 cm distally of the pylorus.
The CC is measured in 10-cm steps for 100 cm from the ileocecal valve. The location of the CC-BPL anastomosis is marked with two sutures. The AL is measured for 150 cm, the location for the DIA is marked with a suture. The bowel is brought into an antecolic position and placed closely to the postpyloric duodenum as an omega-loop. The DIA is created as an end-to-side anastomosis completely handsewn. The ileum with the marked location for the CC-BPL anastomosis is positioned closely to the BPL six centimeters proximal to the DIA. A side-to-side CC-BPL anastomosis is performed. By dividing the bowel between the two anastomosis the omega-loop-construction is transformed into a Roux-y construction. The mesenteric defects are closed.


Conclusion:
In our experience, the SOFY Duodenal Switch with an omega-loop transferred to a Roux-y construction is the most feasible procedure regarding operating time, overview of the anatomically correct positioning of the different limbs and the surgical workflow. The closure of the mesenteric defects is facilitated.