Post-bariatric surgery hypoglycemia is a rare and challenging complication. Restoration of the normal anatomy with gastro-gastric anastomosis has been tried with risk of weight regain. We present jejunal interposition permitting nutrient flow through pylorus and duodenum (‘Branco-Zorron Switch’) restoring the normal gastrointestinal hormonal mechanisms, while maintaining weight control. Surgery started with identification of the gastro-jejunostomy and all limbs measuring: alimentary limb: 90cm; biliopancreatic limb: 90cm and common limb: 275cm. Excluded stomach was resected, preserving 3cm of distal antrum; then, resection of the alimentary limb from 20cm of the gastro-jejunostomy down to the Y-jejuno-jejunal anastomosis and finally an handsewn end-to-end jejunal-antral anastomosis was performed (Fig. 1, Video) This jejuno-antral anastomosis is a much simpler procedure with less potential postoperative complications than gasto-gastric anastomosis.
After 9 months follow-up, patient had no further hypoglycemic episodes and did not experienced food intolerance, nor any other complications.
FundingThere were no grants provided for this study.
