Roslin Mitchell, MD, FACS, Andrew R Brownlee, MD, Yuriy Dudiy, MD. Lenox Hill Hospital.
For years the mechanisms of action for bariatric procedures were considered to be restriction and malabsorption. Recently, it has been found that hormonal changes such as reduction of ghrelin, or increased PYY and incretins are involved in hunger suppression and satiety. As a result, a procedure that could achieve ghrelin suppression, stimulate L cells by having food enter the distal intestine, preserve the pyloric valve to control emptying and reduce the technical difficulty of the classic Duodenal Switch could be an attractive alternative.