Experience with the duodenal switch operation in the presence of intestinal malrotation.

The presence of intestinal malrotation (IM) may pose unexpected problems during bariatric operations. We reviewed the records of patients with IM undergoing bariatric operations at our institution over the last 5 years. Three patients underwent four procedures. These included an open duodenal switch, an attempted laparoscopic gastric bypass with open duodenal switch as a second-stage procedure, and lastly a laparoscopic robot-assisted duodenal switch. All patients have had good outcomes. The key anatomic principles of a tension-free duodeno-enterostomy and maintaining appropriate orientation at the distal enteroenterostomy are emphasized.