Obesity Surgery

, Volume 29, Issue 10, pp 3358–3359 | Cite as

DJ Flexure Pathologies—a Case for a Bowel-First Approach in Gastric Bypass Surgery

  • Sarah Powell-BrettEmail author
  • Martin Richardson
  • Rishi Singhal
Letter to the Editor

Dear Editor,

Roux-En-Y gastric bypass is one of the most commonly performed bariatric procedures worldwide. Despite consensus regarding the overall anatomical configuration, there continues to be two schools of thought with regard to the order of procedure steps: ‘bowel-first’ approach or ‘pouch-first’ approach. Our unit is in a unique position with an equal mix of surgeons doing both the techniques. There continues to be a dialogue regarding which technique is superior. We’ve thus put together some of our experiences to finally put this controversy to rest.

Duodenojejunal (DJ) flexure and proximal small bowel pathologies are not uncommon. Over the last five years, we have encountered paraduodenal hernias, DJ flexure gastrointestinal stromal tumours (GISTs), ectopic pancreas, and malrotation as incidental findings during this procedure. Paraduodenal hernia is the commonest type of internal hernia (accounting for more than 50% of all internal hernias) [1] and can be either left- or...


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Birmingham Heartlands HospitalBirminghamUK

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