This technique is used since 1976, and is popular in Europe (especially in Italy). The main principle of this technique is to inhibit the absorption of fat and starch. The size of the created new stomach is bigger than in other surgery techniques. Only the distal 2/3 part of the stomach is removed and the remaining stomach is stitched at a site 250cm distant to the ileocaecal junction, where the intestine is connected to the colon. The bypassed part of the intestine is stitched to a site 50cm distant to the ileocaecal junction. As the absorption is impaired more than in gastric bypass, the patient should necessarily consume nutritional products to prevent the insufficiency of vitamins, minerals, iron, calcium, and especially protein and a proper follow-up program is needed.
In the USA, the duodenal switch technique was proposed as an alternative to the biliopancreatic diversion. In this technique, the stomach is vertically cut like in sleeve gastrectomy and the proximal part of the duodenum is preserved without bypassing. The success rate of this technique, after which Dumping syndrome and less impairment of the iron absorption are expected, is comparable to BPD.