Conclusions
Although two different metabolic principles underlie the DJOS and DIOS operation, performing loop duodeno-enterostomies with sleeve gastrectomy essentially breaks down bariatric surgery into exactly these two distinct elements, leaving the possibility for individual adaptation. The early results of this small and heterogeneous series most importantly show no mortality and no complication related to the duodeno-enterostomy. Pylorus-preserving duodeno-enterostomies with sleeve gastrectomy may open new technical alternatives in bariatric surgery. If the DJOS and DIOS operations prove to be beneficial will have to be evaluated in randomized controlled trials.