[Maintenance of duodenal passage--yes or no?]

The importance of the duodenal passage in gastric surgery is still unknown. Most gastric procedures exclude the duodenum from food passage without severe postoperative problems. Based on our own studies we are able to demonstrate the importance of the duodenal passage for glucose homeostasis. Since most primary surgical procedures with duodenal anastomoses result in a higher operative risk, the procedures should not be used in primary gastric surgery. In dumping syndrome, however, restoration of the duodenal passage is a very effective surgical treatment.