Simultaneous pancreas and left kidney transplant was performed by first placing the pancreatic graft in the right lower intraperitoneal cavity, with vascularization on the recipient's right common iliac axis and a duodenoenterostomy for the exocrine drainage.
The addition of the duodenal switch (DS), in which a vertical sleeve gastrectomy is combined with a duodenoenterostomy, was termed the "second generation BPD" [15].
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