FIGURE 4. Conversion from RYGB to jejunal interposition with subtotal gastrectomy - Branco switch: A) schematic illustration of the conversion for therapy of severe hypoglycemia after RYGB; the primary objective is transforming the RYGB and restoring the continuity to the duodenum through a jejunal interposition and subtotal gastrectomy; B) performing a pylorus-preserving gastrectomy at 2-4 cm of remaining antrum and, finally, the alimentary limb is resected at 20 cm from the gastrojejunal anastomosis till the Y-Roux anastomosis; C) the 20 cm remaining alimentary limb becomes a handsewn anastomosis to the rest of the antrum and the Y-Roux is closed by a stapler to finalize the resection of the alimentary limb.