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Ponce de Leon-Ballesteros G, Romero-Velez G, Higa K, Himpens J, O' Kane M, Torres A, Prager G, Herrera MF. Single Anastomosis Duodeno-Ileostomy with Sleeve Gastrectomy/Single Anastomosis Duodenal Switch (SADI-S/SADS) IFSO Position Statement-Update 2023. Obes Surg 2024:10.1007/s11695-024-07490-0. [PMID: 39264553 DOI: 10.1007/s11695-024-07490-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 06/28/2024] [Accepted: 08/28/2024] [Indexed: 09/13/2024]
Abstract
The single anastomosis duodeno-ileostomy with sleeve gastrectomy/single anastomosis duodenal switch (SADI-S/SADS) has gained attention as an alternative to the traditional biliopancreatic diversion with duodenal switch (BPD-DS). In 2021, IFSO endorsed SADI-S/SADS as a safe and effective procedure, underscoring the necessity for long-term multidisciplinary care and randomized controlled trials (RCTs). A task force was established to conduct a systematic review of current evidence on SADI-S/SADS to guide clinical practice. A systematic review was conducted across three databases, focusing on studies examining SADI-S/SADS and its outcomes. A total of 93 studies were analyzed. SADI-S/SADS demonstrated efficacy in weight loss and medium-to-long-term control of type 2 diabetes mellitus (T2DM), along with positive outcomes regarding hypertension and hyperlipidemia. However, its impact on other comorbidities remains inconclusive. Frequent nutritional deficiencies were identified, particularly in fat-soluble vitamins, anemia, and hypoalbuminemia. Despite significant efforts, high-quality evidence on SADI-S/SADS remains scarce, prompting IFSO to advocate for increased registry participation, publication of long-term studies, and more RCTs. Lifelong supplementation and monitoring for nutritional deficiencies are recommended. The current position statement will be reviewed in 2 years.
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Affiliation(s)
| | - Gustavo Romero-Velez
- International Federation for Surgery of Obesity and Metabolic Disorders, Naples, Italy
| | - Kelvin Higa
- International Federation for Surgery of Obesity and Metabolic Disorders, Naples, Italy
| | - Jacques Himpens
- International Federation for Surgery of Obesity and Metabolic Disorders, Naples, Italy
| | - Mary O' Kane
- International Federation for Surgery of Obesity and Metabolic Disorders, Naples, Italy
| | - Antonio Torres
- International Federation for Surgery of Obesity and Metabolic Disorders, Naples, Italy
| | - Gerhard Prager
- International Federation for Surgery of Obesity and Metabolic Disorders, Naples, Italy
| | - Miguel F Herrera
- International Federation for Surgery of Obesity and Metabolic Disorders, Naples, Italy.
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Si Y, Lin S, Guan W, Shen J, Liang H. Comparison of Sleeve Gastrectomy with Loop Duodenojejunal Bypass Versus One Anastomosis Gastric Bypass for Type 2 Diabetes: The Role of Pylorus Preservation. Obes Surg 2024; 34:2391-2398. [PMID: 38780835 DOI: 10.1007/s11695-024-07294-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND One anastomosis gastric bypass (OAGB) is recognized as a standard procedure in metabolic surgery. However, concerns about postoperative bile reflux and nutritional risks are prevalent. Comparatively, sleeve gastrectomy with loop duodenojejunal bypass (SG + LoopDJB) bypasses an equivalent length of the foregut as OAGB while maintaining pyloric function. The role of pylorus function remains to be further elucidated regarding these metabolic procedures' therapeutic outcomes and side effects. METHOD A retrospective study was conducted in our center to compare the surgical safety and 1-year outcomes of OAGB and SG + LoopDJB regarding type 2 diabetes mellitus (T2DM) remission, weight loss, gastrointestinal disorders, and nutritional status in T2DM patients matched by gender, age, and BMI. RESULTS The baseline characteristics were comparable between groups. Compared with OAGB, SG + LoopDJB had longer operative time and length of stay (LOS) but similar major postoperative complications. At 1-year follow-up, OAGB has similar diabetes remission (both 91.9%), weight loss effect (28.1 ± 7.1% vs. 30.2 ± 7.0% for %TWL), and lipidemia improvement to SG + LoopDJB (P > 0.05). However, OAGB presented a higher incidence of hypoalbuminemia (11.9% vs. 2.4%, P = 0.026) but a low incidence of gastroesophageal reflux disease (GERD) symptoms (9.5% vs. 26.2%, P = 0.046) than SG + LoopDJB. There was no statistical difference regarding other gastrointestinal disorders and nutritional deficiencies between groups. CONCLUSION Both OAGB and SG + LoopDJB show comparable, favorable outcomes in weight loss, T2DM remission, and lipidemia improvement at the 1-year follow-up. Pylorus preservation, while increasing surgical difficulty and the risk of de novo GERD, may reduce the risk of postoperative hypoalbuminemia.
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Affiliation(s)
- Yiming Si
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Shibo Lin
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Wei Guan
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - JiaJia Shen
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Hui Liang
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
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Huang CK, Hsin MC, Patel A, Katakwar A, Patel A, Yagnik VD. Reoperation After Loop Duodenojejunal Bypass with Sleeve Gastrectomy: A 9-Year Experience. Obes Surg 2024:10.1007/s11695-024-07348-5. [PMID: 38869832 DOI: 10.1007/s11695-024-07348-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/03/2024] [Accepted: 06/03/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE Loop duodenojejunal bypass with sleeve gastrectomy (LDJBSG) is effective for weight loss and resolution of obesity-related associated medical problems. However, a description of the reoperative surgery following LDJBSG is lacking. MATERIAL AND METHODS In this retrospective study, we analyzed the surgical complications and reoperation (conversion or revision) following LDJBSG from 2011 to 2019 in a single institution. RESULTS A total of 337 patients underwent LDJBSG during this period. Reoperative surgery (RS) was required in 10LDJBSG patients (3%). The mean age and BMI before RS were 47 ± 9 years and 28.9 ± 3.6 kg/m2, respectively. The mean interval between primary surgery and RS for early (n = 5) and late (n = 5)complications was 8 ± 11 days and 32 ± 15.8 months, respectively. The conversion procedures were Roux-en-Y gastric bypass(n = 5), followed by Roux-en-Y duodenojejunal bypass (n = 2) and one-anastomosis gastric bypass (n = 1); other revision procedures were seromyotomy (n = 1) and re-laparoscopy (n = 1). Perioperative complications were observed in four patients after conversion surgery such as multiorgan failure (n = 1), re-laparoscopy (n = 1), marginal ulcer (n = 1), GERD (n = 1), and dumping syndrome (n = 1). CONCLUSION LDJBSG has low reoperative rates and conversion RYGB could effectively treat the early and late complications of LDJBSG. Because of its technical demands and risk of perioperative complications, conversion surgery should be reserved for a selected group of patients and performed by an experienced metabolic bariatric surgical team.
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Affiliation(s)
- Chih-Kun Huang
- Department of Body Science and Metabolic Disorders International Medical Center, China Medical University Hospital, Yude Rd., North Dist, Taichung, Taiwan
| | - Ming-Che Hsin
- Department of Body Science and Metabolic Disorders International Medical Center, China Medical University Hospital, Yude Rd., North Dist, Taichung, Taiwan
| | - Anand Patel
- Departmentof Bariatric and Gastrointestinal Surgery, Noble Gastro Hospital, Ahmedabad, India.
| | - Abhishek Katakwar
- Department of Obesity and Metabolic Therapy, AIG Hospitals (Unit of Asian Institute of Gastroenterology), Hyderabad, India
| | - Apurva Patel
- Department of Laparoscopic and Bariatric Surgery, IRIS Hospital, Anand, Gujarat, India
| | - Vipul D Yagnik
- Department of Surgery, Banas Medical College and Research Institute, Palanpur, Gujarat, India
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Si Y, Lin S, Li C, Shen J, Guan W, Liang H. Comparison of Single Versus Double Anastomosis Bariatric Metabolic Surgery in Obesity: a Systematic Review and Meta-analysis. Obes Surg 2023; 33:3545-3564. [PMID: 37700148 DOI: 10.1007/s11695-023-06805-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 09/14/2023]
Abstract
Major BMS are modified through loop rather than Roux-en-Y type reconstruction recently, and this study systematically reviews the BMS from the perspective of SA (single anastomosis) and DA (double anastomosis) procedures, aiming to research the differences among bariatric procedures. A total of 39 studies compared SA- and DA-BMS were finally eligible for analysis after searching in PubMed, Web of Science, and Cochrane Library. Compared with DA, SA shortens operative time and decreases complications especially obstruction, internal hernia, and reoperation. SA-GB (gastric bypass) has significantly higher %TWL and T2DM remission rate than DA-GB 1- and 5-year postoperatively. SA-DS (duodenal switch) has similar 1-year %TWL and lower 5-year %TWL, and comparable 1- and 5-year T2DM remission with DA-DS. SA provides significant advantages about simplicity and safety. This, together with the shorter learning curve, makes SA a promising choice.
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Affiliation(s)
- Yiming Si
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Shibo Lin
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Cong Li
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - JiaJia Shen
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Wei Guan
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Hui Liang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
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Lin S, Li C, Shen J, Guan W, Liang H. Loop versus Roux-en-Y duodenojejunal bypass with sleeve gastrectomy for type 2 diabetes mellitus: short-term outcomes of a single-center randomized controlled trial. Surg Obes Relat Dis 2022; 18:1277-1285. [DOI: 10.1016/j.soard.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/28/2022] [Accepted: 07/06/2022] [Indexed: 10/31/2022]
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Li Y, Gu Y, Jin Y, Mao Z. Is Bariatric Surgery Effective for Chinese Patients with Type 2 Diabetes Mellitus and Body Mass Index < 35 kg/m 2? A Systematic Review and Meta-analysis. Obes Surg 2021; 31:4083-4092. [PMID: 34244912 DOI: 10.1007/s11695-021-05520-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 05/30/2021] [Accepted: 06/08/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Bariatric surgery has been applied for weight loss and comorbidity control in China since 2000. Recent studies have shown positive results for bariatric surgery in patients with a body mass index (BMI) of less than 35 kg/m2. However, the effect of surgery on Chinese patients with type II diabetes mellitus (T2DM) has not yet been systematically investigated. METHODS A comprehensive literature search was performed in the Cochrane Library, Embase, PubMed, and Web of Science from January 2014 to March 2020. All studies examined bariatric surgery outcomes on Chinese patients at 12-, 36-, and 60-month follow-up. The research followed the guidance of Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) recommendations. RESULTS Eleven studies containing 611 patients were included in this meta-analysis. Clinical indices at 12-, 36-, and 60-month follow-up were analyzed. Significant decreases were identified in body weight, BMI, waist circumference (WC), blood pressure (BP), fasting plasma glucose (FPG), glycosylated hemoglobin A1c (hemoglobin A1c, or HbA1c), triglyceride (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) postoperatively. An increasing trend in the T2DM remission rate was discovered. The remission group was observed to have significantly lower HbA1c and C-peptide level, a shorter duration of T2DM, and a higher BMI than the nonremission group at 12 months. CONCLUSIONS Bariatric surgery successfully provided significant BMI control as well as a reduction and normalization of glucose- and lipid-related metabolism at 12, 36, and 60 months postoperatively in Chinese patients with T2DM with a preoperative BMI of less than 35 kg/m2. An increasing trend in the T2DM remission rate suggested promising future applications in this population.
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Affiliation(s)
- Yichen Li
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215123, China
| | - Yijie Gu
- Department of Gastrointestinal Medicine, The First Affiliated Hospital of Soochow University, Suzhou, 215123, China
| | - Yujia Jin
- Department of Pulmonology and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, 215123, China
| | - Zhongqi Mao
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215123, China.
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Li C, Lin S, Liang H. Single-Anastomosis Duodenal Switch: Conceptual Difference between East and West. Obes Surg 2021; 31:3296-3302. [PMID: 33970394 DOI: 10.1007/s11695-021-05441-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 12/11/2022]
Abstract
Single-anastomosis duodenal switch (SADS) has become increasingly popular. This review compared the conceptual difference between Eastern (SADS-E) and Western (SADS-W) countries. After searching for SADS through PubMed and high-impact journals, 19 articles with 2280 patients were included for analysis. We found SADS-W was reserved for patients with a high body mass index (BMI) without type 2 diabetes mellitus (T2DM). Surgeons performing SADS-W used larger bougies and preferred shorter common channels. However, SADS-E was mainly preferred in T2DM patients with a low BMI. SADS-E bypassed less bowel and used smaller bougies. The spectra of major postoperative complications, nutritional deficiencies, and gastrointestinal disorders were different between SADS-E and SADS-W. SADS-W yielded better weight loss and better T2DM remission than SADS-E. SADS are effective bariatric and metabolic procedures with promising therapeutic outcomes and acceptable safety.
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Affiliation(s)
- Cong Li
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Shibo Lin
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Hui Liang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
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Chen G, Zhang GX, Peng BQ, Cheng Z, Du X. Roux-En-Y Gastric Bypass Versus Sleeve Gastrectomy Plus Procedures for Treatment of Morbid Obesity: Systematic Review and Meta-Analysis. Obes Surg 2021; 31:3303-3311. [PMID: 33956302 DOI: 10.1007/s11695-021-05456-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 02/07/2023]
Abstract
Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most commonly performed bariatric procedures globally, but both techniques have shortcomings. Several modifications of SG (SG plus procedures) have been developed, but the efficacy of the different procedures has not been completely elucidated. In this meta-analysis, we aimed to evaluate the efficacy and safety of SG plus procedures. Out of the initially identified 2357 studies, thirteen were selected for this meta-analysis: two studies on banded sleeve gastrectomy (BSG), four studies on sleeve gastrectomy plus duodenal-jejunal bypass (SG + DJB) or sleeve gastrectomy with loop duodenal-jejunal bypass (SADJB), two studies on sleeve gastrectomy with jejunal-jejunal bypass (SG + JJB), four studies on single anastomosis duodenal-ileal switch (SADI-S), and one study on stomach intestinal pylorus-sparing surgery (SIPS). SADI-S procedure was found to achieve significantly greater percentage of excess weight loss than the RYGB. SG + DJB and SADJB achieved greater weight loss than the RYGB. Major complications were fewer with SG + JJB than with RYGB, but the difference was not significant. Overall, SG plus procedures appear to achieve better weight loss and cause fewer complications than RYGB.
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Affiliation(s)
- Gang Chen
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Gui-Xiang Zhang
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Bo-Qiang Peng
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Zhong Cheng
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao Du
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, China.
- Department of General Surgery, Yaan People's Hospital, Yaan, China.
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Ji G, Li W, Li P, Tang H, Yu Z, Sun X, Li R, Zhu L, Zhu S. Effect of Roux-en-Y Gastric Bypass for Patients with Type 2 Diabetes Mellitus and a BMI < 32.5 kg/m2: a 6-Year Study in Chinese Patients. Obes Surg 2021; 30:2631-2636. [PMID: 32157520 DOI: 10.1007/s11695-020-04534-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is an effective treatment for morbidly obese patients to improve type 2 diabetes mellitus (T2DM). Recently, T2DM patients with a lower body mass index (BMI) have been receiving more attention, and these patients could benefit from RYGB. METHODS Fifty-two patients with T2DM underwent RYGB between October 2008 and December 2012 in our hospital. Weight, BMI, oral glucose tolerance test (OGTT), insulin release test (IRT), C-peptide release test (CRT), glycosylated hemoglobin (HbA1c), and lipid metabolic parameters were measured at baseline and at 3 and 6 months and 1, 2, 3, 4, 5, and 6 years after surgery. RESULTS The mean age of the 52 patients was 46.8 ± 9.5 years, and 57.7% were male. The mean duration of T2DM was 6.5 ± 4.6 years. Compared with the baseline values, weight and BMI were significantly decreased at several time points after surgery. HbA1c decreased from 8.2 ± 1.7% at baseline to 6.5 ± 1.4% at 3 months, 6.5 ± 1.4% at 6 months, 7.2 ± 1.3% at 4 years, and 7.5 ± 1.2% at 6 years. OGTT, OGTT-IRT, and OGTT-CRT improved after surgery. There was a decrease in triglycerides (TGs), total cholesterol (TC), and low-density lipoprotein (LDL) and an increase in high-density lipoprotein (HDL). At 6 years after surgery, 16.7% of patients achieved complete remission of T2DM, and 66.7% achieved improvement in T2DM. CONCLUSION RYGB may be a safe and effective treatment for T2DM patients with a BMI < 32.5 kg/m2 in China. However, a long-term study without loss to follow-up is necessary for better evaluation.
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Affiliation(s)
- Guangnian Ji
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Weizheng Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Pengzhou Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Haibo Tang
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Zhaomei Yu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Xulong Sun
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Rao Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Liyong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China.
| | - Shaihong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, 410013, China.
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Bhandari M, Kosta S, Khurana M, Mathur W, Reddy MK, Fobi M. Emerging Procedures in Bariatric Metabolic Surgery. Surg Clin North Am 2021; 101:335-353. [PMID: 33743973 DOI: 10.1016/j.suc.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Bariatric/metabolic surgery has emerged as an option for significant and durable weight loss in the treatment of clinically severe obesity; there is increasing demand for bariatric/metabolic surgery worldwide. New procedures have been developed and changed the face of modern bariatric surgery. Gastrointestinal metabolic surgery is a new treatment modality for obesity-related type 2 diabetes mellitus for patients with body mass index greater than 35 kg/m2. Providing safe bariatric/metabolic surgery, training qualified bariatric surgeons, and developing better techniques are important issues. This article discusses emerging procedures; a multitude of bariatric metabolic procedures enables surgeons to tailor treatment to patients' needs.
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Affiliation(s)
- Mohit Bhandari
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India.
| | - Susmit Kosta
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Manoj Khurana
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Winni Mathur
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Manoj Kumar Reddy
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
| | - Mathias Fobi
- Mohak Bariatrics and Robotics Center, SAIMS Campus, Indore-Ujjain Highway, Indore, Madhya Pradesh, India
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Safety and feasibility of laparoscopic sleeve gastrectomy with loop duodenojejunal bypass for obesity. THE JOURNAL OF MINIMALLY INVASIVE SURGERY 2021; 24:10-17. [PMID: 35601283 PMCID: PMC8965984 DOI: 10.7602/jmis.2021.24.1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/10/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022]
Abstract
Purpose Laparoscopic sleeve gastrectomy (SG) with loop duodenojejunal bypass (LDJB) is a combination of SG and one anastomosis gastric bypass surgeries. This study was intended to evaluate the safety and feasibility of SG-LDJB surgery. Methods This was a retrospective study analyzing SG-LDJB surgery using 250-cm length biliopancreatic limbs that was performed between May 2013 and December 2017 in 113 Indians with obesity. All demographic, clinical, operative, and follow-up data were analyzed for weight loss and diabetes remission efficacy. Weight-loss success was defined as percentage of total weight loss (%TWL) ≥ 25%. Diabetes remission was defined as hemoglobin A1c < 6% without the need for antidiabetic medications. Safety and feasibility were analyzed in terms of intraoperative and postoperative complications and serum albumin, iron, and calcium levels. Results The %TWL was 35.0% and 31.0% at the 1-year and 3-year follow-ups, respectively. The weight-loss success rate was 91.3% and 78.1% at the 1-year and 3-year follow-ups, respectively. Sixty-six out of 113 patients had type 2 diabetes. Diabetes remission was 80.0% and 75.4% at the 1-year and 3-year follow-ups, respectively. Major perioperative complications occurred in 0.9% of the patients. The 30-day mortality rate was zero. None of the patients had serum albumin levels of <3 g/dL at the 1-year and 3-year follow-ups or symptoms of hypoproteinemia. Conclusion SG-LDJB surgery using a 250-cm biliopancreatic limb is a safe and effective procedure to treat obesity. It is technically complex but has the advantages of endoscopic access to the stomach and negligible postoperative complications or hypoproteinemia.
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Ohta M, Seki Y, Ohyama T, Bai R, Kim SH, Oshiro T, Jiang T, Sasaki A, Naitoh T, Yamaguchi T, Inamine S, Miyazaki Y, Ahn SM, Heo Y, Liang H, Choi SH, Yang W, Yao Q, Inoue K, Yamamoto H, Lee HJ, Park YS, Ha TK, Ryu SW, Wang C, Park S, Kasama K. Prediction of Long-Term Diabetes Remission After Metabolic Surgery in Obese East Asian Patients: a Comparison Between ABCD and IMS Scores. Obes Surg 2021; 31:1485-1495. [PMID: 33411317 DOI: 10.1007/s11695-020-05151-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/24/2020] [Accepted: 12/02/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Recently, more than 10 models have been developed to predict remission of type 2 diabetes mellitus (T2DM) after metabolic surgery. The ABCD score was compared to the individualized metabolic surgery (IMS) score in terms of prediction of T2DM remission, but which of the two scoring systems is better remains controversial. METHODS Patient data from 463 obese East Asian patients who underwent laparoscopic Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), or SG with duodenojejunal bypass (SG-DJB) as a primary operation and were followed for at least 3 years were retrospectively collected from 24 institutions. The correlation between the ABCD and IMS scoring systems and the discrimination power of the models was evaluated. The cut-off point for the IMS stage of T2DM severity was also revised to adjust the scoring system to obese East Asian patients. RESULTS The two scoring systems were significantly well correlated. The IMS scoring system showed significant differences in T2DM remission rates between the procedures in the moderate stage, but the ABCD score showed no significant differences in each category. The discrimination power of the IMS score was comparable to that of the ABCD score at both 3 and 5 years. The revised IMS scoring system showed that SG-DJB had significantly higher T2DM remission rates in the moderate stage at 5 years than RYGB or SG. CONCLUSION IMS score may be comparable to ABCD score to predict T2DM remission in obese East Asian patients. The revised IMS scoring system may also select candidates for SG or SG-DJB.
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Affiliation(s)
- Masayuki Ohta
- Global Oita Medical Advanced Research Center for Health, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan. .,Departments of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Japan.
| | - Yosuke Seki
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | | | - Rixing Bai
- Department of General Surgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Sang Hyun Kim
- Department of Surgery, Soonchunhyang University Seoul Hospital, Seoul, South Korea
| | - Takashi Oshiro
- Department of Surgery, Toho University Sakura Medical Center, Sakura, Japan
| | - Tao Jiang
- Department of Hepatobiliary-Pancreatic Surgery, China-Japan Union Hospital of Jilin University, Jilin, China
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan
| | - Takeshi Naitoh
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | | | - Susumu Inamine
- Department of Surgery, Ohama Dai-ichi Hospital, Naha, Japan
| | | | - Soo Min Ahn
- Department of Pediatric Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yoonseok Heo
- Department of General Surgery, College of Medicine, Inha University, Incheon, South Korea
| | - Hui Liang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Seung Ho Choi
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Qiyuan Yao
- Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Kentaro Inoue
- Department of Surgery, Kansai Medical University, Hirakata, Japan
| | | | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, South Korea
| | - Tae Kyung Ha
- Department of Surgery, Hanyang University College of Medicine, Seoul, South Korea
| | - Seung-Wan Ryu
- Department of Surgery, Keimyung University School of Medicine, Daegu, South Korea
| | - Cunchuan Wang
- Department of Metabolic and Bariatric Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Sungsoo Park
- Department of Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
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Zhang X, Shen Y, Cao T, Wang Y, Qiao Z, Zhang Z, Zhang P. A Rodent Model of Jejunal-Ileal Loop Bipartition (JILB): a Novel Malabsorptive Operation. Obes Surg 2021; 31:1361-1368. [PMID: 33405187 DOI: 10.1007/s11695-020-05163-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/03/2020] [Accepted: 12/09/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND We designed a novel malabsorptive procedure named as jejunal-ileal loop bipartition (JILB), in which a jejunal-ileal loop is created to reduce the effective length of food chyme passage in the small bowel, but without exclusion of any segment of the intestine. This study is to investigate the feasibility and efficacy of JILB on weight loss and glycemic control in obese diabetic mouse model. METHODS High-fat diet-induced C57BL/6 mice with typical obese and diabetic phenotypes were randomly divided into two groups according to the surgical procedure performed, including JILB (n = 8) and sham group (n = 8). Age-matched naïve C57BL/6 mice fed with rodent chow diet were adopted as normal controls. Body weight, food intake, fasting plasma glucose (FPG), fasting plasma insulin (FPI), and oral glucose tolerance test (OGTT) were measured in vivo before and 2, 4, and 8 weeks after surgery. Plasma glucagon-like peptide 1 (GLP-1) was assayed before and 15 min after oral glucose challenge at the 8th week postoperatively. RESULTS Comparing to the sham animals, JILB group consumed similar amount of food, but had lower body weight after surgery (P < 0.01). It led to significant lower FPG (p < 0.05) and improved glucose tolerance with lower FPI (p < 0.001). And GLP-1 secretion at 15 min after oral glucose challenge was higher than shams (P < 0.05). No intestinal obstruction was identified. CONCLUSIONS JILB is potentially a metabolic and bariatric procedure that leads to effective weight loss and diabetes remission in obese diabetic subjects.
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Affiliation(s)
- Xiong Zhang
- Center for Metabolic and Bariatric Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai, 201399, China
| | - Yunlong Shen
- Center for Metabolic and Bariatric Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai, 201399, China
| | - Ting Cao
- Center for Medical Research and Innovation, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai, 201399, China
| | - Yueqian Wang
- Center for Medical Research and Innovation, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai, 201399, China
| | - Zhengdong Qiao
- Center for Medical Research and Innovation, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai, 201399, China
| | - Zhongtao Zhang
- Department of Surgery, Beijing Friendship Hospital, Capital Medical University, 36 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Peng Zhang
- Department of Surgery, Beijing Friendship Hospital, Capital Medical University, 36 Yong'an Road, Xicheng District, Beijing, 100050, China.
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Brown WA, de Leon Ballesteros GP, Ooi G, Higa K, Himpens J, Torres A, Shikora S, Kow L, Herrera MF. Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy/One Anastomosis Duodenal Switch (SADI-S/OADS) IFSO Position Statement-Update 2020. Obes Surg 2021; 31:3-25. [PMID: 33409979 DOI: 10.1007/s11695-020-05134-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/12/2020] [Accepted: 11/23/2020] [Indexed: 12/11/2022]
Abstract
PreambleThe International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) has played an integral role in educating both the metabolic surgical and the medical communities at large about the role of innovative and new surgical and or endoscopic interventions in treating adiposity-based chronic diseases. The single anastomosis duodenal-ileal bypass with sleeve gastrectomy/one anastomosis duodenal switch (SADI-S/OADS) is a relatively new procedure that has been proposed as an alternative to the conventional duodenal switch (DS) procedure. The IFSO published a position paper on SADI-S/OADS in 2018 with which concluded that this procedure was likely to be a safe and efficacious treatment for adiposity and its related diseases. However, it noted that there was insufficient long-term data and minimal high-level evidence available. The position statement called for patients to be enrolled in long-term multidisciplinary care encouraged the registration of patients in national registries, and called for more randomized controlled trials (RCT) (Obes Surg 28:1207-16, 2018) involving the procedure. The following position statement is an update of the previous position statement. It is issued by the IFSO SADI-S/OADS task force and has been reviewed and approved by both the IFSO Scientific Committee and Executive Board. This statement is based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence. It will be reviewed again in 2 years.
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Affiliation(s)
- Wendy A Brown
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy.
| | | | - Geraldine Ooi
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Kelvin Higa
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Jacques Himpens
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Antonio Torres
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Scott Shikora
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Lilian Kow
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Miguel F Herrera
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
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Vennapusa A, Panchangam RB, Kesara C, Madivada MSS. Metabolic Efficacy and Diabetes Remission Predictors Following 'Sleeve Gastrectomy with Loop Duodenojejunal Bypass' Surgery. JOURNAL OF METABOLIC AND BARIATRIC SURGERY 2020; 9:33-41. [PMID: 36688116 PMCID: PMC9847657 DOI: 10.17476/jmbs.2020.9.2.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/06/2020] [Accepted: 10/14/2020] [Indexed: 06/17/2023]
Abstract
PURPOSE Laparoscopic sleeve gastrectomy with loop duodenojejunal bypass (SLDJB) is a novel metabolic surgery that is a modification of the single anastomosis duodenoileal bypass with sleeve. Compared to conventional surgeries, SLDJB is highly effective in inducing diabetes remission. This study analyzed the metabolic efficacy of SLDJB. MATERIALS AND METHODS Seventy-eight patients with obesity and diabetes who underwent SLDJB between May 2013 and October 2017 were retrospectively analyzed to investigate the efficacy of their surgery and diabetes remission predictors. Complete diabetes remission was defined as an HbA1c level <6% with cessation of insulin and oral hypoglycemic agents. RESULTS Complete diabetes remission occurred in 80.52% and 76.71% of patients at 1- and 3-year follow-ups, respectively. There was no significant difference in the rates of complete diabetes remission between the groups based on gender, preoperative body mass index (BMI), diabetes duration or preoperative insulin use. There was a significantly higher rate of complete remission in patients <50 years of age at the 1-year follow-up. Additionally, the rate of complete remission was significantly less when preoperative glycemic control was poor. Preoperative HbA1c levels negatively predicted complete remission, but was significant only at the 3-year follow-up. CONCLUSION SLDJB is highly effective in treating obesity with type 2 diabetes, and preoperative glycemic control was found to predict complete remission. Patients under 50 years of age had a better short-term response rate; however, the surgery was effective regardless of gender, preoperative BMI, duration of diabetes or preoperative insulin use.
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Affiliation(s)
- Amar Vennapusa
- Department of Bariatric & Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Hyderabad, Telangana, India
| | | | - Charita Kesara
- Department of Bariatric & Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Hyderabad, Telangana, India
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Vennapusa A, Panchangam RB, Kesara C, Chivukula T. Factors Predicting Weight Loss after "Sleeve Gastrectomy with Loop Duodenojejunal Bypass" Surgery for Obesity. J Obes Metab Syndr 2020; 29:208-214. [PMID: 32908024 PMCID: PMC7539344 DOI: 10.7570/jomes20044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/11/2020] [Accepted: 08/19/2020] [Indexed: 12/20/2022] Open
Abstract
Background Laparoscopic sleeve gastrectomy with loop duodenojejunal bypass (SG LDJB) is a loop modification of biliopancreatic diversion with duodenal switch. The aim of this study was to analyze weight loss response and factors predicting weight loss outcomes after SG LDJB. Methods This was a retrospective study analyzing SG LDJB surgeries performed between May 2013 and December 2017 in 126 Indians suffering from obesity. The collected data was analyzed to understand weight loss efficacy and the factors predicting weight loss. Surgery was considered successful when percentage excess weight loss (%EWL) was ≥50% or percentage total weight loss (%TWL) was ≥25%. Results %EWL was 95.77% and 83.84% and %TWL was 34.64% and 30.32% at the 1-year and 3-year follow-up, respectively. %EWL ≥50% was 99.04% and 96.47% and %TWL ≥25% was 91.35% and 75.29% at the 1-year and 3-year follow-up, respectively. Patient age and sex did not independently predict %EWL or %TWL. Preoperative body mass index (BMI), weight, and excess weight negatively predicted %EWL and positively predicted %TWL at the 1-year and 3-year follow-up. Multiple regression analysis showed that these parameters were independent predictors of %EWL and %TWL at 1 year, while preoperative weight and excess weight also independently predicted %EWL at the 3-year follow-up. In diabetic patients, %EWL was significantly lower at the 3-year follow-up and %TWL was significantly lower at the 1-year and 3-year follow-up. Conclusion SG LDJB was an effective bariatric surgery to treat obesity. Preoperative BMI, weight, excess weight, and the presence of diabetes were the significant factors associated with the weight loss outcomes.
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Affiliation(s)
- Amar Vennapusa
- Department of Bariatric and Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Hyderabad, India
| | | | - Charita Kesara
- Department of Bariatric and Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Hyderabad, India
| | - Tejaswi Chivukula
- Department of Bariatric and Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Hyderabad, India
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Abstract
BACKGROUND Standardization of the key measurements of a procedure's finished anatomic configuration strengthens surgical practice, research, and patient outcomes. A consensus meeting was organized to define standard versions of 25 bariatric metabolic procedures. METHODS A panel of experts in bariatric metabolic surgery from multiple continents was invited to present technique descriptions and outcomes for 4 classic, or conventional, and 21 variant and emerging procedures. Expert panel and audience discussion was followed by electronic voting on proposed standard dimensions and volumes for each procedure's key anatomic alterations. Consensus was defined as ≥ 70% agreement. RESULTS The Bariatric Metabolic Surgery Standardization World Consensus Meeting (BMSS-WOCOM) was convened March 22-24, 2018, in New Delhi, India. Discussion confirmed heterogeneity in procedure measurements in the literature. A set of anatomic measurements to serve as the standard version of each procedure was proposed. After two voting rounds, 22/25 (88.0%) configurations posed for consideration as procedure standards achieved voting consensus by the expert panel, 1 did not attain consensus, and 2 were not voted on. All configurations were voted on by ≥ 50% of 50 expert panelists. The Consensus Statement was developed from scientific evidence collated from presenters' slides and a separate literature review, meeting video, and transcripts. Review and input was provided by consensus panel members. CONCLUSIONS Standard versions of the finished anatomic configurations of 22 surgical procedures were established by expert consensus. The BMSS process was undertaken as a first step in developing evidence-based standard bariatric metabolic surgical procedures with the aim of improving consistency in surgery, data collection, comparison of procedures, and outcome reporting.
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Initial Experience with Laparoscopic Loop Duodenojejunal Bypass with Sleeve Gastrectomy in Korean Obese Patients. THE JOURNAL OF MINIMALLY INVASIVE SURGERY 2020; 23:52-56. [PMID: 35600728 PMCID: PMC9012210 DOI: 10.7602/jmis.2020.23.1.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/04/2020] [Accepted: 02/26/2020] [Indexed: 11/08/2022]
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Yeo D, Yeo C, Low TY, Ahmed S, Phua S, Oo AM, Rao J, Koura A, Venkataraman K, Kaushal S. Outcomes After Metabolic Surgery in Asians-a Meta-analysis. Obes Surg 2020; 29:114-126. [PMID: 30196357 DOI: 10.1007/s11695-018-3484-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Obesity and type 2 diabetes mellitus (T2DM) are now increasingly epidemic in Asia. As obesity and T2DM have different disease patterns in Asians compared to Westerners, outcomes after metabolic surgery may differ. The aim of this meta-analysis was to gather the current available evidence on the outcomes after metabolic surgery in Asians. METHODS A literature search was conducted in September 2017. Four outcome measures were examined: (1) % excess weight loss (EWL), (2) post-intervention body mass index (BMI), (3) T2DM resolution or improvement, and (4) hypertension resolution. RESULTS Thirteen publications with a total of 1052 patients were analyzed, of which nine were randomized controlled trials, and four were case-matched studies. All the studies had a minimum follow-up duration of at least 1 year. % EWL was significantly higher in those who have undergone Roux-en-Y gastric bypass (RYGB) (SMD 0.53, 95% CI 0.12 to 0.94) versus sleeve gastrectomy (SG). T2DM resolution/improvement was favorable in those who have undergone RYGB (pooled OR 1.39, 95% CI 0.53 to 3.67) versus SG, although not statistically significant. Hypertension resolution was not significantly different between patients who have undergone SG versus RYGB (pooled OR 0.96, 95% CI 0.44 to 2.11). CONCLUSION RYGB results in better weight loss compared to SG in Asians, but the rate of T2DM resolution/improvement and improvement of hypertension appears to be similar. In Asian patients without symptoms of gastro-esophageal reflux disease in whom metabolic surgery is performed mainly for T2DM and metabolic syndrome, SG may be the surgery of choice.
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Affiliation(s)
- Danson Yeo
- Upper Gastrointestinal Surgery Unit, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Charleen Yeo
- Upper Gastrointestinal Surgery Unit, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Tze Yi Low
- Upper Gastrointestinal Surgery Unit, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Saleem Ahmed
- Upper Gastrointestinal Surgery Unit, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Sheena Phua
- Upper Gastrointestinal Surgery Unit, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Aung Myint Oo
- Upper Gastrointestinal Surgery Unit, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Jaideepraj Rao
- Upper Gastrointestinal Surgery Unit, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Aaryan Koura
- Upper Gastrointestinal Surgery Unit, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Kavita Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Sanghvi Kaushal
- Upper Gastrointestinal Surgery Unit, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
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Impacts of Different Modes of Bariatric Surgery on Plasma Levels of Hepassocin in Patients with Diabetes Mellitus. REPORTS 2019. [DOI: 10.3390/reports2040024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Hepassocin is a liver-derived protein and its serum concentrations significantly increase in diabetes and fatty liver patients. Hepassocin is also a biomarker for diabetes and fatty liver; therefore, we aimed to investigate the impacts of different types of bariatric surgery on hepassocin plasma levels in obese patients with diabetes, and to determine if hepassocin could be a potential new marker for monitoring the effects of bariatric surgery and a treatment target. Methods: Overall, 12 patients undergoing gastric bypass (GB), 10 patients undergoing sleeve gastrectomy (SG) and 11 patients undergoing duodeno-jejunal bypass with sleeve gastrectomy (DJB-SG) were enrolled. Fasting hepassocin levels were measured at baseline, three, 12, and 24 months after surgery. Results: All the three groups significantly decreased their body mass index, waist-to-hip ratio, a body shape index (ABSI), triglycerides, fasting blood sugar, hemoglobin A1c, C-peptide levels and homeostasis model assessment of insulin resistance 24 months after surgery. There were no significant changes in hepassocin levels, even 24 months after the three surgeries. Hepassocin had a significant negative relationship with the ABSI (p< 0.001) 24 months after the SG. Conclusions: Neither GB, SG, nor DJB-SG altered plasma hepassocin levels in diabetic patients up to 24 months after surgery. The use of hepassocin in clinical settings requires more investigation.
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Brown WA, Ooi G, Higa K, Himpens J, Torres A. Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy/One Anastomosis Duodenal Switch (SADI-S/OADS) IFSO Position Statement. Obes Surg 2019; 28:1207-1216. [PMID: 29572769 DOI: 10.1007/s11695-018-3201-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) has played an integral role in educating both the metabolic surgical and the medical community at large about the role of innovative and new surgical and or endoscopic interventions in treating adiposity-based chronic diseases. The single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) is also called the one anastomosis duodenal switch (OADS). This is a relatively new procedure that has been proposed as an alternative to the currently accepted duodenal switch (DS) procedure. The IFSO commissioned a task force (Appendix 1) to determine if SADI-S/OADS is an effective and safe procedure and if it should be considered a surgical option for the treatment of adiposity and adiposity-based chronic diseases. The following position statement is issued by the IFSO SADI-S/OADS task force and approved by the IFSO Executive Board. This statement is based on current clinical knowledge, expert opinion and published peer-reviewed scientific evidence. It will be reviewed in 2 years.
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Affiliation(s)
- Wendy A Brown
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy.
| | - Geraldine Ooi
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Kelvin Higa
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Jacques Himpens
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Antonio Torres
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
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Lin S, Yang N, Guan W, Liang H. Can Chinese T2D patients with BMI 20–32.5 kg/m2 benefit from loop duodenojejunal bypass with sleeve gastrectomy? Surg Obes Relat Dis 2019; 15:1513-1519. [DOI: 10.1016/j.soard.2019.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 01/31/2019] [Accepted: 03/17/2019] [Indexed: 12/14/2022]
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Wu WC, Lee WJ, Yeh C, Chen SC, Chen CY. WITHDRAWN: Do different bariatric surgery procedures impact hepassocin plasma levels in patients with type 2 diabetes mellitus? LIVER RESEARCH 2019. [DOI: 10.1016/j.livres.2019.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Laparoscopic single-anastomosis duodenal-jejunal bypass with sleeve gastrectomy (SADJB-SG): Surgical risk and long-term results. Surg Obes Relat Dis 2019; 15:236-243. [DOI: 10.1016/j.soard.2018.11.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/23/2018] [Accepted: 11/20/2018] [Indexed: 12/18/2022]
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Park YS, Ahn SH, Park DJ, Kim HH. Effectiveness of Sleeve Gastrectomy for Metabolic Surgery in Korea. J Obes Metab Syndr 2018; 27:131-133. [PMID: 31089554 PMCID: PMC6504201 DOI: 10.7570/jomes.2018.27.3.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 08/13/2018] [Accepted: 09/04/2018] [Indexed: 12/24/2022] Open
Affiliation(s)
- Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Cheng Y, Huang X, Wu D, Liu Q, Zhong M, Liu T, Zhang X, Zhang G, Hu S, Liu S. Sleeve Gastrectomy with Bypass of Proximal Small Intestine Provides Better Diabetes Control than Sleeve Gastrectomy Alone Under Postoperative High-Fat Diet. Obes Surg 2018; 29:84-92. [DOI: 10.1007/s11695-018-3520-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Foschi D, Sorrentino L, Tubazio I, Vecchio C, Vago T, Bevilacqua M, Rizzi A, Corsi F. Ileal interposition coupled with duodenal diverted sleeve gastrectomy versus standard medical treatment in type 2 diabetes mellitus obese patients: long-term results of a case-control study. Surg Endosc 2018; 33:1553-1563. [PMID: 30225603 DOI: 10.1007/s00464-018-6443-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 09/05/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Randomized controlled trials have demonstrated that bariatric surgery is effective in obtaining remission of type 2 diabetes mellitus (T2DM) in obese patients, yet no data exist in the literature from prospective studies with ileal interposition with duodenal diversion sleeve gastrectomy (II-DD-SG). The aim of this case-control study is to investigate if II-DD-SG is superior to medical treatment in T2DM obese patients. METHODS Thirty obese patients (BMI > 30) affected by T2DM were recruited for surgery (II-DD-SG) between 2008 and 2011 and were matched with an equal control group which received standard medical treatment. Anthropometric measures, glucose metabolism, cardiovascular risk factors were determined baseline and during follow-up. The primary end point was T2DM remission; reduction of body weight, BMI, and cardiovascular risk factors were secondary end-points. RESULTS Shortly after II-DD-SG, normalization of glucose plasma levels and glycated hemoglobin was observed followed by a significant decrease in body weight and BMI. At one-year follow-up, insulin resistance strongly declined as did insulin plasma levels. Complete remission was observed in 26 patients (86%); 2 (6.6%) had partial remission, and two (6.6%) were still diabetic. After 5 years, 17 of 25 patients on follow-up (68%) showed complete remission of T2DM and 56% had remission of cardiovascular risk factors. Only two patients receiving medical treatment showed complete remission of T2DM (p < 0.0001 versus II-DD-SG). No significant changes of anthropometric parameters and lipid metabolism were recorded. CONCLUSIONS II-DD-SG is an effective surgical procedure, able to induce complete and prolonged remission of T2DM in obese patients as opposed to medical treatment.
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Affiliation(s)
- Diego Foschi
- Chair of General Surgery, Department of Biomedical and Clinical Sciences "Luigi Sacco", L. Sacco Hospital, University of Milan, via G. B. Grassi 74, 20157, Milan, Italy.
| | - Luca Sorrentino
- Chair of General Surgery, Department of Biomedical and Clinical Sciences "Luigi Sacco", L. Sacco Hospital, University of Milan, via G. B. Grassi 74, 20157, Milan, Italy
| | - Igor Tubazio
- Chair of General Surgery, Department of Biomedical and Clinical Sciences "Luigi Sacco", L. Sacco Hospital, University of Milan, via G. B. Grassi 74, 20157, Milan, Italy
| | - Consuelo Vecchio
- Unit of Dietetics, Department of Medicine, Luigi Sacco Hospital, via G. B. Grassi 74, 20157, Milan, Italy
| | - Tarcisio Vago
- Endocrine Laboratory Unit, Department of Medicine, Luigi Sacco Hospital, via G. B. Grassi 74, 20157, Milan, Italy
| | - Maurizio Bevilacqua
- Unit of Endocrinology, Department of Medicine, Luigi Sacco Hospital, via G. B. Grassi 74, 20157, Milan, Italy
| | - Andrea Rizzi
- Chair of General Surgery, Department of Biomedical and Clinical Sciences "Luigi Sacco", L. Sacco Hospital, University of Milan, via G. B. Grassi 74, 20157, Milan, Italy
| | - Fabio Corsi
- Chair of General Surgery, Department of Biomedical and Clinical Sciences "Luigi Sacco", L. Sacco Hospital, University of Milan, via G. B. Grassi 74, 20157, Milan, Italy
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Li YX, Fang DH, Liu TX. Laparoscopic sleeve gastrectomy combined with single-anastomosis duodenal-jejunal bypass in the treatment of type 2 diabetes mellitus of patients with body mass index higher than 27.5 kg/m2 but lower than 32.5 kg/m2. Medicine (Baltimore) 2018; 97:e11537. [PMID: 30075520 PMCID: PMC6081088 DOI: 10.1097/md.0000000000011537] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 06/20/2018] [Indexed: 12/25/2022] Open
Abstract
This study aimed to introduce this surgical technique laparoscopic sleeve gastrectomy combined with single-anastomosis duodenal-jejunal bypass (LDJB-LSG), and to confirm this new surgical technique was safe in the treatment of type 2 diabetes mellitus (T2DM) of patients with body mass index (BMI) higher than 27.5 kg/m but lower than 32.5 kg/m.A total of 34 T2DM patients with (BMI) higher than 27.5 kg/m but lower than 32.5 kg/m were admitted to our department between January 2014 and October 2016, of whom 25 received laparoscopic gastric bypass surgery (LRYGB) and 9 received LDJB-LSG. The efficacy and safety were compared between the 2 groups.None in both groups died and had severe postoperative complications. All the surgeries were performed by laparoscopy, and none received switching to open surgery. Patients received regular follow-up after surgery and none were lost to follow-up.Our study indicates LDJB-LSG is similar to LRYGB in the improvements of the body weight, blood glucose, insulin resistance, islet β cell function, blood lipid profile and serum uric acid, and thus LDJB-LSG is applicable in T2DM patients with 27.5 kg/m ≤ BMI ≤ 32.5 kg/m and risk for gastric cancer. However, long-term therapeutic effects need to be evaluated by studies with multicenter, large sample size, and long-term follow-ups.
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Tsai YN, Wang HP, Huang CK, Chang PC, Lin IC, Tai CM. Endoluminal stenting for the management of leak following sleeve gastrectomy and loop duodenojejunal bypass with sleeve gastrectomy. Kaohsiung J Med Sci 2018; 34:43-48. [DOI: 10.1016/j.kjms.2017.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/25/2017] [Accepted: 08/10/2017] [Indexed: 02/07/2023] Open
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Abstract
Single-anastomosis pylorus-preserving procedures (SAPPP) were recently introduced into bariatric surgery in order to combine the physiologic advantages of a post-pyloric reconstruction with the technical advantages of an omega loop. Surgery consists of a sleeve gastrectomy that is performed first, followed by a duodeno-enterostomy. Two main variants exist: proximal and distal SAPPP, with duodeno-jejunostomy and duodeno-ileostomy, respectively. This review describes the SAPPP reported in the literature and analyzes their outcomes in comparison with the most frequently performed bariatric techniques. Preliminary results appear as promising in terms of both safety and effectiveness on weight loss and comorbidities improvement.
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