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Chu Y, Widjaja J, Wang J, Wu W, Hong J, Zhu X, Yao L. Comparison of three different anastomotic methods of sleeve gastrectomy with transit bipartition using an obese rodent model. Sci Rep 2023; 13:21247. [PMID: 38040907 PMCID: PMC10692095 DOI: 10.1038/s41598-023-48059-8] [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: 02/13/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023] Open
Abstract
The long-term effects and safety of single-anastomosis sleeve ileal (SASI) bypass have not been confirmed. The one anastomosis procedure carries the risk of bile reflux, and Braun anastomosis has the capacity to reduce bile reflux. This study was designed to compare the influences of bile reflux and histological changes in the esogastric sections of rats. Obese Sprague-Dawley rats underwent sleeve gastrectomy with transit bipartition (RYTB) (n = 12), SASI (n = 12), SASI bypass with Braun anastomosis (BTB) (n = 12), esojejunostomy (EJ) (n = 12), and SHAM (n = 8) surgery. During the 12-week follow-up period, weight changes, glucose improvement, and changes in serum nutrition were evaluated. Histological expression and bile acid concentration in the rats in all groups were also evaluated. No significant differences in weight loss and glucose improvements were observed in the RYTB, SASI, and BTB groups. The RYTB and BTB groups had significantly lower bile acid concentration and albumin levels than the SASI group. In addition, mucosal height in the RYTB and BTB groups was significantly lower than in the SASI group. Braun anastomosis had a significant effect on anti-reflux. BTB may be a superior primary procedure due to its potential for parallel bariatric and metabolic improvements, effective anti-reflux effects, simplified operations, and avoidance of severe malnutrition. Further clinical studies are needed to confirm these findings.
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Affiliation(s)
- Yuxiao Chu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, People's Republic of China
| | - Jason Widjaja
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, People's Republic of China
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China
| | - Jian Wang
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, People's Republic of China
| | - Wei Wu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, People's Republic of China
| | - Jian Hong
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, People's Republic of China
| | - Xiaocheng Zhu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, People's Republic of China
| | - Libin Yao
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, People's Republic of China.
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2
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Baratte C, Willemetz A, Ribeiro-Parenti L, Carette C, Msika S, Bado A, Czernichow S, Le Gall M, Poghosyan T. Analysis of the Efficacy and the Long-term Metabolic and Nutritional Status of Sleeve Gastrectomy with Transit Bipartition Compared to Roux-en-Y Gastric Bypass in Obese Rats. Obes Surg 2023; 33:1121-1132. [PMID: 36729363 DOI: 10.1007/s11695-023-06477-7] [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: 06/18/2022] [Revised: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE Sleeve gastrectomy with transit bipartition (SG-TB) could be an attractive alternative to Roux-en-Y gastric bypass (RYGB) on weight loss and improvement of comorbidities in patients with obesity. However, there is little long-term data. Translational research on a rat model could allow long-term projection to assess efficacy and safety of SG-TB. The aim of this research was to evaluate the long-term efficacy and safety of SG-TB compared to RYGB and SHAM in rat model. MATERIALS AND METHODS Ninety-four male obese Wistar rats were distributed into 3 groups: SG-TB (n = 34), RYGB (n = 32), and SHAM (control group, n = 28). The percentage of total weight loss (%TWL), coprocalorimetry, glucose and insulin tolerance test, insulin, GLP-1, PYY, and GIP before and after surgery were assessed. The animals were followed over 6 months (equivalent to 16 years in humans). RESULTS At 6 months, %TWL was significantly greater(p = 0.025) in the SG-TB group compared to the RYGB group. There was no difference between the groups (p = 0.86) in malabsorption 15 and 120 days postoperatively. Glucose tolerance was significantly improved (p = 0.03) in the SG-TB and RYGB groups compared to the preoperative state. Insulin secretion, at 3 months, was significantly more important in the SG-TB group (p = 0.0003), compared to the RYGB and SHAM groups. GLP-1 secretion was significantly increased in the SG-TB and RYGB groups compared to the preoperative state (p = 0.001) but similar between SG-TB and RYGB animals (p = 0.72). CONCLUSION In a rat model, at long term compared to RYGB, SG-TB provides greater and better-maintained weight loss and an increased insulin secretion without impairing nutritional status.
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Affiliation(s)
- Clement Baratte
- Université de Paris Cité, F-75015, Paris, France.,INSERM, U1149, Centre de Recherche sur l'Inflammation, 75018, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Service de chirurgie digestive, œsogastrique et bariatrique, Centre Spécialisé Obésité (CSO) Ile de France Nord, Hôpital Bichat-Claude Bernard, 16 rue Henri Huchard, 75018, Paris, France
| | - Alexandra Willemetz
- Université de Paris Cité, F-75015, Paris, France.,INSERM, U1149, Centre de Recherche sur l'Inflammation, 75018, Paris, France
| | - Lara Ribeiro-Parenti
- Université de Paris Cité, F-75015, Paris, France.,INSERM, U1149, Centre de Recherche sur l'Inflammation, 75018, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Service de chirurgie digestive, œsogastrique et bariatrique, Centre Spécialisé Obésité (CSO) Ile de France Nord, Hôpital Bichat-Claude Bernard, 16 rue Henri Huchard, 75018, Paris, France
| | - Claire Carette
- Université de Paris Cité, F-75015, Paris, France.,Assistance Publique-Hôpitaux de Paris, service de Nutrition, Centre Spécialisé Obésité (CSO) Ile de France Sud, Hôpital Européen Georges Pompidou, 75015, Paris, France
| | - Simon Msika
- Université de Paris Cité, F-75015, Paris, France.,INSERM, U1149, Centre de Recherche sur l'Inflammation, 75018, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Service de chirurgie digestive, œsogastrique et bariatrique, Centre Spécialisé Obésité (CSO) Ile de France Nord, Hôpital Bichat-Claude Bernard, 16 rue Henri Huchard, 75018, Paris, France
| | - Andre Bado
- Université de Paris Cité, F-75015, Paris, France.,INSERM, U1149, Centre de Recherche sur l'Inflammation, 75018, Paris, France
| | - Sebastien Czernichow
- Université de Paris Cité, F-75015, Paris, France.,Assistance Publique-Hôpitaux de Paris, service de Nutrition, Centre Spécialisé Obésité (CSO) Ile de France Sud, Hôpital Européen Georges Pompidou, 75015, Paris, France.,Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), F-75004, Paris, France
| | - Maude Le Gall
- Université de Paris Cité, F-75015, Paris, France.,INSERM, U1149, Centre de Recherche sur l'Inflammation, 75018, Paris, France
| | - Tigran Poghosyan
- Université de Paris Cité, F-75015, Paris, France. .,INSERM, U1149, Centre de Recherche sur l'Inflammation, 75018, Paris, France. .,Assistance Publique-Hôpitaux de Paris (AP-HP), Service de chirurgie digestive, œsogastrique et bariatrique, Centre Spécialisé Obésité (CSO) Ile de France Nord, Hôpital Bichat-Claude Bernard, 16 rue Henri Huchard, 75018, Paris, France.
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Taskin HE, Al M. Longitudinal Outcomes Through 4 Years After Sleeve Gastrectomy with Transit Bipartition. Bariatr Surg Pract Patient Care 2022. [DOI: 10.1089/bari.2021.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Halit Eren Taskin
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Muzaffer Al
- Department of Surgery, Faculty of Medicine, Near East University Nicosia, Turkey
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Wang M, Widjaja J, Dolo PR, Yao L, Hong J, Zhu X. The Protective Effect of Transit Bipartition and Its Modification Against Sleeve Gastrectomy-Related Esophagitis in a Rodent Model. Obes Surg 2022; 32:1149-1156. [PMID: 35103916 DOI: 10.1007/s11695-022-05907-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND The protective effect of transit bipartition against esophagitis has not yet been proven. Thus, we investigate and compare the bariatric outcomes and esophagus' histological changes of sleeve gastrectomy (SG), SG with transit bipartition (SG-TB), and the proximal SG-TB (SG-PTB) in a rodent model. METHODS This study included 45 diabetic Sprague-Dawley rats assigned to one of the four groups, SG-PTB (n = 15), SG-TB (n = 12), SG (n = 10), and SHAM (n = 8). Eight surviving rats from each group were included for further investigation. Histological analysis of the gastroesophageal junction was performed. Body weight, food intake, glucose control, and hormonal changes (glucagon-like peptide-1 and insulin) were assessed before and after surgery in all groups. RESULTS Preoperatively, no significant differences were observed in food intake, body weight, and fasting blood glucose levels among the groups. Postoperatively, the SG-PTB and SG-TB groups showed significantly superior glucose control compared to the SG group following the gavage of glucose (p < 0.05). Postoperatively, the SG-PTB and SG-TB groups had higher postoperative GLP-1 levels than postoperative SG and SHAM groups. More severe esophageal hyperpapillomatosis (EHP) of the esophageal section was observed in the SG group. The mucosal height of the SG group was significantly higher than that of the SG-PTB, SG-TB, and SHAM groups (p < 0.05). CONCLUSION The transit bipartition procedure may protect the distal esophagus from histological changes associated with esophagitis. Clinical studies are needed to confirm the anti-reflux effects of transit bipartition.
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Affiliation(s)
- Meng Wang
- Department of Gastrointestinal Surgery, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221002, People's Republic of China
| | - Jason Widjaja
- Department of Gastrointestinal Surgery, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221002, People's Republic of China
| | - Ponnie Robertlee Dolo
- Department of Gastrointestinal Surgery, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221002, People's Republic of China
| | - Libin Yao
- Department of Gastrointestinal Surgery, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221002, People's Republic of China
| | - Jian Hong
- Department of Gastrointestinal Surgery, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221002, People's Republic of China
| | - Xiaocheng Zhu
- Department of Gastrointestinal Surgery, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221002, People's Republic of China.
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Taskin HE, Al M. Testosterone Changes in Men With Obesity and Type 2 Diabetes 6 Months After Sleeve Gastrectomy With Transit Bipartition. Surg Laparosc Endosc Percutan Tech 2022; 32:188-196. [PMID: 35180734 DOI: 10.1097/sle.0000000000001039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Metabolic/bariatric surgery has been shown to increase testosterone in males with obesity. This study investigated the effect of the novel metabolic/bariatric surgery procedure, sleeve gastrectomy with transit bipartition (SG-TB), on serum total testosterone and metabolic variable changes in men with obesity and type 2 diabetes. METHODS In a prospective single-center cohort study, laboratory samples were analyzed preoperatively and at 6 months following SG-TB in patients with a body mass index (BMI) ≥30 kg/m2. Changes in metabolic parameters and testosterone were evaluated. RESULTS Between July 2018 and March 2019, 166 patients with a mean baseline BMI of 34.9±3.8 kg/m2 (mean age 51.5±9.3 y), glycosylated hemoglobin 9.5±1.3%, and testosterone 3.1±1.3 underwent SG-TB. At 6-month follow-up, mean excess BMI loss was 70.2±24.3%; glycosylated hemoglobin, 6.6±1.1% (P<0.001); and testosterone, 4.5±1.5 (P<0.001). CONCLUSION In the early term following SG-TB, more than any other factor assessed, BMI loss was found to be a significant driver of improvement in testosterone levels. Regardless of preoperative obesity classification, patients with initially low testosterone attained significantly increased testosterone levels at 6-month follow-up.
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Affiliation(s)
- Halit E Taskin
- Department of Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul
| | - Muzaffer Al
- Department of Surgery, Faculty of Medicine, Near East University, Nicosia, Turkey
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Widjaja J, Chu Y, Yang J, Wang J, Gu Y. Can we abandon foregut exclusion for an ideal and safe metabolic surgery? Front Endocrinol (Lausanne) 2022; 13:1014901. [PMID: 36440199 PMCID: PMC9687376 DOI: 10.3389/fendo.2022.1014901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/24/2022] [Indexed: 11/12/2022] Open
Abstract
Foregut (foregut exclusions) and hindgut (rapid transit of nutrients to the distal intestine) theories are the most commonly used explanations for the metabolic improvements observed after metabolic surgeries. However, several procedures that do not comprise duodenal exclusions, such as sleeve with jejunojejunal bypass, ileal interposition, and transit bipartition and sleeve gastrectomy were found to have similar diabetes remission rates when compared with duodenal exclusion procedures, such as gastric bypass, biliopancreatic diversion with duodenal switch, and diverted sleeve with ileal interposition. Moreover, the complete exclusion of the proximal intestine could result in the malabsorption of several important micronutrients. This article reviews commonly performed procedures, with and without foregut exclusion, to better comprehend whether there is a critical need to include foregut exclusion in metabolic surgery.
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Affiliation(s)
- Jason Widjaja
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, China
| | - Yuxiao Chu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jianjun Yang
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, China
| | - Jian Wang
- Department of Gastrointestinal Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yan Gu
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, China
- *Correspondence: Yan Gu,
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Al M, Taskin HE. Sleeve gastrectomy with transit bipartition in a series of 883 patients with mild obesity: early effectiveness and safety outcomes. Surg Endosc 2021; 36:2631-2642. [PMID: 34671822 DOI: 10.1007/s00464-021-08769-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 10/09/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND At least 25 metabolic/bariatric procedures have been proposed globally, 5 formally endorsed. A newer procedure, sleeve gastrectomy with transit bipartition (SG + TB), appears to markedly reduce weight and improve metabolic syndrome while being relatively simple technically and protective of long-term nutritional stability. We aimed to investigate SG + TB effectiveness and safety. METHODS In a single-center retrospective analysis of prospectively collected data, SG + TB patients were followed through 12 months. Primary outcomes were changes in weight [body mass index (BMI), total weight loss (TWL)], metabolic parameters [HbA1C, LDL cholesterol, triglycerides (TG), hypertension], and nutritional status. Repeated-measures analysis of variance (ANOVA) was used to assess changes in weight and metabolic parameters at 1, 3, 6, 9, and 12 months after surgery. RESULTS Between 2015 and 2019, 883 patients (mean age 51.8 yrs, BMI 34.1 ± 5.0 kg/m2) underwent SG + TB. Mean operative time was 124 ± 25.4 min; hospitalization, 4.0 ± 2.5 days. ANOVA indicated significant reductions in weight and metabolic parameters (p < 0.005). In 646 patients with complete weight data at 12 months, mean BMI was reduced to 27.2 ± 3.4 kg/m2 (p < 0.001), TWL 19.8 ± 6.0%. HbA1C was normalized in 83.3% of SG + TB patients; hyperlipidemia, hypertension, and hypertriglyceridemia were significantly reduced (p < 0.001). Also, there was a significant reduction in the proportion of patients outside normal nutritional reference ranges. The overall complication rate was 10.2%. There was no mortality. CONCLUSION In a series of 833 lower-BMI patients who underwent SG + TB and were followed through 12 months (73.2% follow-up), significant weight loss, comorbidity reduction, and nutritional stability were attained with few major complications and no mortality.
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Affiliation(s)
- Muzaffer Al
- Department of General Surgery, Faculty of Medicine, Near East University, Nicosia, Turkey
| | - Halit Eren Taskin
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
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Calisir A, Ece I, Yilmaz H, Alptekin H, Acar F, Yormaz S, Colak B, Sahin M. The Mid-Term Effects of Transit Bipartition with Sleeve Gastrectomy on Glycemic Control, Weight Loss, and Nutritional Status in Patients with Type 2 Diabetes Mellitus: a Retrospective Analysis of a 3-Year Follow-up. Obes Surg 2021; 31:4724-4733. [PMID: 34195935 DOI: 10.1007/s11695-021-05536-1] [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: 12/28/2020] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Metabolic surgery is an effective treatment method for glycemic control and weight loss in obese patients with type 2 diabetes mellitus (T2DM). This study aimed to present the mid-term metabolic effects and weight loss results of the patients with T2DM who underwent transit bipartition with sleeve gastrectomy (TB-SG). METHODS A total of 32 obese patients with T2DM who underwent TB-SG were included in the study. The T2DM remission status after surgery was evaluated. The postoperative glycemic variables, weight loss, lipid profile, and nutritional profile were also compared with the baseline values. RESULTS At 36 months after surgery, T2DM remission occurred in 27 patients (84.3%) and the mean BMI decreased from 44.70 ± 9.34 to 29.75 ± 2.19 kg/m2. The percentage of total weight loss (TWL) and excess weight loss (EWL) was 33.84% and 77.19%, respectively. The mean LDL values significantly decreased compared to baseline; however, the mean HDL did not significantly differ. No significant difference was observed regarding the mean albumin, vitamin B12, and folic acid levels. CONCLUSION TB-SG procedure seems promising in terms of T2DM remission and weight loss with less malnutrition and vitamin deficiency in treating obese patients with T2DM.
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Affiliation(s)
- Akin Calisir
- Department of Surgery, Faculty of Medicine, Selcuk University, 42075, Konya, Turkey.
| | - Ilhan Ece
- Department of Surgery, Faculty of Medicine, Selcuk University, 42075, Konya, Turkey
| | - Huseyin Yilmaz
- Department of Surgery, Faculty of Medicine, Selcuk University, 42075, Konya, Turkey
| | - Husnu Alptekin
- Department of Surgery, Faculty of Medicine, Selcuk University, 42075, Konya, Turkey
| | - Fahrettin Acar
- Department of Surgery, Faculty of Medicine, Selcuk University, 42075, Konya, Turkey
| | - Serdar Yormaz
- Department of Surgery, Faculty of Medicine, Selcuk University, 42075, Konya, Turkey
| | - Bayram Colak
- Department of Surgery, Faculty of Medicine, Selcuk University, 42075, Konya, Turkey
| | - Mustafa Sahin
- Department of Surgery, Faculty of Medicine, Selcuk University, 42075, Konya, Turkey
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Topart P, Becouarn G, Finel JB. Comparison of 2-Year Results of Roux-en-Y Gastric Bypass and Transit Bipartition with Sleeve Gastrectomy for Superobesity. Obes Surg 2021; 30:3402-3407. [PMID: 32418188 DOI: 10.1007/s11695-020-04691-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Although Roux-en-Y gastric bypass is a powerful procedure, achieving and maintaining significant weight loss remains challenging in superobese populations. Transit bipartition with sleeve gastrectomy is derived from biliopancreatic diversion with duodenal switch and might improve weight loss control. MATERIALS AND METHODS Two series of 71 primary laparoscopic Roux-en-Y gastric bypass (RYGB) and transit bipartition (TB) with a body mass index ≥ 50 kg/m2 were retrospectively compared after 2 years. Postoperative course, side effects, nutritional status, and weight outcomes were reviewed. Weight was expressed as BMI, percentage of excess BMI lost (%EBMIL), and percentage of total weight lost (%TWL). RESULTS The 2 groups were comparable for age and BMI of 51.9 ± 1.8 for RYGB and 51.6 ± 5 for TB. TB was longer to perform (92 vs 74 min, p ≤ 0.001) with a 30-day complication rate of 4.2% and 5.6%, but there was 1 death after RYGB. Weight loss was greater after TB compared with RYGB with %EBMIL of 85.3 ± 15.8% vs 73.9 ± 17.2% (p = 0.0002). One TB patient suffered from protein malnutrition but none after RYGB. After TB, 7% of the patients experienced > 3 stools a day and 1 patient required revision, while 3 patients had diarrhea after RYGB. Late reoperations were required for 7 and 1 patients after RYGB and TB. Comorbidity improvement was similar. CONCLUSION In a superobese population, TB appeared relatively safer compared with RYGB. It achieved a better weight loss at 2 years with a trend for more digestive side effects.
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Affiliation(s)
- Philippe Topart
- Centre Médico-Chirurgical de l'Obésité, Clinique de l'Anjou, 142, avenue de Lattre de Tassigny, 49000, Angers, France.
| | - Guillaume Becouarn
- Centre Médico-Chirurgical de l'Obésité, Clinique de l'Anjou, 142, avenue de Lattre de Tassigny, 49000, Angers, France
| | - Jean-Baptiste Finel
- Centre Médico-Chirurgical de l'Obésité, Clinique de l'Anjou, 142, avenue de Lattre de Tassigny, 49000, Angers, France
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Karaca FC. Effects of Sleeve Gastrectomy with Transit Bipartition on Glycemic Variables, Lipid Profile, Liver Enzymes, and Nutritional Status in Type 2 Diabetes Mellitus Patients. Obes Surg 2021; 30:1437-1445. [PMID: 31984455 DOI: 10.1007/s11695-019-04326-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Sleeve gastrectomy with transit bipartition (SG + TB) surgery is an effective treatment modality for the patients with type 2 diabetes mellitus (T2DM). Here, we aimed to present the 1-year follow-up data of our patients with T2DM who underwent SG + TB. METHODS We evaluated the follow-up results of 45 patients and evaluated the remission status of T2DM. Additionally, biochemical variables including lipid status, liver function and nutritional status were presented. RESULTS A total of 40 T2DM remissions occurred among the 45 patients (88.8%). The complete remission was present in 35 of the patients at the end of the postoperative first year. The lipid profile markers improved following the first postoperative month. The levels of the liver enzyme alanine aminotransferase (ALT) decreased after the first postoperative month, while aspartate aminotransferase (AST) levels did not alter significantly during the follow-up period. We did not observe a change regarding albumin and vitamin B12 levels following the surgery. CONCLUSION SG + TB is a convenient and therapeutic method for the treatment of T2DM, along with the improvement in lipid profile and liver enzyme levels.
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Affiliation(s)
- Fatih Can Karaca
- Department of Health Sciences, Bilgi University, İstanbul, Turkey.
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11
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Comparing the Anti-diabetic Effect of Sleeve Gastrectomy with Transit Bipartition Against Sleeve Gastrectomy and Roux-en-Y Gastric Bypass Using a Diabetic Rodent Model. Obes Surg 2021; 31:2203-2210. [PMID: 33507518 DOI: 10.1007/s11695-021-05256-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/15/2021] [Accepted: 01/20/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Roux-en-Y gastric bypass (RYGB) has superior long-term diabetes remission outcomes to sleeve gastrectomy (SG). However, in regions with a high prevalence of gastric cancer, RYGB may not be the best option. This study aimed to investigate the anti-diabetic effect of SG with transit bipartition (SG-TB) compared with SG and RYGB. MATERIALS AND METHODS A total of 32 diabetic Sprague-Dawley rat models were assigned to one of four groups: SG (n = 8), RYGB (n = 8), SG-TB (n = 8), and SHAM (n = 8). Body weight, food intake, blood glucose, and hormonal changes (glucagon-like peptide-1 (GLP-1), insulin, and glucagon) were measured to investigate the effect of surgery in all groups. Oral glucose tolerance test and insulin tolerance test were performed before and 8 weeks after surgery. RESULTS There were no significant differences in the postoperative changes in body weight and food intake among the SG, RYGB, and SG-TB groups. Postoperatively, the RYGB and SG-TB groups had significantly higher GLP-1 levels and lower insulin levels than the SG group. Further, RYGB and SG-TB had significantly better glucose control improvements than SG. There were no significant differences in GLP-1, insulin, glucagon, and homeostasis model assessment of insulin resistance levels between RYGB and SG-TB. The preoperative and postoperative values of all variables in the SHAM group did not show significant differences. CONCLUSION In this study using a diabetes-induced rodent model, we found that the anti-diabetic effect of SG-TB is superior to that of SG and non-inferior to that of RYGB.
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Ece I, Yilmaz H, Yormaz S, Çolak B, Calisir A, Sahin M. The Short-Term Effects of Transit Bipartition with Sleeve Gastrectomy and Distal-Roux-en-Y Gastric Bypass on Glycemic Control, Weight Loss, and Nutritional Status in Morbidly Obese and Type 2 Diabetes Mellitus Patients. Obes Surg 2021; 31:2062-2071. [PMID: 33409969 DOI: 10.1007/s11695-020-05212-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE The aim of this study was to compare the postoperative metabolic and nutritional outcomes after transit bipartition with sleeve gastrectomy (TB-SG) and distal-Roux-en-Y gastric bypass (D-RYGB). MATERIALS AND METHODS A retrospective evaluation was made of 109 morbidly obese patients who underwent TB-SG or D-RYGB. Primary outcomes included metabolic variables such as glycemic control and serum lipid levels, and secondary outcomes consisted of nutritional deficiencies and weight loss after surgical procedures. RESULTS During the study period, 83 and 26 patients underwent D-RYGB and TB-SG, respectively. The preoperative characteristics and nutritional status of the groups were similar. D-RYGB resulted in significantly higher weight loss rates in the first 3 months, but the percentage of excess weight loss (EWL %) was not different in the 12-month follow-up period. Although D-RYGB provided faster glycemic control due to early weight loss, there was no difference between the two groups. At the end of the follow-up period, the TB-SG was associated with significantly less deficiency of vitamin D, vitamin B12, iron, and folic acid. Anastomosis leakage was more common in the D-RYGB technique. The overall complication rates of the groups were similar. CONCLUSION TB-SG is a safe and effective alternative to D-RYGB for the treatment of obesity-related metabolic disorders with fewer nutritional deficiencies.
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Affiliation(s)
- Ilhan Ece
- Department of Surgery, Faculty of Medicine, Selcuk University, Selcuklu, 42075, Konya, Turkey.
| | - Huseyin Yilmaz
- Department of Surgery, Faculty of Medicine, Selcuk University, Selcuklu, 42075, Konya, Turkey
| | - Serdar Yormaz
- Department of Surgery, Faculty of Medicine, Selcuk University, Selcuklu, 42075, Konya, Turkey
| | - Bayram Çolak
- Department of Surgery, Faculty of Medicine, Selcuk University, Selcuklu, 42075, Konya, Turkey
| | - Akin Calisir
- Department of Surgery, Faculty of Medicine, Selcuk University, Selcuklu, 42075, Konya, Turkey
| | - Mustafa Sahin
- Department of Surgery, Faculty of Medicine, Selcuk University, Selcuklu, 42075, Konya, Turkey
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Is transit bipartition a better alternative to biliopancreatic diversion with duodenal switch for superobesity? Comparison of the early results of both procedures. Surg Obes Relat Dis 2020; 16:497-502. [DOI: 10.1016/j.soard.2019.12.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/10/2019] [Accepted: 12/16/2019] [Indexed: 01/23/2023]
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Metabolic Effects of Sleeve Gastrectomy with Transit Bipartition in Obese Females with Type 2 Diabetes Mellitus: Results After 1-Year Follow-up. Obes Surg 2020; 29:805-810. [PMID: 30448981 DOI: 10.1007/s11695-018-3603-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To present the early metabolic effects of sleeve gastrectomy with transit bipartition (SG + TB) procedure in female obese patients with type 2 diabetes mellitus (T2DM). METHODS This prospective clinical study was carried out between January 2016 and June 2017. Inclusion criteria were female participants under 60 years old with T2DM, body mass index ≥ 40 kg/m2 and HbA1c level ≥ 8%. All patients underwent to SG + TB procedure. Primary outcomes were the glycemic control variables, and the secondary outcomes were weight loss and dyslipidemia levels up to the last follow-up point. RESULTS A total of 35 female participants with an average age of 48.8 ± 6.0 years old and a mean preoperative BMI of 42.0 ± 1.3 kg/m2 were included during the study period. Diabetic remission was achieved in 88.6% of patients (n = 31) on the third month without any antidiabetic medications. The mean postoperative BMI of patients was 24.8 ± 1.6 kg/m2, and dyslipidemia levels were significiantly lower at the last follow-up point of all patients. CONCLUSIONS SG + TB procedure may be a potent therapeutic option for the treatment of obese patients with T2DM.
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Yan K, Chen W, Zhu H, Lin G, Sun W, Liu X, Pan H, Wang L, Yang H, Liu M, Gong F. The Changes of Serum Metabolites in Diabetic GK Rats after Ileal Transposition Surgery. Obes Surg 2020; 29:882-890. [PMID: 30397878 DOI: 10.1007/s11695-018-3582-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Ileal transposition (IT) surgery could improve metabolism. Metabolomics has been applied comprehensively in analyzing the global dynamic alterations of metabolites. In the present study, we aimed to investigate serum metabolite alterations in diabetic Goto-Kakizaki (GK) rats after IT surgery. METHODS Male GK rats were subjected to IT and Sham-IT surgery. Six weeks later, body weight, food intake, fat mass, and serum biochemical parameters were measured. The serum metabolomic fingerprint was analyzed using ultra-performance liquid chromatography-mass spectrometry (LC-MS)-based, non-targeted metabolomic approach. The differential metabolites were identified using principal component analysis and orthogonal partial least squares discriminant analysis. Metabolic pathway analysis was performed using HMDB and KEGG databases. RESULTS The body weight, food intake, fat mass, serum levels of glucose and insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) of IT rats were significantly decreased when compared with Sham-IT rats (all P < 0.05). In the metabolomics analysis, ten serum differential metabolites were identified. Compared with Sham-IT rats, serum LysoPC(O-18:0) and PG(20:4/20:0) of IT rats were decreased, while genistein 4'-O-glucuronide, 5,6:8,9-Diepoxyergost-22-ene-3,7beta-diol, PI(16:0/18:2(9Z,12Z)), docosapentaenoic acid, 3-Oxo-4,6-choladienoic acid, 3-Oxocholic acid, and TG were increased. Pathway analysis highlighted the following pathways: ether lipid metabolism, alpha linolenic acid and linolenic acid metabolism, incretin synthesis and secretion, free fatty acid receptors, and biosynthesis of unsaturated fatty acids. CONCLUSIONS IT surgery could significantly decrease body weight and fat mass and improve glucose metabolism in diabetic GK rats. These beneficial effects might be related to the changes of serum metabolites which involved in lipid metabolism, bile acids, and incretin.
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Affiliation(s)
- Kemin Yan
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Weijie Chen
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Huijuan Zhu
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Guole Lin
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Wei Sun
- Core Facility of Instrument, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences/School of Basic Medicine, Peking Union Medical College, Beijing, 100730, China
| | - Xiaoyan Liu
- Core Facility of Instrument, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences/School of Basic Medicine, Peking Union Medical College, Beijing, 100730, China
| | - Hui Pan
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Linjie Wang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Hongbo Yang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Meijuan Liu
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Fengying Gong
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
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Azevedo FR, Santoro S, Correa-Giannella ML, Toyoshima MT, Giannella-Neto D, Calderaro D, Gualandro DM, Yu PC, Caramelli B. A Prospective Randomized Controlled Trial of the Metabolic Effects of Sleeve Gastrectomy with Transit Bipartition. Obes Surg 2019; 28:3012-3019. [PMID: 29704228 DOI: 10.1007/s11695-018-3239-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To compare the effects of the sleeve gastrectomy with transit bipartition (SG + TB) procedure with standard medical therapy (SMT) in mildly obese patients with type II diabetes (T2D). METHODS This is a prospective, randomized, controlled trial. Twenty male adults, ≤ 65 years old, with T2D, body mass index (BMI) > 28 kg/m2 and < 35 kg/m2, and HbA1c level > 8% were randomized to SG + TB or to SMT. Outcomes were the remission in the metabolic and cardiovascular risk variables up to 24 months. RESULTS At 24 months, SG + TB group showed a significant decrease in HbaA1c values (9.3 ± 2.1 versus 5.5 ± 1.1%, P = < 0.05) whereas SMT group maintained similar levels from baseline (8.0 ± 1.5 versus 8.3 ± 1.1%, P = NS). BMI values were lower in the SG + TB group (25.3 ± 2.8 kg/m2 versus 30.9 ± 2.5 kg/m2; P = < 0.001). At 24 months, none patient in SG + TB group needed medications for hyperlipidemia/hypertension. HDL-cholesterol levels increased in the SG + TB group (33 ± 8 to 45 ± 15 mg/dL, P < 0.001). After 24 months, the area under the curve (AUC) of GLP1 increased and in the SG + TB group and the AUC of the GIP concentrations was lower in the SG + TB group than in the SMT. At 3 months, SG + TB group showed a marked increase in FGF19 levels (74.1 ± 45.8 to 237.3 ± 234 pg/mL; P = 0.001). CONCLUSIONS SG + TB is superior to SMT and was associated with a better metabolic and cardiovascular profile.
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Affiliation(s)
- Fernanda R Azevedo
- Unidade de Medicina Interdisciplinar em Cardiologia, InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Eneas de Carvalho Aguiar 44-Cerqueira Cesar, São Paulo, SP, Brazil
| | | | - Maria L Correa-Giannella
- Laboratorio de Carboidratos e Radioimunoinsaio, LIM 18, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil.,Programa de Pós-Graduação em Medicina, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Marcos T Toyoshima
- Serviço de Onco-Endocrinologia, ICESP, HCFMUSP Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Daniel Giannella-Neto
- Programa de Pós-Graduação em Medicina, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Daniela Calderaro
- Unidade de Medicina Interdisciplinar em Cardiologia, InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Eneas de Carvalho Aguiar 44-Cerqueira Cesar, São Paulo, SP, Brazil
| | - Danielle M Gualandro
- Unidade de Medicina Interdisciplinar em Cardiologia, InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Eneas de Carvalho Aguiar 44-Cerqueira Cesar, São Paulo, SP, Brazil
| | - Pai C Yu
- Unidade de Medicina Interdisciplinar em Cardiologia, InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Eneas de Carvalho Aguiar 44-Cerqueira Cesar, São Paulo, SP, Brazil
| | - Bruno Caramelli
- Unidade de Medicina Interdisciplinar em Cardiologia, InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Eneas de Carvalho Aguiar 44-Cerqueira Cesar, São Paulo, SP, Brazil.
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Early Results of Laparoscopic Sleeve Gastrectomy With Loop Bipartition. Surg Laparosc Endosc Percutan Tech 2019; 28:385-389. [PMID: 29782429 DOI: 10.1097/sle.0000000000000541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE We evaluated early results of this new procedure of transit loop bipartition with sleeve gastrectomy (TLB-SG), making a comparison with transit bipartition with sleeve gastrectomy. MATERIALS AND METHODS Between January 2017 and September 2017, 22 patients have undergone transit bipartition with sleeve gastrectomy or TLB-SG surgery in our clinic. Patients' body mass index, excess body mass index loss, and HOMA-IR were calculated before and after the surgical operation. The values of c-peptide, HgA1C, insulin, blood sugar, albumin, Hg, urea, creatinine, calcium, total cholesterol, 25-hydroxy vitamin D, and vitamin B12 were evaluated retrospectively. RESULTS Vitamin and mineral deficiency, malnutrition, and anemia were not observed in both groups during the follow-up process. The operation time was shorter in the TLB-SG operation. Both groups were found to be effective at the expected level in terms of weight loss, diabetes remission, and improvement. CONCLUSIONS TLB-SG is a more effective and simpler method, becoming a candidate for being the most frequently performed surgical operation, in the field of metabolic surgery.
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Akcay MN, Karadeniz E, Ahiskalioglu A. Bariatric/Metabolic Surgery in Type 1 and Type 2 Diabetes Mellitus. Eurasian J Med 2019; 51:85-89. [PMID: 30911264 DOI: 10.5152/eurasianjmed.2018.18298] [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: 11/22/2022] Open
Abstract
The prevalence of type 2 diabetes mellitus (T2DM) and obesity shows a gradual increase nowadays. Despite the introduction of multiagent treatment modalities, many patients with T2DM still do not have good results. Bariatric/metabolic surgery performed in obese patients to attain weight loss has been shown to improve T2DM. Type 1 diabetes mellitus is another type of diabetes that also shows an increase in prevalence. The aim of the present study was to evaluate the literature about the bariatric/metabolic surgical procedures performed in patients with type 1 and type 2 diabetes.
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Affiliation(s)
- Mufide Nuran Akcay
- Department of General Surgery, Division of Breast and Endocrine Surgery, Atatürk University School of Medicine, Erzurum, Turkey
| | - Erdem Karadeniz
- Department of General Surgery, Division of Breast and Endocrine Surgery, Atatürk University School of Medicine, Erzurum, Turkey
| | - Ali Ahiskalioglu
- Department of Anesthesiology and Reanimation, Atatürk University School of Medicine, Erzurum, Turkey
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Santoro S, Mota FC, Aquino CG. Treating Severe GERD and Obesity with a Sleeve Gastrectomy with Cardioplication and a Transit Bipartition. Obes Surg 2019; 29:1439-1441. [PMID: 30737760 DOI: 10.1007/s11695-019-03752-4] [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: 11/30/2022]
Abstract
INTRODUCTION Epidemiological data have demonstrated that obesity is an important risk factor for the development of gastroesophageal reflux disease (GERD). The proportion of subjects with GERD symptoms can be as high as 50% for BMI > 30. Although still controversial in the literature, there are several studies associating sleeve gastrectomy (SG) with an increase in GERD prevalence. The current video shows the technique of a SG with cardioplication associated with transit bipartition (TB) for the treatment of an obese patient with severe GERD. CASE REPORT AND MANAGEMENT A 46-year-old male presented with obesity and GERD symptoms for several years. His BMI was 37.8 kg/m2 with mainly central obesity and several obesity-related comorbidities, including hypertension, dyslipidemia, severe insulin resistance, and obstructive sleep apnea. After a diagnostic evaluation, the patient was submitted to a sleeve gastrectomy with a transit bipartition. He presented satisfactory weight loss, reaching a BMI of 26 and remission of all comorbidities and complete remission of GERD symptoms. The current follow-up period is 2.5 years and the patient did not present any weight regain or return of the GERD symptoms. CONCLUSION We presented a surgical alternative that is effective in both weight loss and remission of GERD. SG + TB is a potent intervention for metabolic syndrome and obesity. Furthermore, this alternative is capable of treating both obesity and GERD, in a simple way, avoiding mechanical restriction and the significant malabsorption related to excluded segments.
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Affiliation(s)
- Sergio Santoro
- Gastroenterology Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627. Morumbi, São Paulo, SP, 050652-900, Brazil
| | - Filippe Camarotto Mota
- Gastroenterology Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627. Morumbi, São Paulo, SP, 050652-900, Brazil.
| | - Caio Gustavo Aquino
- Gastroenterology Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627. Morumbi, São Paulo, SP, 050652-900, Brazil
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