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Alamo M, Sepúlveda M. The Sleeve Gastrectomy with Jejunal Bypass (Original Technique). J Laparoendosc Adv Surg Tech A 2024; 34:77-81. [PMID: 38100311 DOI: 10.1089/lap.2023.0319] [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] [Indexed: 12/17/2023] Open
Abstract
Introduction: Sleeve gastrectomy with jejunal bypass (SGJB) has been used as a bariatric/metabolic procedure since 2003, in the search for a simpler than other standard techniques and as effective as them. The jejunal-ileal anastomosis can deliver food directly to the hindgut where incretins are secreted. This procedure has gained popularity around the globe and has been studied in rat models as in humans, especially in South America and Asia. In this review, we present the details of the original surgical technique SGJB, summarized all the publications of the procedure, discuss possible advantages and disadvantages, and provide scientific information to look for the real place between bariatric/metabolic procedures. Methods: With 20 years of experience performing the original SGJB, the authors present the details of the procedure. Results: The SGJB consists of a traditional sleeve with the addition of a jejunal bypass. The jejunum is transected 20-30 cm distally to the ligament of Treitz. Then, the biliopancreatic limb is anastomosed to restore transit 250-300 cm distal to the jejunum transection. This way, the ileum gets in contact with partially digested food with the subsequent production of incretins. Conclusion: In this article, we describe the original Alamo technique of SGJB. It is important to clarify the technical details since many publications have presented different lengths of the defunctionalized jejunal limb. Also, the SGJB has been categorized in the "sleeve plus" procedures and its promising outcomes should rapidly position it as an alternative metabolic surgery.
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Systematic review of the outcome of single-anastomosis sleeve ileal (SASI) bypass in treatment of morbid obesity with proportion meta-analysis of improvement in diabetes mellitus. Int J Surg 2021; 92:106024. [PMID: 34252597 DOI: 10.1016/j.ijsu.2021.106024] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/11/2021] [Accepted: 07/08/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Single-anastomosis sleeve ileal (SASI) bypass has emerged as a promising bariatric and metabolic procedure. We aimed to review the current literature on the outcome of SASI procedure in terms of weight loss, improvement in comorbidities, and complications. METHODS We conducted a systematic literature search, querying electronic databases and Google Scholar, for studies that reported the outcome of the SASI bypass. The main outcome measures of the review were change in body mass index (BMI), % of excess weight loss (%EWL), improvement in comorbidities, and complications after SASI bypass. RESULTS This systematic review comprised ten studies including 941 patients with a median BMI of 45.6 kg/m2. The median %EWL at 6 months was 59.4% and significantly (p = 0.04) increased to 90.1% at 12 months. The weighted mean rate of improvement in diabetes mellitus was 99.1 (95%CI: 98.2-99.9, I2 = 0). The crude percentages of patients with improvement in hypertension, hyperlipidemia, and gastroesophageal reflux disease were 51%, 76.6%, and 92%, respectively. The median operation time was 111.3, ranging between 75 and 148.4 min. Complications were recorded in 116 (12.3%) patients. Longer common limb was associated with less %EWL at 6 months and less complications whereas larger anastomosis size was associated with higher weight loss and greater improvement in hypertension. CONCLUSIONS SASI bypass was associated with good short-term outcomes in regard to weight loss and improvement in comorbidities, namely diabetes mellitus with an acceptably low complication rate.
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Marciniak C, Chávez-Talavera O, Caiazzo R, Hubert T, Zubiaga L, Baud G, Quenon A, Descat A, Vallez E, Goossens JF, Kouach M, Vangelder V, Gobert M, Daoudi M, Derudas B, Pigny P, Klein A, Gmyr V, Raverdy V, Lestavel S, Laferrère B, Staels B, Tailleux A, Pattou F. Characterization of one anastomosis gastric bypass and impact of biliary and common limbs on bile acid and postprandial glucose metabolism in a minipig model. Am J Physiol Endocrinol Metab 2021; 320:E772-E783. [PMID: 33491532 PMCID: PMC8906817 DOI: 10.1152/ajpendo.00356.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The alimentary limb has been proposed to be a key driver of the weight-loss-independent metabolic improvements that occur upon bariatric surgery. However, the one anastomosis gastric bypass (OAGB) procedure, consisting of one long biliary limb and a short common limb, induces similar beneficial metabolic effects compared to Roux-en-Y Gastric Bypass (RYGB) in humans, despite the lack of an alimentary limb. The aim of this study was to assess the role of the length of biliary and common limbs in the weight loss and metabolic effects that occur upon OAGB. OAGB and sham surgery, with or without modifications of the length of either the biliary limb or the common limb, were performed in Gottingen minipigs. Weight loss, metabolic changes, and the effects on plasma and intestinal bile acids (BAs) were assessed 15 days after surgery. OAGB significantly decreased body weight, improved glucose homeostasis, increased postprandial GLP-1 and fasting plasma BAs, and qualitatively changed the intestinal BA species composition. Resection of the biliary limb prevented the body weight loss effects of OAGB and attenuated the postprandial GLP-1 increase. Improvements in glucose homeostasis along with changes in plasma and intestinal BAs occurred after OAGB regardless of the biliary limb length. Resection of only the common limb reproduced the glucose homeostasis effects and the changes in intestinal BAs. Our results suggest that the changes in glucose metabolism and BAs after OAGB are mainly mediated by the length of the common limb, whereas the length of the biliary limb contributes to body weight loss.NEW & NOTEWORTHY Common limb mediates postprandial glucose metabolism change after gastric bypass whereas biliary limb contributes to weight loss.
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Affiliation(s)
- Camille Marciniak
- U1190, Institut Pasteur de Lille, University of Lille, Inserm, Lille, France
| | | | - Robert Caiazzo
- U1190, Institut Pasteur de Lille, University of Lille, Inserm, Lille, France
| | - Thomas Hubert
- U1190, Institut Pasteur de Lille, University of Lille, Inserm, Lille, France
| | - Lorea Zubiaga
- U1190, Institut Pasteur de Lille, University of Lille, Inserm, Lille, France
| | - Gregory Baud
- U1190, Institut Pasteur de Lille, University of Lille, Inserm, Lille, France
| | - Audrey Quenon
- U1190, Institut Pasteur de Lille, University of Lille, Inserm, Lille, France
| | - Amandine Descat
- Mass Spectrometry Department, Pharmacy Faculty, PSM-GRITA, Lille, France
| | - Emmanuelle Vallez
- U1011, Institut Pasteur de Lille, University of Lille, Inserm Lille, France
| | | | - Mostafa Kouach
- Mass Spectrometry Department, Pharmacy Faculty, PSM-GRITA, Lille, France
| | - Vincent Vangelder
- U1190, Institut Pasteur de Lille, University of Lille, Inserm, Lille, France
| | - Mathilde Gobert
- U1190, Institut Pasteur de Lille, University of Lille, Inserm, Lille, France
| | - Mehdi Daoudi
- U1190, Institut Pasteur de Lille, University of Lille, Inserm, Lille, France
| | - Bruno Derudas
- U1011, Institut Pasteur de Lille, University of Lille, Inserm Lille, France
| | - Pascal Pigny
- Mass Spectrometry Department, Pharmacy Faculty, PSM-GRITA, Lille, France
| | - André Klein
- Metabolism and Glycosylation Diseases, Biology Pathology Center, Lille, France
| | - Valéry Gmyr
- U1190, Institut Pasteur de Lille, University of Lille, Inserm, Lille, France
| | - Violeta Raverdy
- U1190, Institut Pasteur de Lille, University of Lille, Inserm, Lille, France
| | - Sophie Lestavel
- U1011, Institut Pasteur de Lille, University of Lille, Inserm Lille, France
| | - Blandine Laferrère
- Division of Endocrinology, Department of Medicine, New York Obesity Research Center, Columbia University Irving Medical Center, New York, New York
| | - Bart Staels
- U1011, Institut Pasteur de Lille, University of Lille, Inserm Lille, France
| | - Anne Tailleux
- U1011, Institut Pasteur de Lille, University of Lille, Inserm Lille, France
| | - François Pattou
- U1190, Institut Pasteur de Lille, University of Lille, Inserm, Lille, France
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Santoro S, Aquino CGG, Mota FC, Artoni RF. DOES EVOLUTIONARY BIOLOGY HELP THE UNDERSTANDING OF METABOLIC SURGERY? A FOCUSED REVIEW. ACTA ACUST UNITED AC 2020; 33:e1503. [PMID: 32667533 PMCID: PMC7357560 DOI: 10.1590/0102-672020190001e1503] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/04/2019] [Indexed: 02/07/2023]
Abstract
Introduction: The wide net of physiological issues involved in metabolic surgery is
extremely complex. Nonetheless, compared anatomy and phisiology can provide
good clues of how digestive tracts are shaped for more or less caloric food,
for more or less fiber, for abundance and for scarcity.
Objective: To review data from Compared Anatomy and Physiology, and in the Evolutionary
Sciences that could help in the better comprehension of the metabolic
surgery.
Method: A focused review of the literature selecting information from these three
fields of knowledge in databases: Cochrane Library, Medline and SciELO,
articles and book chapters in English and Portuguese, between 1955 and 2019,
using the headings “GIP, GLP-1, PYY, type 2 diabetes, vertebrates digestive
system, hominid evolution, obesity, bariatric surgery “.
Results: The digestive tract of superior animals shows highly specialized organs to
digest and absorb specific diets. In spite of the wide variations of
digestive systems, some general rules are observed. The proximal part of the
digestive tract, facing the scarcity of sugars, is basically dedicated to
generate sugar from different substrates (gluconeogenesis). Basic proximal
gut tasks are to proportionally input free sugars, insulin, other fuels and
to generate anabolic elements to the blood, some of them obesogenic. To
limit the ingestion by satiety, by gastric emptying diminution and to limit
the excessive elevation of major fuels (sugar and fat) in the blood are
mostly the metabolict asks of the distal gut. A rapid and profound change in
human diet composition added large amounts of high glycemic index foods.
They seem to have caused an enhancement in the endocrine and metabolic
activities of the proximal gut and a reduction in these activities of the
distal gut. The most efficient models of metabolic surgery indeed make
adjustments in this proximal/distal balance in the gut metabolic activities.
Conclusion: Metabolic surgery works basically by making adjustments to the proximal and
distal gut metabolic activities that resemble the action of natural
selection in the development the digestive systems of superior animals.
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Affiliation(s)
- Sergio Santoro
- Department of Surgery, Albert Einstein Hospital, São Paulo, SP, Brazil
| | - Caio G G Aquino
- Department of Surgery, Albert Einstein Hospital, São Paulo, SP, Brazil
| | - Filippe Camarotto Mota
- Department of Surgery, Albert Einstein Hospital, São Paulo, SP, Brazil.,Department of Surgery, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Roberto Ferreira Artoni
- Evolutionary Genetics Laboratory, Department of Structural, Molecular and Genetic Biology, Ponta Grossa State University, PR, Brazil
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LIPINSKI LEANDROC, KMETIUK LOUISEB, MATHIAS PAULOC, MALTA ANANDA, FAVERO GIOVANIM, RIBEIRO TATIANEA, TOLEDO ALCEU, NETTO MARIORMONTEMOR, RODRIGUES MARCOSR. Oral insulin improves metabolic parameters in high fat diet fed rats. ACTA ACUST UNITED AC 2017; 89:1699-1705. [DOI: 10.1590/0001-3765201720170040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/29/2017] [Indexed: 01/15/2023]
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Sleeve gastrectomy with transit bipartition: a potent intervention for metabolic syndrome and obesity. Ann Surg 2012; 256:104-10. [PMID: 22609843 DOI: 10.1097/sla.0b013e31825370c0] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To present 5-year results of sleeve gastrectomy (SG) with transit bipartition (TB) as a metabolic intervention for obesity. BACKGROUND Recent data suggest that high glycemic index foods may lead to a hormonally hyperactive proximal gut and a hypoactivate distal gut, which are linked to metabolic syndrome. TB was designed to counterbalance these effects. METHODS A total of 1020 obese patients with body mass index (BMI) ranging from 33 to 72 Kg/m underwent SG and TB (SG + TB). TB creates a gastroileal anastomosis in the antrum after the SG; nutrient transit is maintained in the duodenum, avoiding blind loops and minimizing malabsorption. The stomach retains 2 outflow pathways. A lateral enteroanastomosis connects both segments at 80 cm proximal to the cecum. RESULTS Adequate follow-up data were collected in 59.1% of patients from 4 months to 5 years. The average percent of excess BMI loss was 91%, 94%, 85%, 78%, and 74% in the first, second, third, fourth, and fifth year, respectively. Patients experienced early satiety and major improvement in presurgical comorbidities, including diabetes (86% in remission), following surgery. Two deaths occurred (0.2%). Other surgical complications occurred in 6% of patients. Signs of malabsorption were rare. CONCLUSIONS SG + TB is a simple procedure that results in rapid weight loss and remission or major improvement of comorbidities. Strictly aiming at physiological correction, TB avoids prostheses, narrow anastomoses, excluded segments, and malabsorption. Weight and comorbidities are much improved. Diabetes is improved without duodenal exclusion. TB is an excellent complement to an SG.
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Santoro S. Stomachs: does the size matter? Aspects of intestinal satiety, gastric satiety, hunger and gluttony. Clinics (Sao Paulo) 2012; 67:301-3. [PMID: 22522753 PMCID: PMC3317257 DOI: 10.6061/clinics/2012(04)01] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
Bariatric surgery is the most effective modality of achieving weight loss as well as the most effective treatment for type 2 diabetes mellitus (T2DM). Glucose-dependent insulinotropic polypeptide (GIP) is an incretin and is implicated in the pathogenesis of obesity and T2DM. Its role in weight loss and resolution of T2DM after bariatric surgery is very controversial. We have made an attempt to review the physiology of GIP and its role in weight loss and resolution of T2DM after bariatric surgery. We searched PubMed and included all relevant original articles (both human and animal) in the review. Whereas most human studies have shown a decrease in GIP post-malabsorptive bariatric surgery, the role of GIP in bariatric surgery done in animal experiments remains inconclusive.
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Affiliation(s)
- Raghavendra S Rao
- Division of Metabolic, Endocrine and Minimally Invasive Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Milleo FQ, Campos ACL, Santoro S, Lacombe A, Santo MA, Vicari MR, Nogaroto V, Artoni RF. Metabolic effects of an entero-omentectomy in mildly obese type 2 diabetes mellitus patients after three years. Clinics (Sao Paulo) 2011; 66:1227-33. [PMID: 21876979 PMCID: PMC3148469 DOI: 10.1590/s1807-59322011000700018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 04/15/2011] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Various digestive tract procedures effectively improve metabolic syndrome, especially the control of type 2 diabetes mellitus. Very good metabolic results have been shown with vertical gastrectomy and entero-omentectomy; however, the metabolic effects of an isolated entero-omentectomy have not been previously studied. METHODS Nine patients with type 2 diabetes mellitus and a body mass index ranging from 29 to 34.8 kg/m² underwent an entero-omentectomy procedure that consisted of an enterectomy of the middle jejunum and exeresis of the major part of the omentum performed through a mini-laparotomy. Glucagon-like peptide-1 and peptide YY were measured preoperatively and three months following the operation. Fasting and postprandial variations in glycemia, insulinemia, triglyceridemia, hemoglobin A1c, and body mass index were determined in the preoperative period and 3, 18 and, 36 months after the operation. RESULTS All patients significantly improved the control of their type 2 diabetes mellitus. Postprandial secretion of peptide YY and Glucagon-like peptide-1 were enhanced, whereas hemoglobin A1c, fasting and postprandial glucose, insulin, and triglyceride levels were significantly reduced. Mean body mass index was reduced from 31.1 to 27.3 kg/m². No major surgical or nutritional complications occurred. CONCLUSIONS Entero-omentectomy is easy and safe to perform. A simple reduction in jejunal extension and visceral fat causes important improvements in the metabolic profile.
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Affiliation(s)
- Fábio Quirilo Milleo
- Departamento de Cirurgia, Hospital Vicentino da Sociedade Beneficente São Camilo, Ponta Grossa, PR, Brazil
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Is sleeve gastrectomy a restrictive or an adaptive procedure? Reflections on the concepts of restriction and adaptation. Ann Surg 2010; 252:892-3. [PMID: 21037450 DOI: 10.1097/sla.0b013e3181f9bd0f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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