Laparoscopic Sleeve Gastrectomy with Duodeno-Jejunal Bypass: A New Surgical Procedure for Weight Control. Feasibility and Safety Study in a Porcine Model

• Published in: Obesity surgery Vol. 18; no. 10; pp. 1263 - 1267
• Main Authors: del Genio, Gianmattia, Gagner, Michel, Cuenca-Abente, Federico, Nocca, David, Biertho, Laurent, del Genio, Federica, Assalia, Ahmad, del Genio, Alberto
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.10.2008; Springer Nature B.V
• Subjects: Animals; Disease Models, Animal; Duodenum - surgery; Gastrectomy - adverse effects; Gastrectomy - methods; Gastrointestinal surgery; Hogs; Jejunoileal Bypass - adverse effects; Jejunoileal Bypass - methods; Jejunum - surgery; Laparoscopy - adverse effects; Laparoscopy - methods; Medicine; Medicine & Public Health; Modern Surgery: Technical Innovation; Obesity; Obesity - surgery; Surgery; Surgical outcomes; Surgical techniques; Swine; Weight control; Weight Loss; Gut hormones; Roux-en-Y; Bariatric surgery; Gastric bypass; Duodeno-jejunal bypass; Morbid obesity; Sleeve gastrectomy
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-008-9602-z

Background One limit of the Roux-en-Y gastric bypass (GBP) is the preclusion of exploring the bypassed stomach with conventional endoscopy and radiological studies. In this study, we explored the feasibility, safety, and weight progression of a new bariatric procedure that eliminates this inconvenience. Methods Eleven 40- to 50-kg Yorkshire pigs underwent laparoscopic sleeve gastrectomy and Roux-en-Y duodeno-jejunal bypass (SG-DJBP). Weight was monitored at postoperative days 15 and 30 and after 3 months; weight progression was compared with an identical group that underwent a sham procedure or GBP. At autopsy, surgical site was evaluated at microscopic and macroscopic level. Results Mean operating time was 66 ± 5.76 min. All the survivors tolerated the procedure well, except one subject that experienced a gastric leak from the stapler line. The SG-DJBP had a had significantly slower weight gains than the sham group ( P  = 0.005). The absence of histological abnormalities in the duodenal wall was confirmed at autopsy. Conclusion SG-DJBP is feasible and produces effects of weight progression comparable to those of GBP. Being a combination of previously standardized procedures, we are confident to propose this procedure as a bariatric alternative in humans. Long-term follow-up will be required to establish the efficacy on weight loss in humans.