Laparoscopic sleeve gastrectomy with ileal transposition (SGIT): A new surgical procedure as effective as gastric bypass for weight control in a porcine model.
BACKGROUND
Bariatric surgery has evolved into multiple forms in the last decades, combining food restriction and malabsorption. The aim of this study was to develop a new technique based on food restriction and early stimulation of the distal gut, thus maintaining the alimentary tract continuity.


METHODS
Thirty-two Yorkshire pigs, weight 22.2 +/- 5.4 kg (mean +/- SD) were randomly assigned to four laparoscopic procedures: ileal transposition (IT, n = 8); sleeve gastrectomy with ileal transposition (SGIT, n = 8); Roux-en-Y gastric bypass (GBP, n = 8); sham operation (SHAM, n = 8). Firing 45-mm linear staplers over a 60-F bougie, resecting the greater curvature and fundus, constituted a sleeve gastrectomy. Ileal transposition was performed by isolating a 100-cm ileal segment proximal to the ileocecal valve and by dividing the proximal jejunum 15 cm distal to the ligament of Treitz and performing re-anastomosis. Gastric bypass consisted of creating a proximal gastric pouch and a 300 cm alimentary limb. Sham operation was performed by bowel transections and re-anastomosis in the ileum and proximal jejunum together with gastrotomy and closure. Animals were evaluated weekly for weight increase and food intake. We performed a logistic regression analysis to compare weight progression curves, and analysis of variance (ANOVA) and Bonferroni (Dunn) tests to detect differences in weight and food intake.


RESULTS
We observed significant differences in mean weight after 18 weeks between SGIT (30.9 +/- 13.4 kg) and SHAM (72.5 +/- 10.7 kg) (p = 0.0002), and GBP (28.6 +/- 2.5 kg) and SHAM (p = 0.0001), and IT (56.1 +/- 13.4 kg) and SHAM (p = 0.0081). No differences were observed between RYGB and SGIT. We also observed significant differences in food intake (grams per day) in the third month between SGIT (1668 +/- 677 g) versus SHAM (3252 +/- 476 g) (p = 0.0006), and GBP (2011 +/- 565 g) versus SHAM (p = 0.039). No differences were observed in food intake between SGIT and GBP.


CONCLUSIONS
SGIT proved to be as effective in the short term as GBP on weight progression with no bypass of the proximal gut.
Boza
Camilo
C
Division of Laparoscopic and Bariatric Surgery, Department of Surgery, New-York Presbyterian Hospital, Weill Medical College of Cornell University, New York, NY, USA. bozauc@med.puc.cl
Gagner
Michel
M
Devaud
Nicolás
N
Escalona
Alex
A
Muñoz
Rodrigo
R
Gandarillas
Monica
M
D000704:Analysis of Variance; D000818:Animals; D005743:Gastrectomy / Q000379:methods*; D015391:Gastroplasty; D007082:Ileum / Q000601:surgery; D010535:Laparoscopy; D016015:Logistic Models; D023421:Models, Animal; D009767:Obesity, Morbid / Q000601:surgery; D011897:Random Allocation; D013552:Swine