Laparoscopic sleeve gastrectomy with duodeno-jejunal bypass: a new surgical procedure for weight control. Feasibility and safety study in a porcine model.
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.


CONCLUSIONS
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.
Del Genio
Gianmattia
G
Foregut and Obesity Pathophysiology Study Center, Department of Surgery, University of Naples II, via Pansini 5, Naples, 80131, Italy. gdg@doctor.com
Gagner
Michel
M
Cuenca-Abente
Federico
F
Nocca
David
D
Biertho
Laurent
L
Del Genio
Federica
F
Assalia
Ahmad
A
Del Genio
Alberto
A
D000818:Animals; D004195:Disease Models, Animal; D004386:Duodenum / Q000601:surgery*; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D007581:Jejunoileal Bypass / Q000009:adverse effects / Q000379:methods*; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D009765:Obesity / Q000601:surgery*; D013552:Swine; D015431:Weight Loss