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.
Foregut and Obesity Pathophysiology Study Center, Department of Surgery, University of Naples II, via Pansini 5, Naples, 80131, Italy. gdg@doctor.com
Gianmattia
G
Del Genio
Michel
M
Gagner
Federico
F
Cuenca-Abente
David
D
Nocca
Laurent
L
Biertho
Federica
F
Del Genio
Ahmad
A
Assalia
Alberto
A
Del Genio
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