title: Sleeve gastrectomy with ileal transposition (SGIT) induces a significant weight loss and diabetes improvement without exclusion of the proximal intestine.
abstract: BACKGROUND
  Current effective bariatric procedures such as gastric bypass generate a duodenal-jejunal exclusion, which has been implicated in the resolution of type 2 diabetes. The aim of this study was to test the hypothesis that sleeve gastrectomy with ileal transposition (SGIT), a new procedure, is as effective as Roux-en-Y gastric bypass (RYGB) to induce glucose control on an obese rat model of type 2 diabetes mellitus.
  
  
  METHODS
  Twenty eight obese diabetic Zucker rats, weighing 571 ± 151 g were assigned into three procedures: SGIT (n = 11), RYGB (n = 7), and sham operation (n = 10). Animals were followed, evaluating weekly weight increase and food intake. We performed an insulin tolerance test after 8 weeks and measured serum peptide tyrosine-tyrosine (PYY 3-36) and ghrelin levels.
  
  
  RESULTS
  Nine weeks after surgery, sham-operated animals increased their body weight by 24%. In far contrast, SGIT and RYGB rats weighed 21% and 18% less than sham animals, respectively (sham, 884 ± 15 g; SGIT, 720 ± 19 g; RYGB, 754 ± 14 g; p < 0.001). No significant differences were found between SGIT and RYGB. Cumulative food intake in SGIT and RYGB procedures decreased by 29.6% and 32.9%, respectively (sham, 576.3 ± 33 g; SGIT, 405.8 ± 10 g; RYGB, 386.4 ± 21 g; p < 0.001). No differences were found between SGIT and RYGB rats. Sixty minutes after oral gavage, PYY levels were increased by 185% and 74% in SGIT and RYGB, respectively (sham, 63.4 ± 2.1 pg/ml; SGIT, 192.7 ± 17 pg/ml; RYGB, 117.7 ± 4.8 pg/ml; p < 0.001). Glucose tolerance was improved after SGIT and RYGB surgery demonstrated by area under the curve analysis (sham, 27,090 ± 1,424; SGIT, 17,704 ± 1,288 mg/dl; p < 0.018; RYGB, 16,212 ± 2,522; p < 0.01).
  
  
  CONCLUSIONS
  SGIT proved to be as effective as RYGB on obese diabetic rats as a weight loss procedure. Also, glucose homeostasis improved in SGIT, similar to RYGB, in spite of the absence of duodenal-jejunal exclusion. This observation does not support the theory that RYGB reversal of diabetes is due to duodenal-jejunal exclusion.
authors: Division of Laparoscopic and Bariatric Surgery, Department of Surgery, NewYork-Presbyterian Hospital, Weill Medical College of Cornell University, New York, NY, USA. bozauc@med.puc.cl
authors: Camilo
authors: C
authors: Boza
authors: Rodrigo
authors: R
authors: Muñoz
authors: Elliot
authors: E
authors: Yung
authors: Luca
authors: L
authors: Milone
authors: Michel
authors: M
authors: Gagner
mesh_terms: D000818:Animals; D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000601:surgery*; D004435:Eating; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass / Q000379:methods*; D007082:Ileum / Q000601:surgery*; D007328:Insulin / Q000008:administration & dosage; D008297:Male; D023421:Models, Animal; D051381:Rats; D011924:Rats, Zucker; D012074:Remission Induction; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D007328:Insulin