title: Sleeve gastrectomy with transit bipartition: a potent intervention for metabolic syndrome and obesity.
abstract: OBJECTIVE
  To present 5-year results of sleeve gastrectomy (SG) with transit bipartition (TB) as a metabolic intervention for obesity.
  
  
  BACKGROUND
  Recent data suggest that high glycemic index foods may lead to a hormonally hyperactive proximal gut and a hypoactivate distal gut, which are linked to metabolic syndrome. TB was designed to counterbalance these effects.
  
  
  METHODS
  A total of 1020 obese patients with body mass index (BMI) ranging from 33 to 72 Kg/m underwent SG and TB (SG + TB). TB creates a gastroileal anastomosis in the antrum after the SG; nutrient transit is maintained in the duodenum, avoiding blind loops and minimizing malabsorption. The stomach retains 2 outflow pathways. A lateral enteroanastomosis connects both segments at 80 cm proximal to the cecum.
  
  
  RESULTS
  Adequate follow-up data were collected in 59.1% of patients from 4 months to 5 years. The average percent of excess BMI loss was 91%, 94%, 85%, 78%, and 74% in the first, second, third, fourth, and fifth year, respectively. Patients experienced early satiety and major improvement in presurgical comorbidities, including diabetes (86% in remission), following surgery. Two deaths occurred (0.2%). Other surgical complications occurred in 6% of patients. Signs of malabsorption were rare.
  
  
  CONCLUSIONS
  SG + TB is a simple procedure that results in rapid weight loss and remission or major improvement of comorbidities. Strictly aiming at physiological correction, TB avoids prostheses, narrow anastomoses, excluded segments, and malabsorption. Weight and comorbidities are much improved. Diabetes is improved without duodenal exclusion. TB is an excellent complement to an SG.
authors.affiliation: Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil. sergio@santoro.med.br
authors.forename: Sergio
authors.initials: S
authors.lastname: Santoro
authors.forename: Luis Carlos
authors.initials: LC
authors.lastname: Castro
authors.forename: Manoel Carlos Prieto
authors.initials: MC
authors.lastname: Velhote
authors.forename: Carlos Eduardo
authors.initials: CE
authors.lastname: Malzoni
authors.forename: Sidney
authors.initials: S
authors.lastname: Klajner
authors.forename: Leandro Perandin
authors.initials: LP
authors.lastname: Castro
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Lacombe
authors.forename: Marco Aurélio
authors.initials: MA
authors.lastname: Santo
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology; D005743:Gastrectomy / Q000379:methods*; D005749:Gastric Inhibitory Polypeptide / Q000502:physiology; D038321:Glycemic Index; D006801:Humans; D007082:Ileum / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D024821:Metabolic Syndrome / Q000601:surgery*; D009752:Nutritional Status; D009767:Obesity, Morbid / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D019990:Perioperative Care; D012528:Satiety Response; D017792:Surgical Stapling; D013536:Suture Techniques; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D005749:Gastric Inhibitory Polypeptide