title: Pylorus preserving loop duodeno-enterostomy with sleeve gastrectomy - preliminary results.
abstract: BACKGROUND
  Bariatric operations mostly combine a restrictive gastric component with a rerouting of the intestinal passage. The pylorus can thereby be alternatively preserved or excluded. With the aim of performing a "pylorus-preserving gastric bypass", we present early results of a proximal postpyloric loop duodeno-jejunostomy associated with a sleeve gastrectomy (LSG) compared to results of a parallel, but distal LSG with a loop duodeno-ileostomy as a two-step procedure.
  
  
  METHODS
  16 patients underwent either a two-step LSG with a distal loop duodeno-ileostomy (DIOS) as revisional bariatric surgery or a combined single step operation with a proximal duodeno-jejunostomy (DJOS). Total small intestinal length was determined to account for inter-individual differences.
  
  
  RESULTS
  Mean operative time for the second-step of the DIOS operation was 121 min and 147 min for the combined DJOS operation. The overall intestinal length was 750.8 cm (range 600-900 cm) with a bypassed limb length of 235.7 cm in DJOS patients. The mean length of the common channel in DIOS patients measured 245.6 cm. Overall excess weight loss (%EWL) of the two-step DIOS procedure came to 38.31% and 49.60%, DJOS patients experienced an %EWL of 19.75% and 46.53% at 1 and 6 months, resp. No complication related to the duodeno-enterostomy occurred.
  
  
  CONCLUSIONS
  Loop duodeno-enterosomies with sleeve gastrectomy can be safely performed and may open new alternatives in bariatric surgery with the possibility for inter-individual adaptation.
authors.affiliation: Department of General and Visceral Surgery, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany. jodok.grueneberger@uniklinik-freiburg.de.
authors.forename: Jodok Matthias
authors.initials: JM
authors.lastname: Grueneberger
authors.forename: Iwona
authors.initials: I
authors.lastname: Karcz-Socha
authors.forename: Goran
authors.initials: G
authors.lastname: Marjanovic
authors.forename: Simon
authors.initials: S
authors.lastname: Kuesters
authors.forename: Krystyna
authors.initials: K
authors.lastname: Zwirska-Korczala
authors.forename: Katharina
authors.initials: K
authors.lastname: Schmidt
authors.forename: W Konrad
authors.initials: WK
authors.lastname: Karcz
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D050110:Bariatric Surgery / Q000379:methods*; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007082:Ileum / Q000601:surgery*; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D009767:Obesity, Morbid / Q000601:surgery; D011446:Prospective Studies; D011708:Pylorus / Q000601:surgery*; D016896:Treatment Outcome; D015431:Weight Loss
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