title: Medium-Term Results of Combined Laparoscopic Sleeve Gastrectomy and Modified Jejuno-Ileal Bypass in Bariatric Surgery.
abstract: The ideal bariatric operation achieves 70-100 % maintained excess weight loss, is simple with low operative risks, and maintains absorption of trace elements. Our aim was to find a bariatric procedure that achieves the above while avoiding drawbacks of current options.
  
  
  
  A standard sleeve gastrectomy was combined with a modified jejuno-ileal bypass dividing the small bowel 75 cm distal to the duodeno-jejunal flexure, anastomosing it to the ileum 75 cm proximal to the ileocaecal valve. Operative and follow-up data were collected prospectively between December 2004 and January 2013.
  
  
  
  One hundred sixty-eight procedures were analysed (110 female, 58 male). Mean patient age was 43 years (IQR 37-47), and median preoperative body mass index (kg/m(2)) was 52 (IQR 49-59). All operations were completed laparoscopically. Excess weight loss was 78 % (IQR 70-83 %, 12 months, n = 168), 79 % (IQR 70-85 %, 24 months), maintained at most recent follow-up with 77 % (IQR 68-84 %, n = 168), and for 8 year follow-up alone 75 % (IQR 66-84 %, n = 18). There was no operative mortality and 5.4 % morbidity. A 6.5 % of patients experienced transient vomiting. No symptoms of dumping or bacterial overgrowth were observed. All had normal liver enzymes. Hypocalcaemia (20.8 %) and zinc deficiency (25.6 %) resolved with oral supplementation. Type 2 diabetes mellitus resolved in 80.3 % and improved in the remainder of patients, hypertension resolved in 92.3 % and improved in the rest.
  
  
  
  Whilst currently an investigative procedure, and within the studies limitations combined sleeve gastrectomy with modified jejuno-ileal bypass is safe and effective, and evades many problems associated with current bariatric operations whilst offering maintained excess weight loss.
authors.affiliation: Department of Surgery, Princess of Wales Hospital, Bridgend, UK.|Department of Surgery, El Zayton Hospital, Cairo, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Hassn
authors.affiliation: Department of Surgery, Ninewells Hospital, Dundee, Scotland. andreasluhmann@hotmail.com.
authors.forename: Andreas
authors.initials: A
authors.lastname: Luhmann
authors.affiliation: Department of Surgery, Princess of Wales Hospital, Bridgend, UK.
authors.forename: Samir
authors.initials: S
authors.lastname: Rahmani
authors.affiliation: Department of Surgery, Princess of Wales Hospital, Bridgend, UK.|Department of Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Gareth
authors.initials: G
authors.lastname: Morris-Stiff
mesh_terms: D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000209:etiology / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000209:etiology / Q000601:surgery*; D007581:Jejunoileal Bypass / Q000379:methods*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult
keywords: Bariatric surgery; Jejuno-ileal bypass; Laparoscopic surgery; New procedure; Sleeve gastrectomy