Efficiency mechanisms of sleeve gastrectomy and Hess-Marceau biliopancreatic diversion with duodenal switch in patients with morbid obesity

Abstract

Aim – to assess the passage through the gastric tube and the small intestine after sleeve gastrectomy and Hess-Marceau biliopancreatic diversion with duodenal switch, as well as compare the passage speed in obese patients and in patients with type 2 diabetes mellitus (T2DM) associated with obesity Materials and methods. The results of treatment of 49 patients (25 of them with T2DM) were analyzed. In 27 patients (the main group), was performed a sleeve gastrectomy (laparoscopic access in 13 patients, midline laparotomy in 14 patients), in 22 patients (the comparison group) – Hess-Marceau biliopancreatic diversion with duodenal switch. The main group included 12 patients with T2DM, the comparison group – 13 patients with T2DM, among them in 5 patients were first diagnosed with diabetes. After taking contrast solution per os all patients in the preoperative period underwent contrast gastro-enterography using a mixture of suspension of barium sulfate and balanced intestinal food mixture. X-ray monitoring at the gastrography stage was performed in 20-30 minutes. The passage of the contrast solution through the pylorus was controlled during 15 seconds. During passage of contrast solution to ileocecal valve, X-ray images were performed every 30-60 minutes. To study changes in the passage through the gastric tube and the small intestine after the bariatric surgery, a similar X-ray with contrast solution was carried out within 3 and 6 months after the operation. X-ray images were performed every 5-10 minutes to study the passage of contrast through the formed gastric tube. Results and discussion. There is no established difference in the time of complete evacuation of contrast agent from the stomach into the small intestine between the patients of both groups. No significant difference was found in the time of the passage of a modified solution of barium sulfate to the ileocecal valve between patient groups after sleeve gastrectomy and Hess-Marceau biliopancreatic diversion with duodenal switch. 3 and 6 months after one of these surgical interventions, a significant increase in the passage speed of contrast in the small intestine was observed in comparison with the preoperative data. At the same time, the difference in passage speed between patients with T2DM associated with obesity (25 patients), and without diabetes (24 patients) was not established either before surgery or after 3 and 6 months after surgery. Conclusions. These results confirm that there is an important place among many other mechanisms of metabolic efficacy of sleeve gastrectomy and Hess-Marceau biliopancreatic diversion with duodenal switch by accelerating the passage through the stomach and small intestine and giving the early contact of the food with the distal part of the ileum and the bowel. It was also found that there was no significant difference in the GI tract passage in obese patients and in patients with T2DM associated with obesity.