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 75cm distal to the duodeno-jejunal flexure, anastomosing it to the ileum 75cm 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 43years (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%, 12months, n = 168), 79% (IQR 70-85%, 24months), maintained at most recent follow-up with 77% (IQR 68-84%, n = 168), and for 8year 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.