Abstract
BackgroundBariatric 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.Methods16 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.ResultsMean 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.ConclusionsLoop duodeno-enterosomies with sleeve gastrectomy can be safely performed and may open new alternatives in bariatric surgery with the possibility for inter-individual adaptation.
Highlights
Bariatric operations mostly combine a restrictive gastric component with a rerouting of the intestinal passage
In order to avoid a dumping syndrome and marginal ulcers that occasionally occurred after Scopinaros initial BPD, Marceau et al successfully changed the technique to perform a biliopancreatic diversion with duodenal switch (BPD/DS) with similar limb variations, using a postpyloric reconstruction [3]
A proximal duodeno-jejunostomy with sleeve gastrectomy (DJOS) was conducted as an alternative to Roux-en-Y gastric bypass (RYGB) in 7 selected patients eligible for bariatric surgery with a body mass index (BMI) range from 35.7 to 47.9 kg/m2
Summary
Bariatric operations mostly combine a restrictive gastric component with a rerouting of the intestinal passage. Most procedures combine a restrictive gastric component with a rerouting of the intestinal passage. Gastric restriction either involves the entire stomach preserving the pylorus when reconstructing the intestinal passage, or only the proximal part of the stomach is used to form a gastric pouch leaving a remnant stomach. Preserving the pylorus when bypassing the duodenum has led to important technical changes in bariatric surgery. In order to avoid a dumping syndrome and marginal ulcers that occasionally occurred after Scopinaros initial BPD, Marceau et al successfully changed the technique to perform a biliopancreatic diversion with duodenal switch (BPD/DS) with similar limb variations, using a postpyloric reconstruction [3]
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