Safety and Efficacy of Sleeve Gastrectomy with Sleeve Jejunal Bypass: An Advantage over Other Bypass Procedures – Multicenter 3 and 5 year Data

Abstract

Abstract Background: The sleeve gastrectomy with sleeve jejunal (SG + SJ) bypass is a single anastomosis, sleeve plus procedure which was introduced as a loop modification of the transit bipartition and the single-anastomosis sleeve-ileal bypass, continuing with the original idea of maintaining biliary access by avoiding duodenal transection, while creating a functional bypass to achieve weight loss and resolution of the metabolic syndrome. Objectives: This study was done to evaluate the extent of weight reduction, control of type 2 diabetes mellitus (T2DM), their maintenance up to 5 years, nutritional stability, and documentation of any complications, following this procedure. Methods: This is a retrospective analysis of prospectively collected data of patients who underwent SG + SJ bypass, with a follow-up of 1–5 years, in three centers, amounting to 112 patients. A SG is followed by anastomosis of a loop of jejunum, usually at 200 cm distal to the duodenojejunal flexure (sometimes at 150 cm or even 100 cm depending on total small bowel length [TSBL]), with the antrum. The cohort included 41 male and 71 female patients with a mean age of 42 years and mean preoperative body mass index (BMI) of 45.8 kg/m2 (range: 30.15–74.6 kg/m2). Seventy-three (65.2%) patients had T2DM, with mean glycated hemoglobin (HbA1c) of 7.5% (range: 4.9%–16%). The primary outcome of this study was weight loss and remission of T2DM, and the secondary outcome was its safety and nutritional stability. Results: Of these 112 patients analyzed in this study, 110 (98.2%) followed up at 1 year, 45 out of 58 (77.6%) at 3 years, and 14 out of 25 (56%) at 5 years. Operative duration was 120–180 min with an average hospital stay of 2–4 days with no postoperative problems. The mean TSBL was 793 cm (range: 530–1035 cm); the mean common channel (CC) was 587 cm (range: 330–835). Reduction in BMI was observed from 45.8 to 28.2 kg/m2 at 1 year, 27.4 kg/m2 at 3 years, and 27.3 at 5 years. The mean percentage of total body weight loss was 37.9% at 1 year, 40.7% at 3 years, and 40.6% at 5 years. Remission of diabetes was seen in 98.6% at 1 year, 97% at 3 years, and 91.7 at 5 years, with a mean fall in HbA1c from 7.5% to 5.2% at 1 year, 5% at 3 years, and 4.96% at 5 years. No mortality was seen in any of these 112 patients. Four patients had complications such as nausea, vomiting, diarrhea, dumping syndrome, hypoproteinemia, and hypoalbuminemia. Two patients required a partial reversal of the procedure (disconnection of the jejunal bypass while retaining the sleeve), while the rest were managed conservatively. Conclusions: This procedure was found to be safe and effective in achieving and maintaining weight loss and diabetes remission, along with nutritional stability, even at 3 and 5-year follow-up; long-term data are awaited. It has the advantage of maintaining biliary access and if necessary a partial reversal can be done in a simpler manner compared to other bypass procedures.