Side-to-Side Jejunoileal Anastomosis plus Proximal Loop Ligation: a Novel Intestinal Bypass Model for Diabetic Rats

Abstract

To the Editor: In the late 1960s and early 1970s, jejunoileal bypass (JIB) was performed frequently as a bariatric surgical option for massive obesity; however, this technique had become obsolete by the mid-1980s due to the serious complications of the procedure, which include severe malnutrition, liver failure, and blind loop syndrome [1]. The end-to-side jejunoileal anastomosis necessitates transection of the jejunum, thus dividing the jejunal limb from the native pacemaker. As a result, the ectopic pacemakers are generated in the middle of the bypassed limb and are paced at a much lower frequency and, occasionally, in an oral direction, which leads to the reflux of nutrients into the bypassed limb [2] and intestinal intussusception [3]. However, the JIB procedure is still being performed with modifications at certain medical centers. Recent animal and clinical studies have indicated that 50 to 60% of intestinal bypass or resection procedures can resolve diabetes in streptozotocin (STZ)-induced diabetic rats [4] and restore glucose homeostasis in nonobese or mildly obese type 2 diabetic patients [5]. With a degree of clinical success, a number of surgeons have used proximal loop ligation during the loop esophagojejunostomy after total gastrectomy to prevent blind loop syndrome [6]. The “uncut Roux” reconstructive technique has been found to be successful in promoting myoelectric continuity in the aboral direction and preventing the formation of ectopic pacemakers [7, 8]. Inspired by these idea, we designed a new jejunoileal bypass procedure that we termed “side-to-side jejunoileal anastomosis plus proximal loop ligation” or SSJIAL (Fig. 1). This innovation is based on the following principles: