Sleeve Gastrectomy with Ileal Transposition (SGIT) Induces a Significant Weight Loss and Diabetes Improvement Without Exclusion of the Proximal Intestine

Abstract

IntroductionCurrent effective bariatric procedures such as gastric bypass generate a duodenal–jejunal exclusion, which has been implicated in the resolution of type 2 diabetes. The aim of this study was to test the hypothesis that sleeve gastrectomy with ileal transposition (SGIT), a new procedure, is as effective as Roux-en-Y gastric bypass (RYGB) to induce glucose control on an obese rat model of type 2 diabetes mellitus. MethodsTwenty eight obese diabetic Zucker rats, weighing 571 ± 151 g were assigned into three procedures: SGIT (n = 11), RYGB (n = 7), and sham operation (n = 10). Animals were followed, evaluating weekly weight increase and food intake. We performed an insulin tolerance test after 8 weeks and measured serum peptide tyrosine–tyrosine (PYY 3-36) and ghrelin levels. ResultsNine weeks after surgery, sham-operated animals increased their body weight by 24%. In far contrast, SGIT and RYGB rats weighed 21% and 18% less than sham animals, respectively (sham, 884 ± 15 g; SGIT, 720 ± 19 g; RYGB, 754 ± 14 g; p < 0.001). No significant differences were found between SGIT and RYGB. Cumulative food intake in SGIT and RYGB procedures decreased by 29.6% and 32.9%, respectively (sham, 576.3 ± 33 g; SGIT, 405.8 ± 10 g; RYGB, 386.4 ± 21 g; p < 0.001). No differences were found between SGIT and RYGB rats. Sixty minutes after oral gavage, PYY levels were increased by 185% and 74% in SGIT and RYGB, respectively (sham, 63.4±2.1 pg/ml; SGIT, 192.7 ± 17 pg/ml; RYGB, 117.7±4.8 pg/ml; p < 0.001). Glucose tolerance was improved after SGIT and RYGB surgery demonstrated by area under the curve analysis (sham, 27,090 ± 1,424; SGIT, 17,704 ± 1,288 mg/dl; p < 0.018; RYGB, 16,212 ± 2,522; p < 0.01). ConclusionSGIT proved to be as effective as RYGB on obese diabetic rats as a weight loss procedure. Also, glucose homeostasis improved in SGIT, similar to RYGB, in spite of the absence of duodenal–jejunal exclusion. This observation does not support the theory that RYGB reversal of diabetes is due to duodenal–jejunal exclusion.