Stomach Intestinal Pylorus Sparing Research Articles

Bariatric and endo-bariatric interventions for diabetes: What is the current evidence?

Bariatric interventions have shown the best therapeutic benefits in individuals with obesity. They can be classified into surgical procedures (bariatric/metabolic surgery) and endoscopic procedures. Common surgical procedures include sleeve gastrectomy, Roux-en-Y gastric bypass, bilio-pancreatic diversion with or without duodenal switch and Stomach Intestinal Pylorus Sparing Surgery. Endoscopic procedures include intragastric balloons, transpyloric shuttle, endoscopic gastroplasties, aspiration therapy, duodenal mucosal resurfacing, duodeno-jejunal bypass liner, gastro-duodeno-jejunal bypass and incisionless magnetic anastomosis system among others. However, these procedures are limited by lack of wide availability, high costs, immediate and long-term complications and poor acceptability in some regions. Weight re-gain is a common concern and revisional metabolic surgery is often required. Appropriate pre-operative evaluation and correction of nutritional deficiencies post-surgery are very important. The most appropriate procedure for a person would depend on multiple factors like the intended magnitude of weight-loss, comorbidities and surgical fitness, as well as choice of the patient. Recently, glucagon-like insulinotropic peptide-1 receptor agonists (GLP) and the GLP-1/gastric inhibitory polypeptide co-agonist–Tirzepatide have shown remarkable weight loss potential, which is at par with bariatric interventions in some patients. How far these can help in avoiding invasive bariatric procedures in near future remains to be explored. An updated and comprehensive clinical review by He et al in the recent issue of World Journal of Diabetes address has addressed the avenues and challenges of currently available bariatric surgeries which will enable clinicians to make better decisions in their practice, including their applicability in special populations like the elderly and pediatric age groups, type 1 diabetes mellitus, and non-diabetics.

A196 Safe Adoption of Stomach Intestinal Pylorus-Sparing Surgery (SIPS) in a Community Practice: A CUSUM Analysis of Learning Curve

A196 Safe Adoption of Stomach Intestinal Pylorus-Sparing Surgery (SIPS) in a Community Practice: A CUSUM Analysis of Learning Curve

Clinical efficacy of laparoscopic stomach intestinal pylorus sparing surgery in the treatment of severe obesity

Objective To investigate the clinical efficacy of laparoscopic stomach intestinal pylorus sparing surgery (SIPS) in the treatment of severe obesity. Methods The retrospective and descriptive study was conducted. The clinical data of 5 patients with severe obesity who were admitted to the China-Japan Union Hospital Affiliated to Jilin University from October to November 2018 were collected. There was 1 male and 4 females, aged from 18 to 55 years, with an average age of 33 years. All the 5 patients underwent laparoscopic SIPS. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up was performed by outpatient examination, telephone interview and Wechat up to February 2019, including general condition, changes in body weight, body mass index, waistline, blood pressure, percentage of excess weight loss, fasting plasma glucose, glycosylated hemoglobin, blood lipid, and uric acid at 3 months after surgery. Measurement data with normal distribution were represented as Mean±SD, and they were tested with Hotelling T2 test. Measurement data with skewed distribution were represented as M (range). Results (1) Surgical situations: 5 patients underwent successfully laparoscopic SIPS under clear surgical field, without obvious bleeding, conversion to open surgery or perioperative death. The operation time was 240 minutes (range, 165-345 minutes). (2) Postoperative situations: the time to initial out-of-bed activity, time to first and flatus, and time to initial drinking and liquid intake were 2 days (range, 2-3 days), 3 days (range, 2-3 days), and 3 days (range, 3-4 days), respectively. On the third day after surgery, all the 5 patients were confirmed anastomotic patency, without gastric leakage, stenosis, or obstruction by upper gastrointestinal contrast. The abdominal drainage-tube was removed on the fourth day after feeding without obvious discomfort and foreign substances extraction from the drainage-tube. The duration of postoperative hospital stay was 6 days (range, 6-7 days). (3) Follow-up: 5 patients with severe obesity were successfully followed up for 3 months. During the follow-up, one patient had significantly increased frequency of defecation, roughly 5-8 times a day, especially after eating greasy food. According to the dietary guidance of the case manager, diarrhea was improved significantly after reducing the intake of oily food. Of the 5 patients with severe obesity, color doppler ultrasonography examination revealed that cholestasis was found in 2 patients at 3 months after operation, which may be related to significant weight loss, ratio imbalance of bile acid to and cholesterol, intestinal microbiota, injury of vagus nerve, significant increasing in mucin of gallbladder, and without oral ursodeoxycholic acid as prescribed by the doctor. The body weight, body mass index, waistline, systolic blood pressure, and diastolic blood pressure of 5 patients with severe obesity were (100±15)kg, (36±4)kg/m2, (111±10)cm, (130±12)mmHg (1 mmHg=0.133 kPa), and (78±14)mmHg at 3 months after operation, respectively, showing significant differences compared with these of preoperation (F=61.631, 75.558, 87.045, 9.501, 16.248, P<0.05). The percentage of excess weight loss was 44%±9%. Among the 5 patients with severe obesity, the fasting plasma glucose of 2 patients with type 2 diabetes mellitus decreased from 9.55 mmol/L and 13.49 mmol/L to 5.18 mmol/L and 5.62 mmol/L after operation, respectively. Level of glycated hemoglobin decreased from 10.0% and 9.9% to 5.2% and 6.2% after operation, respectively. In the 2 patients with hyperlipidemia, one patient with hypertriglyceride had level of triglyceride, total cholesterol, and low density lipoprotein increased from preoperative 2.24 mmol/L, 4.84 mmol/L and 2.92 mmol/L to 2.47 mmol/L, 6.68 mmol/L and 5.51 mmol/L after operation, another patient with hypercholesterol had cholesterol level decreased from preoperative 5.97 mmol/L to postoperative 5.75 mmol/L after operation. In the 3 patients with hyperuricemia, two patients had the uric acid decreased from 404 μmol/L and 484 μmol/L to 319 μmol/L and 417 μmol/L after operation, respectively, one had the uric acid increased from 531 μmol/L to 674 μmol/L after operation. Conclusions Laparoscopic SIPS has a significant short-term effect on patients with severe obesity, but its long-term safety and efficacy need to be further followed up. Key words: Obesity; Type 2 diabetes mellitus; Stomach intestinal pylorus sparing surgery; Biliopancreatic diversion surgery; Laparoscopy

A408 - Does the Number of Follow-Up Following Stomach Intestinal Pylorus-Sparing Surgery Affect Weight-Loss Outcomes?

Background: It is presumed that good postoperative programs correlate with weight loss outcomes. Therefore, surgeons design “optimal” programs to maximal weight loss. However, we wondered does compliance with postoperative programs result in better weight loss?

An Analysis of Mid-Term Complications, Weight Loss, and Type 2 Diabetes Resolution of Stomach Intestinal Pylorus-Sparing Surgery (SIPS) Versus Roux-En-Y Gastric Bypass (RYGB) with Three-Year Follow-Up.

For many years, the Roux-en-Y Gastric Bypass (RYGB) was considered a good balance of complications and weight loss. According to several short-term studies, single anastomosis duodenal switch or stomach intestinal pylorus sparing surgery (SIPS) offers similar weight loss to RYGB with fewer complications and better diabetes resolution. No one has substantiated mid-term complication and nutritional differences between these two procedures. This paper seeks to compare complication and nutritional outcomes between RYGB and SIPS. A retrospective analysis of 798 patients who either had SIPS or RYGB from 2010 to 2016. Complications were gathered for each patient. Nutritional outcomes were measured for each group at 1, 2, and 3years. Regression analysis was applied to interpolate each patient's weight at 3, 6, 9, 12, 18, 24, and 36months. These were then compared with t tests, Fisher's exact tests, and chi-squared tests. RYGB and SIPS have statistically similar weight loss at 3, 6, 9, 12, and 36months. They statistically differ at 18 and 24months. At 36months, there is a trend for weight loss difference. There were only statistical differences in nutritional outcomes between the two procedures with calcium at 1 and 3years and vitamin D at 1year. There were statistically significantly more long-term class IIIb-V complications, class I-IIIacomplications, reoperations, ulcers, small bowel obstructions, nausea, and vomiting with the RYGB than the SIPS. With comparable weight loss and nutritional outcomes, SIPS has fewer short- and long-term complications than RYGB and better type 2 diabetes resolution rates.

Stomach Intestinal Pylorus-Sparing Surgery for Morbid Obesity.

Background and Objective:The Roux-en-Y duodenal switch (RYDS) is one of the most efficient forms of bariatric surgery. However, diarrhea, malnutrition, ulcers, and internal hernias have hampered its widespread adoption. The stomach intestinal pylorus-sparing (SIPS) procedure was developed to alleviate these sequelae while retaining the same weight loss as the RYDS. In this study, we report our midterm experience with this novel technique.Methods:Retrospective analysis was performed on data from 225 patients who underwent a primary SIPS procedure by 2 surgeons at a single center from October 2013 through December 2016.Results:Two hundred twenty-five patients were identified for analysis. The mean preoperative body mass index (BMI) was 52.4 ± 9.1 kg/m2. Forty-eight patients were beyond 2 years after surgery, with data available for 30 patients (62.5% follow-up). Three patients were lost to follow-up. At 2 years, the patients had an average change in BMI of 26.6 U (kg/m2) with an average of 88.7% of excess weight loss. Three deaths were related to the surgery. The most common short-term complication was a leak (2.2%), whereas the most common long-term complication was diarrhea (2.2%).Conclusion:In conclusion, SIPS surgery is a safe procedure with favorable weight loss outcomes at 2 years.

A140 - Laparoscopic Stomach Intestinal Pylorus-Sparing Surgery as a Revisional Option after Failed Adjustable Gastric Banding: Report of 27 Cases

Inadequate weight loss, weight recidivism, and device-related complications following adjustable gastric banding (AGB) can be treated by a laparoscopic conversion to stomach intestinal pylorus-sparing surgery (SIPS). Objective: The aim of this study was to assess the indications and outcomes of revision of AGB to laparoscopic SIPS surgery. Setting: Private practice, United States.

The single anastomosis duodenal switch modifications: a review of the current literature on outcomes

BackgroundThe single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) was designed in 2007 to reduce the side effects of biliopancreatic diversion with duodenal switch (BPD-DS) by replacing the Roux-en-Y construction with a single duodeno-ileal anastomosis and combining the common channel with the alimentary limb. Several variants using different channel lengths were published. The objective of this study was to identify the published cases of SADI-S and variants and assess the results regarding potential benefits on side effects and revisions. MethodsPubMed, ClinicalTrials.gov, and the databases of 3 relevant surgical journals were searched for any publication from 2007 to date. ResultsIn all, 19 studies were analyzed. After identifying overlaps, 1,041 patients among 9 institutions were identified: 304 with SADI-S, 667 with stomach intestinal pylorus sparing surgery, and 70 with single anastomosis duodenojejunal bypass with sleeve gastrectomy. There were no postoperative deaths and the early complication rate was 7.3% (range 1.6–14%). The mean operative time was 100.8 minutes (range 69.9–181.7 min). The mean 1-year percentage of excess weight loss (%EWL) was 78.7% (range 61.6–87%) and percentage of total weight loss (%TWL) was 36.8% (range 32.7–41.1%). Two studies reported a 2-year %TWL of 38.7% and a single study reported a 5-year %TWL of 37%. A total of 50% of patients had biological data at 1 year. One retrospective study found no difference between BPD-DS and SIPS for vitamin deficiency at 2 years, but there was less severe diarrhea and malnutrition after SIPS. The revision rate increased from 2% to 7% after SADI-S between 2- and 5-year follow-up. ConclusionThere are still limited long-term data available for single anastomosis duodenal switch. In the absence of published prospective randomized trials, no evidence exists in favor of this variant of the BPD-DS despite a possible trend in less malabsorption side effects.

A retrospective comparison of biliopancreatic diversion with duodenal switch with single anastomosis duodenal switch (SIPS-stomach intestinal pylorus sparing surgery) at a single institution with two year follow-up

BackgroundThe traditional duodenal switch is performed using a Roux-en-Y configuration. This procedure has proven to be the most effective procedure for long-term weight loss and co-morbidity reduction.Recently, stomach intestinal pylorus sparing surgery (SIPS) has been introduced as a simpler and potentially safer variation of the duodenal switch (DS). It is a single anastomosis end-to-side proximal duodeno-ileal bypass with a sleeve gastrectomy. In this study, we compare our outcomes between biliopancreatic diversion with duodenal switch (BPD-DS) and SIPS at 2 years. SettingThis is a retrospective analysis from a single surgeon at a single private institution. MethodsWe analyzed data from 182 patients retrospectively, 62 patients underwent BPD-DS while 120 other patients underwent SIPS between September 2011 and March 2015. A subset analysis was performed comparing data from both procedures to evaluate weight loss and complications. ResultsOf 182 patients, 156 patients were beyond 1 year postoperative mark and 99 patients were beyond 2 year postoperative mark. Five patients were lost to follow-up. None of our patients had complications resulting in death. BPD-DS and SIPS had statistically similar weight loss at 3 months but percent excess weight loss (%EWL) was more with BPD-DS than SIPS at 6, 9, 12, 18, and 24 months. Patient lost a mean body mass index (BMI) of 23.3 (follow-up: 69%) and 20.3 kg/m2 (follow-up: 71%) at 2 years from the BPD-DS and SIPS surgery, respectively. However, patients who had undergone SIPS procedure had significantly shorter operative time, shorter length of stay, fewer perioperative and postoperative complications than BPD-DS (P<.001). Interestingly, even though BPD-DS patients lost slightly more weight, the actual final BMI for SIPS group was lower than BPD-DS group (25.6 versus 26.9) (P<.05). There was no statistical difference between 2 groups for postoperative nutritional data such as vitamins D, B1, B12, serum calcium, fasting blood glucose, glycosylated hemoglobin (HbA1C), insulin, serum albumin, serum total protein, and lipid panel. ConclusionThe SIPS is a simplified DS procedure. The SIPS eliminates one anastomosis and compared with BPD-DS has fewer perioperative and postoperative complications, shorter operative time and length of stay, and similar nutritional results at 2 years. However, weight loss was more with BPD-DS. A fair criticism is that the vast majority of BPD-DS cases were done before the SIPS cases. As a result, experience and learning curve cannot be completely dismissed when viewing postoperative complications.

A step-by-step surgical technique video with two reported cases of common channel lengthening in patients with previous stomach intestinal pylorus sparing surgery to treat chronic diarrhea

A step-by-step surgical technique video with two reported cases of common channel lengthening in patients with previous stomach intestinal pylorus sparing surgery to treat chronic diarrhea

Laparoscopic stomach intestinal pylorus sparing surgery in a patient with morbid obesity and situs inversus: first video case report

Stomach intestinal pylorus sparing surgery (SIPS) is one of the most effective weight loss procedures with mean excess weight loss at 2 years of 85% [ 1 Mitzman B. Cottam D. Goriparthi R. et al. Stomach intestinal pylorus sparing surgery for morbid obesity: retrospective analysis of our preliminary experiences. Obes Surg. 2016; 26: 2098-2104 Crossref PubMed Scopus (66) Google Scholar , 2 Zaveri H. Surve A. Cottam D. et al. Stomach intestinal pylorus sparing surgery (SIPS) with laparoscopic fundoplication (LF): a new approach to gastroesophageal reflux disease (GERD) in the setting of morbid obesity. Springerplus. 2015; 4: 596 Crossref PubMed Scopus (14) Google Scholar , 3 Cottam A. Cottam D. Medlin W. et al. A matched cohort analysis of loop duodenal switch versus Roux-en-Y gastric bypass with 18 month follow up. Surg Endosc. 2015; 30: 3958-3964 Crossref PubMed Scopus (32) Google Scholar ]. Since 2013, we have successfully performed SIPS in>300 patients. However, performance of any weight loss operation can be complicated by any patient with mirror image transposition of the abdominal and thoracic organs known as situs inversus (SI).

A Matched Cohort Analysis of Stomach Intestinal Pylorus Saving (SIPS) Surgery Versus Biliopancreatic Diversion with Duodenal Switch with Two-Year Follow-up.

In bariatric surgery, the procedure with the highest average weight loss is the biliopancreatic diversion with duodenal switch (BPDDS). A new simplified duodenal switch called the stomach intestinal pylorus sparing (SIPS) surgery with less malabsorption and one fewer anastomosis claims to have similar outcomes when compared to the BPDDS. A retrospective matched cohort analysis of SIPS versus BPDDS patients in a single private practice was obtained by matching every BPDDS to a SIPS patient of the same gender and BMI. Excess weight loss percentage (EWL), BMI, and percentage total weight loss (%TWL) were compared. Additionally, comorbidity resolution, nutritional data, and complications were also compared. Data was analyzed using both descriptive and comparative statistics. Over 2years, there was no statistical difference in weight loss between BPDDS and SIPS. There also was no difference in nutritional data between the two procedures pre- and post-op. Complication rates were lower in SIPS however, due to the small sample sizes this is not statistically significant. Weight loss and nutritional results between SIPS and BPDDS are similar at 2years. However, there are fewer complications with SIPS.

A5079 - The incidence of stricture and ulcerative disease at the duodenoileostomy in stomach intestinal pylorus sparing surgery and its successful management

A5079 - The incidence of stricture and ulcerative disease at the duodenoileostomy in stomach intestinal pylorus sparing surgery and its successful management

A158 - Laparoscopic Stomach Intestinal Pylorus Sparing Surgery in Patient with Morbid Obesity and Situs Inversus; First Video Case Report

Stomach intestinal pylorus sparing surgery (SIPS) is one of the most effective weight loss procedures. Since 2013, we have successfully performed SIPS in more than 250 patients. However, performance of any weight loss operation can be complicated by any patient with mirror image transposition of the abdominal and thoracic organs known as situs inversus [SI]. SI is a rare autosomal recessive condition. SI is divided into two types: situs inversus partialis [SIP], which involves transposition (left or right side) through sagittal plane of either thoracic organs (dextrocardia) or abdominal viscera, and situs inversus totalis [SIT], which involves both the thoracic organs and abdominal viscera, while the organ function is normal. Our patient had SIT.Few articles have discussed the incidence of SI and the issue of performing weight loss surgery on these patients. None have reported laparoscopic SIPS in patients with morbid obesity and SI. We herein report a video case involving our laparoscopic SIPS technique in a patient with morbid obesity and SIT. This is the first report in the literature to describe laparoscopic SIPS in a patient with SI.

A5015 - Weight loss outcomes in patients with Stomach Intestinal Pylorus Sparing surgery at 3 years

A5015 - Weight loss outcomes in patients with Stomach Intestinal Pylorus Sparing surgery at 3 years

A video case report of stomach intestinal pylorus sparing surgery with laparoscopic fundoplication: a surgical procedure to treat gastrointestinal reflux disease in the setting of morbid obesity

A video case report of stomach intestinal pylorus sparing surgery with laparoscopic fundoplication: a surgical procedure to treat gastrointestinal reflux disease in the setting of morbid obesity

Stomach Intestinal Pylorus Sparing (SIPS) Surgery for Morbid Obesity: Retrospective Analyses of Our Preliminary Experience.

Although the duodenal switch (DS) has been the most effective weight loss surgical procedure, it is a small minority of the total bariatric surgical cases performed. Modifications that can make the operation technically simpler and reduce a long-term risk of short bowel syndrome would be of benefit. The aim of this study was to detail our initial experience with a modified DS called stomach intestinal pylorus sparing (SIPS) procedure. Data from patients who underwent a primary SIPS procedure performed by two surgeons at two centers from January 2013 to August 2014 were retrospectively analyzed. All revisions of prior bariatric procedures were excluded. Regression analyses were performed for all follow-up weight loss data. One hundred twenty-three patients were available. One hundred two patients were beyond 1year postoperative, with data available for 64 (62% followed up). The mean body mass index (BMI) was 49.4kg/m(2). Two patients had diarrhea (1.6%), four had abdominal hematoma (3.2%), and one had a stricture (0.8%) in the gastric sleeve. Two patients (1.6%) were readmitted within 30days. One patient (0.8%) was reoperated due to an early postoperative ulcer. At 1year, patients had an average change in BMI of 19units (kg/m(2)), which was compared to an average of 38% of total weight loss or 72% of excess weight loss. Modification of the classic DS to one with a single anastomosis and a longer common channel had effective weight loss results. Morbidity seems comparable to other stapling reconstructive procedures. Future analyses are needed to determine whether a SIPS procedure reduces the risk of future small bowel obstructions and micronutrient deficiencies.

Stomach intestinal pylorus sparing surgery (SIPS) with laparoscopic fundoplication (LF): a new approach to gastroesophageal reflux disease (GERD) in the setting of morbid obesity.

The increase in the prevalence of obesity and gastroesophageal reflux disease (GERD) has paralleled one another. Laparoscopic fundoplication (LF) (Nissen or Toupet) is a minimally invasive form of anti-reflux surgery. The duodenal switch is a highly effective weight loss surgery with a proven record of long term weight loss success. However, fundoplication alone does not give satisfactory results when used for GERD in morbidly obese patients. Here we present a novel approach combining stomach intestinal pylorus sparing surgery (SIPS) with LF for morbidly obese patients with GERD. The data from patients who underwent the SIPS procedure along with LF in past year was retrospectively analyzed. The variables collected were age, sex, height, weight, intra-operative and post-operative complications, length of stay, operative time, and estimated blood loss. All revisions were excluded. Descriptive statistics such as mean and standard deviation were used to analyze the data. The total sample size of the study was 5 patients, with a mean age of 59.6 ± 16.4 years, a mean weight of 292.1 ± 73.6 lbs., and a mean body mass index (BMI) of 43.4 ± 6.3. Weight loss patterns were the same as those without LF. All the 5 patients had resolution or improvement in their GERD symptoms within 6 months. SIPS with LF provides substantial and sustained weight loss and GERD resolution. Long term follow ups and further study on this novel surgical technique is recommended.