Sleeve gastrectomy with transit bipartition in a series of 883 patients with mild obesity: early effectiveness and safety outcomes

Gastro-Jejunal Ileal Interposition with Bipartition: A Salvage Procedure for Severe Protein-Energy Malnutrition After Transit Bipartition

BACKGROUND

Intractable diarrhea or excess weight loss associated with protein-energy malnutrition (PEM) can occur after Transit Bipartition (TB). This study evaluates the effect of transposing the alimentary limb to the proximal intestines.

METHODS

Between 2017 and 2024, ten patients with malnutrition and diarrhea underwent Gastro-Jejunal Ileal Interposition (GJIB) surgery after TB. We prospectively monitored protein-energy malnutrition postoperatively and retrospectively analyzed demographic data, laboratory findings, and anthropometric measurements. Gastric transit scintigraphy was performed on symptomatic and asymptomatic patients to evaluate gastric evacuation diversity between the pylorus and the gastro-ileostomy.

RESULTS

Ten patients (male/female, 6/4) were operated on. The preoperative mean age was 49.4 ± 9.19 years. The mean body mass index (BMI) was 22.19 ± 1.13 kg/m2, the mean excess BMI loss (%EBMIL) percentage was 123.26 ± 14.85%, and the total weight loss percentage (%TWL) was 42.35 ± 0.33. Eighty percent of food passed through the gastroileostomy in all patients. The mean follow-up period was 50.56 ± 57.28 months. Postoperatively, the mean BMI increased to 28.16 ± 2.2 kg/m2 (p = 0.001), %EBMIL decreased to 79.88 ± 21.53% (p = 0.001), and %TWL decreased to 27.31 ± 10.1. Albumin levels rose from a median of 2.1 mg/dl to an average of 3.8 ± 0.78 mg/dl (p = 0.001), and stool frequency decreased from 11.56 ± 0.71 to 2.1 ± 2.12 per day (p = 0.001). The excluded bowel length percentage (Exl.B%) decreased significantly from 72.4 ± 3.18% to 12.3 ± 1.99% after conversion (p = 0.005). All patients were diabetic before and had remission after TB. Glycemic control was preserved after the conversion, with a median HbA1c of 5.4% compared to 5.8% before conversion.

CONCLUSIONS

GJIB may be a viable revision procedure for resolving PEM and related complications without compromising the metabolic benefits of the initial surgery on diabetes resolution by decreasing the Exl.B%.

Sleeve gastrectomy plus single anastomosis sleeve ileal bipartition versus sleeve gastrectomy alone: The role of bipartition

BACKGROUND

Sleeve gastrectomy (SG) with single anastomosis sleeve ileal bipartition (SASI) is a novel procedure for increasing the anti-metabolic efficacy of SG in severely people with obesity.

OBJECTIVES

This study aimed to compare 1-year results between SASI and SG, thereby assessing the role of bipartition.

SETTING

The study was conducted at the Medical University hospital.

METHODS

Between November 2021 and December 2022, 39 patients received an SG + SASI surgery, a total of 35 patients completed 1-year follow-up after the surgery. They were matched with a group of 70 patients with SG that were equal in age, sex, and body mass index (BMI). Operative risk, weight loss, and remission of comorbidities were evaluated after 12 months.

RESULTS

The operation time of the SASI group was significantly longer than the SG group (140.3 ± 22.8 vs. 114.9 ± 21.6 min; p < .001). At 12 months after surgery, the SASI group had better weight loss (total weight loss: 37.0% vs. 29.7%; p = .001) and achieved a lower BMI than SG (23.4 ± 2.6 kg/m2 vs. 24.6 ± 2.9 kg/m2; p = .046). Reduction of A1C and remission of T2D was greater in the SASI group. The SASI group had a higher reduction in uric acid, low-density lipoprotein, total cholesterol, and triglyceride levels after operation than the SG group. However, the SG group is superior to the SASI group in mean corpuscular volume, calcium, and iron levels.

CONCLUSIONS

In this study, adding an ileum bipartition to SG increases the weight loss, glycemic, and blood lipid control of SG only.

Evaluation of the nutritional status of morbid obesity patients in the first six months after sleeve gastrectomy

Introduction

Objective: in recent years, bariatric surgery has gained popularity as a treatment for obesity worldwide. While patients do experience weight loss after surgery, it is important to be aware that serious nutritional deficiencies may also occur. This study was conducted to evaluate the nutritional status of morbidly obese patients in the first six months after sleeve gastrectomy. Methods: the study was planned as a retrospective study. The data of 76 patients aged 19-64 years who had undergone bariatric surgery and were followed by a dietitian for at least 6 months were included in the study. Preoperative and postoperative biochemical parameters and anthropometric measurements of the patients were taken. Results: the lowest body weight of the patients was found at postoperative month 6 (81.74 ± 14.83 kg), the body weight at the preoperative period (115.86 ± 21.28 kg) and postoperative month 1 (100.39 ± 18.28 kg), and the body weight at postoperative month 1 was statistically lower than at the preoperative period. The preoperative body weights and BMI values of the patients were higher than at postoperative months 1 and 6, and the postoperative month 1 values were higher than at postoperative month 6 (p < 0.05). The lowest fasting blood glucose (83.48 ± 8.44 mg/dL), HbA1c (4.96 ± 0.95 %), and Homa-IR (3.34 ± 0.92) were observed at the postoperative month 6. Compared with the preoperative period, the iron level of the patients increased from 69.54 ± 29.82 µg/dL to 96.52 ± 25.39 µg/dL in postoperative month 6, vitamin D levels from 14.48 ± 8.70 µg/dL to 23.96 ± 4.79 µg/dL. While preoperative blood triglyceride and LDL values were statistically higher than in postoperative months 1 and 6, the HDL value was lower (p < 0.05). Conclusion: as a result, after sleeve gastrectomy, patient body weight decreased, and blood lipid profile and diabetes symptoms improved.

Effects of laparoscopic sleeve gastrectomy on thyroid hormones and relationship between metabolic parameters and long-term total weight loss

BACKGROUND

Bariatric surgery has significant effects on metabolic parameters and hormone levels. However, the specific impact of laparoscopic sleeve gastrectomy (LSG) on thyroid hormones and other metabolic parameters remains unclear. This study aimed to investigate the short and long-term effects of LSG on thyroid hormone levels, HbA1c, and other metabolic parameters.

METHODS

A total of 619 euthyroid patients without a history of thyroid disease or thyroid hormone replacement therapy were included in the study. Patients with diabetes were excluded from the study. Preoperative, 1-year postoperative, and 5-year postoperative levels of thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), HbA1c, and other metabolic parameters were recorded and analyzed.

RESULTS

LSG resulted in significant weight loss and improvements in metabolic parameters. At 1 year postoperatively, there were significant reductions in BMI, HbA1c, TSH, fT3, and triglyceride levels, while fT4 levels increased. A statistically significant negative correlation was found between preoperative HbA1c level and percentage of total weight loss (%TWL) value at the fifth postoperative year. Additionally, a statistically significant negative correlation was found between the 5-year change in TSH and %TWL.

CONCLUSION

Being the first study to predict long-term total weight loss based on preoperative HbA1c, it is significant. This finding has important implications for personalized patient management and could aid clinicians in identifying individuals who may benefit most from sleeve gastrectomy as a treatment modality. This is valuable in that it emphasizes multidisciplinary work, including the endocrinologist and dietician.

Comparison of the ABCD Score's Accuracy in Predicting Remission of Type 2 Diabetes Mellitus One Year After Sleeve Gastrectomy, One Anastomosis Gastric Bypass, and Sleeve Gastrectomy with Transit Bipartition

PURPOSE

ABCD score is one of the scoring systems that predicts the probability of T2DM remission after bariatric surgery. Its success in determining T2DM remission after sleeve gastrectomy with transit bipartition (TB) has not yet been validated. The aim of this study was to evaluate the predictive value of ABCD score in TB.

MATERIALS AND METHODS

Of 438 patients with T2DM, 191 underwent sleeve gastrectomy (SG), 136 underwent one anastomosis gastric bypass (OAGB), and 111 underwent TB. Retrospective analysis of ABCD scores, 1-year postoperative remission rates, and the predictive accuracy of ABCD scores for these were conducted.

RESULTS

In the SG, OAGB, and TB groups, respectively, median ABCD scores were 7, 6, and 4, while complete remission rates were 95.3%, 84.6%, and 76.6% (p < 0.001). The area under curves (AUCs) for SG, OAGB, and TB were 0.829 (95% CI = 0.768 to 0.879, p < 0.0001), 0.801 (95% CI = 0.724 to 0.865, p < 0.0001), and 0.840 (95% CI = 0.758 to 0.902, p < 0.0001), respectively. There was no statistically significant difference between AUCs.

CONCLUSION

ABCD score predicts the probability of remission at 1-year follow-up in T2DM patients undergoing TB as accurately as in patients receiving SG or OAGB.

Sleeve gastrectomy with one anastomosis bipartition versus one anastomosis gastric bypass: A pilot study

BACKGROUND

One anastomosis gastric bypass (OAGB) is a new recognized metabolic surgery, but the problem that we cannot screen the excluded stomach is a troubling issue in China. The emergence of sleeve gastrectomy plus one anastomosis bipartition (SG + OAB) makes us see a hope to solve this problem.

OBJECTIVES

By comparing the efficacy of the two surgical methods, to evaluate whether SG + OAB surgery can solve the dilemma faced by OAGB that the excluded stomach cannot be screened.

METHODS

A retrospective study to compare the patients who underwent OAGB and SG + OAB was conducted. The main outcome measures were (1) operation risk, (2) weight loss, and (3) diabetes remission at 6 months.

RESULTS

This study was conducted in the bariatric/metabolic surgical center. From November 2021 to February 2022, a total of 30 patients with obesity who received SG + OAB surgery were recruited. Another matched 60 patients undergoing OAGB were recruited as control group. There was no difference in preoperative age (32.15 ± 9.02 vs. 34.47 ± 7.22; p = .224), female ratio (83% vs. 85%; p = .837), and BMI (36.18 ± 5.30 vs. 34.68 ± 5.58; p = .217) between the two groups. OAGB had a shorter mean operation time (121.67 ± 20.41 vs. 143.50 ± 25.07 min; p < .001) and a lower intraoperative blood loss (21.92 ± 12.35 vs. 32.43 ± 22.01 mL; p = .005), but a longer postoperative flatus passage (2.13 ± 0.43 vs. 1.87 ± 0.43 days; p = .007) compared with the SG + OAB group. Two patients (6.7%) developed major surgical complication in SG + OAB group but no major complication developed in OAGB group. At 6 months after surgery, SG + OAB had a higher %total weight loss than OAGB (31.05 ± 3.12 vs. 28.14 ± 5.43%; p = .015), but diabetes remission rate was similarly high in both groups.

CONCLUSIONS

SG + OAB operation had a non-inferior or even better weight loss than OAGB, with a similar glycemic control efficacy. However, the high complication rate of SG + OAB is the major drawback that needs attention.

BRAZILIAN MULTI-SOCIETY POSITION STATEMENT ON EMERGING BARIATRIC AND METABOLIC SURGICAL PROCEDURES

This Brazilian multi-society position statement on emerging bariatric and metabolic surgical procedures was issued by the Brazilian Society of Bariatric and Metabolic Surgery (SBCBM), the Brazilian College of Digestive Surgery (CBCD), and the Brazilian College of Surgeons (CBC). This document is the result of a Brazilian Emerging Surgeries Forum aimed at evaluating the results of surgeries that are not yet listed in the Federal Council of Medicine (CFM), the regulatory agency that oversees and regulates medical practice in Brazil. The Forum integrated more than 400 specialists and academics with extensive knowledge about bariatric and metabolic surgery, representing the three surgical societies: SBCBM, CBC, and CBCD. International speakers participated online and presented their experiences with the techniques under discussion, emphasizing the regulatory policies in their countries. The indications for surgery and the subsequent procedures were carefully reviewed, including one anastomosis gastric bypass (OAGB), single anastomosis duodeno-ileal with sleeve gastrectomy (SADI-S or OADS), sleeve gastrectomy with transit bipartition (SGTB), and sleeve gastrectomy with ileal interposition (SGII). The recommendations of this document are based on an extensive literature review and discussions among bariatric surgery specialists from the three surgical societies. We concluded that patients with a body mass index over 30 kg/m2 may be candidates for metabolic surgery in the presence of comorbidities (arterial hypertension and type 2 diabetes) with no response to clinical treatment of obesity or in the control of other associated diseases. Regarding the surgical procedures, we concluded that OAGB, OADS, and SGTB are associated with low morbidity rates, satisfactory weight loss, and resolution of obesity-related comorbidities such as diabetes and arterial hypertension. SGII was considered a good and viable promising surgical alternative technique. The recommendations of this statement aim to synchronize our societies with the sentiments and understandings of most of our members and also serve as a guide for future decisions regarding bariatric surgical procedures in our country and worldwide.

Laparoscopic Sleeve Gastrectomy With Transit Loop Bipartition and Transit Bipartition in Type 2 Diabetic Patients With Obesity: A Retrospective Analysis

AIM

We aimed to compare 1-year postoperative results of patients with obesity and type 2 diabetes mellitus (T2DM) who underwent laparoscopic sleeve gastrectomy with transit bipartition (LSG-TB) and transit loop bipartition (LSG-TLB) and mini gastric bypass (MGB).

PATIENTS AND METHODS

This is a retrospective comparison of 2 novel bariatric surgery techniques with MGB. Primary outcome measure of the study was a rate of T2DM remission. Secondary outcomes included excess body mass index (BMI) loss, improvement in hepatosteatosis, and duration of operation. Revision surgery needs were also assessed.

RESULTS

Overall, 32 patients underwent the LSG-TLB, 15 underwent LSG-TB, and 50 underwent MGB. Mean age and sex distribution were comparable for all groups. Presurgical BMI was similar in MGB and LSG + TB groups, whereas LSG + TLB group had significantly lower BMI values compared with the MGB group. In both groups, BMI values reduced significantly compared with respective baseline values. Excess BMI loss was significantly higher in patients who underwent LSG-TLB compared with patients treated with LSG-TB and MGB. Bariatric surgery procedures lasted shorter in LSG-TLB than in LSG-TB. However, the shortest of all was MGB. The remission of T2DM rates were 71% and 73.3% in LSG-TLB and LSG-TB groups, respectively ( P > 9.999). The rate of revision surgeries was comparable in both groups.

CONCLUSION

In conclusion, LSG-TLB took less time and provided significantly higher excess BMI loss compared with LSG-TB. T2DM remission and improvement rates were similar in both groups. LSG-TLB seemed like a promising bariatric surgery technique in patients with obesity and T2DM.

Comparison of the Outcomes of Single Anastomosis Duodeno-Ileostomy with Sleeve Gastrectomy (SADI-S), Single Anastomosis Sleeve Ileal (SASI) Bypass with Sleeve Gastrectomy, and Sleeve Gastrectomy Using a Rodent Model with Diabetes

OBJECTIVE

Single anastomosis duodeno-ileostomy with sleeve gastrectomy (SADI-S) is a powerful form of bariatric surgery; however, it has a high risk of malnutrition. Single anastomosis sleeve ileal (SASI) bypass with sleeve gastrectomy may be used as an alternative procedure to avoid malnutrition associated with SADI-S; however, no comparison between the two procedures has been performed.

METHODS

Sprague-Dawley rats with diabetes (n = 32) were divided into four groups: SADI-S (n = 8), SASI (n = 8), SG (n = 8), and SHAM (n = 8). Body weight, food intake, and fasting blood glucose were measured, and the oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) were performed before and after surgery. Blood samples were collected before and after the surgery to assess the levels of glucagon-like peptide-1 (GLP-1), hemoglobin, albumin, vitamin B12, calcium, and iron.

RESULTS

The SADI-S and SASI groups showed significantly greater weight loss and better glucose control than the SG group postoperatively. The SADI-S and SASI groups showed similar improvements in glucose control throughout the study. The SADI-S and SASI groups had significantly higher GLP-1 levels than the SG group at 6 months. The SADI-S and SASI groups presented with various degrees of deficiencies, with the SADI-S group showing a higher risk for hypoalbuminemia and iron deficiency than the SASI group.

CONCLUSIONS

The SASI procedure may be a better alternative as it has excellent bariatric and metabolic results with lower risk for hypoalbuminemia and can be easily converted into either SADI-S or SG procedures. Nevertheless, further clinical results are needed.