Sleeve Gastrectomy with Duodenal Transit Bipartition (S-DTB): Preliminary Results and Technical Aspects of Its Metabolic Structure — Oak Academic Publishing
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Sleeve Gastrectomy with Duodenal Transit Bipartition (S-DTB): Preliminary Results and Technical Aspects of Its Metabolic Structure
Paulo Reis Institute, Goiania, GO, Brazil
,
Department of Bariatric and Metabolic Surgery, CUF Descobertas Hospital, Lisbon, Portugal
,
Victor Dib Institute, Manaus, AM, Brazil
,
Gastrobese Clinic, Passo Fundo, RS, Brazil
,
Lusiadas Amadora Hospital, Lisbon, Portugal
,
Paulo Reis Institute, Goiania, GO, Brazil
,
Integrated Center for Advanced Medicine (CIMAMED), Sao Paulo, Brazil
,
Integrated Center for Advanced Medicine (CIMAMED), Sao Paulo, Brazil
,
Alfredo Nasser University Center (UNIFAN), Goiania, GO, Brazil
,
Clianest Group, Renaissance Hospital, Goiania, GO, Brazil
1 Paulo Reis Institute, Goiania, GO, Brazil
2 Department of Bariatric and Metabolic Surgery, CUF Descobertas Hospital, Lisbon, Portugal
3 Victor Dib Institute, Manaus, AM, Brazil
4 Gastrobese Clinic, Passo Fundo, RS, Brazil
5 Lusiadas Amadora Hospital, Lisbon, Portugal
6 Paulo Reis Institute, Goiania, GO, Brazil
7 Integrated Center for Advanced Medicine (CIMAMED), Sao Paulo, Brazil
8 Integrated Center for Advanced Medicine (CIMAMED), Sao Paulo, Brazil
9 Alfredo Nasser University Center (UNIFAN), Goiania, GO, Brazil
10 Clianest Group, Renaissance Hospital, Goiania, GO, Brazil
Obesity is a significant and escalating health issue both in Brazil and globally, with over 650 million overweight adults worldwide. The treatment of obesity can be performed clinically, endoscopically or surgically; surgical treatment proves to be safe and more effective in terms of weight loss and long-term maintenance. <b>Objective:</b> This study aimed to monitor the progress of weight loss and comorbidity control in patients undergoing sleeve gastrectomy with duodenal bipartition. <b>Methods:</b> This pilot project involved 8 patients divided into 2 arms. In the first arm, patients underwent sleeve gastrectomy with Roux-en-Y duodenoileal transit bipartition (S-RYDITB), while in the second arm, patients underwent sleeve gastrectomy with Roux-en-Y duodenojejunal transit bipartition (S-RYDJTB). Both procedures involved Roux-en-Y reconstruction without duodenal exclusion. In S-RYDITB, the duodenal-ileal anastomosis was performed 300 cm from the ileocecal valve (ICV), creating a 250 cm common channel and a 50 cm alimentary channel. In S-RYDJTB, a biliopancreatic loop was created 200 cm from the angle of Treitz, with a 1 m alimentary channel. <b>Results:</b> Five patients underwent the procedures, with one undergoing S-RYDITB and four undergoing S-RYDJTB. No adverse events such as hospitalizations, readmissions, reoperations, fistulas, bleeding, pulmonary embolism, diarrhea, dumping syndrome, or hypoglycemia occurred during the study period. The mean length of hospital stay was 2 days. The average BMI decreased from 37.27 kg/m<sup>2</sup> preoperatively to 29.48 kg/m<sup>2</sup> after 6 months. The significant percentage of weight loss was 21.22%, with excess weight loss of 63.6%. Ninety-five percent remission of comorbidities, including hypercholesterolemia, hypertriglyceridemia, diabetes, hypertension, steatosis, and pre-diabetes. Two patients underwent sleeve gastrectomy with duodenal bipartition using a single anastomosis. <b>Conclusion:</b> Duodenal switch surgery has gained worldwide recognition for its safety and efficacy in treating obesity and its associated comorbidities. In efforts to maintain the positive outcomes of the classic technique while minimizing adverse effects such as malnutrition and diarrhea, modifications to the original procedure have been proposed. Among these adaptations, Sleeve gastrectomy with bipartition of duodenal transit (S-DTB) emerges as a promising variant, offering alternative strategies to optimize patients’ nutritional safety while preserving endoscopic access to the duodenum. Initial results of S-DTB, whether performed in Roux-en-Y or single anastomosis (loop) configuration without intestinal exclusions, demonstrate the procedure’s safety and effectiveness in managing obesity and its comorbidities.
KeywordsObesity
Hess, D.S. and Hess, D.W. (1998) Biliopancreatic Diversion with a Duodenal Switch. Obesity Surgery , 8, 267-282. https://doi.org/10.1381/096089298765554476
Marceau, P., Hould, F.-S., Simard, S., Lebel, S., Bourque, R.-A., Potvin, M. and Biron, S. (1998) Biliopancreatic Diversion with Duodenal Switch. World Journal of Surgery , 22, 947-954. https://doi.org/10.1007/s002689900498
Breen, D.M., Rasmussen, B.A., Kokorovic, A., Wang, R., Cheung, G.W.C. and Lam, T.K.T. (2012) Jejunal Nutrient Sensing Is Required for Duodenal-Jejunal Bypass Surgery to Rapidly Lower Glucose Concentrations in Uncontrolled Diabetes. Nature Medicine , 18, 950-956. https://doi.org/10.1038/nm.2745
Freitas, A.C.D. (2007) Gastrointestinal Surgery for the Treatment of Type 2 Diabetes. Arquivos Brasileiros de Cirurgia Digestiva , 20, 119-126. https://doi.org/10.1590/S0102-67202007000200012
Cadian, D.C.F. (2018) Respostas transcriptômica e sistemática de hormônios gastrintestinais à derivação gástrica em Y e Roux e sua correlação com homeostase glicêmica em pacientes obesas portadoras de diabetes mellitus tipo 2. Dissertação de mestrado, Universidade de São Paulo, São Paulo.
Santoro, S., Castro, L.C., Prieto Velhote, M.C., Malzni, C.E., Klajner, S., Castro, L.P., Lacombe, A. and Santo, M.A. (2012) Sleeve Gastrectomy with Transit Bipartition: A Potent Intervention for Metabolic Syndrome and Obesity. Annals of Surgery , 256, 104-110. https://doi.org/10.1097/SLA.0b013e31825370c0
Ruano-Campos, A., Lasses, B., Sánchez-Pernaute, A. and Torres, A. (2020) SADI (Single-Anastomosis Duodeno-Ileal Bypass): Current Evidence. Current Surgery Reports , 8, Article No. 20. https://doi.org/10.1007/s40137-020-00267-1
Sánchez-Pernaute, A., Rubio, M.A. and Torres, A.J. (2016) Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) Surgery. In: Agrawal, S., Ed., Obesity , Bariatric and Metabolic Surgery , Springer, Cham, 463-467. https://doi.org/10.1007/978-3-319-04343-2_47
Paula, A.L., Silva, A., Paula, C.C.L., Venancio, S. and Halpern, A. (2010) Aspectos técnicos da interposição ileal com gastrectomia vertical como possível opção ao tratamento do diabetes mellitus tipo 2. Arquivos Brasileiros de Cirurgia Digestiva , 23, 128-130. https://doi.org/10.1590/S0102-67202010000200014
Paula, A.L., Ugale, S.M., Branco, A.J., Dutra, C.C.L.P., Ugale, A., Ugale, A. and Celik, A. (2023) Ileal Interposition with Sleeve Gastrectomy for Type 2 Diabetes Mellitus and Metabolic Syndrome. In: Agrawal, S. Ed., Obesity , Bariatric and Metabolic Surgery , Springer, Cham, 843-866. https://doi.org/10.1007/978-3-030-60596-4_58
Bariatric Surgery
Metabolic Surgery
Duodenal Switch
Duodenal Transit Bipartition
Duodenal Bipartition
Ser, K.-H., Lee, W.-J., Chen, J.-C., Tsai, P.-L., Chen, S.-C. and Lee, Y.-C. (2019) Laparoscopic Single-Anastomosis Duodenal-Jejunal Bypass with Sleeve Gastrectomy (SADJB-SG): Surgical Risk and Long-Term Results. Surgery for Obesity and Related Diseases , 15, 236-243. https://doi.org/10.1016/j.soard.2018.11.020
Lee, W.-J., Lee, K.-T., Kasama, K., Seiki, Y., Ser, K.-H., Chun, S.-C., Chen, J.-C. and Lee, Y.-C. (2013) Laparoscopic Single-Anastomosis Duodenal-Jejunal Bypass with Sleeve Gastrectomy (SADJB-SG): Short-Term Result and Comparison with Gastric Bypass. Obesity Surgery , 24, 109-113. https://doi.org/10.1007/s11695-013-1067-z
Santoro, S., Milleo, F.Q., Malzoni, C.E., Klainer, S., Borges, P.C.M., Santo, M.A., Campos, F.G. and Artori, R.F. (2008) Enterohormonal Changes after Digestive Adaptation: Five-Year Results of a Surgical Proposal to Treat Obesity and Associated Diseases. Obesity Surgery , 18, 17-26. https://doi.org/10.1007/s11695-007-9371-0
Chacra, A.R. (2006) Efeito fisiológico das incretinas. Johns Hopkins Advanced St u dies in Medi cine , 6, S613-S617.
Alves, M., Neves, C. and Medina, J.L. (2007) Incretinas e Tratamento da Diabetes. Revista Portuguesa de Diabetes , 2, 22-25.
Zubiaga, L., Vilallonga, R., Ruiz-Tovar, J., Torres, A. and Pattou, F. (2018) Importancia del tracto gastrointestinal en la diabetes de tipo 2. La cirugıa metabolica es mas que incretinas. Cirugía Española , 96, 537-545. https://doi.org/10.1016/j.ciresp.2018.09.004
Pareja, J.C., Pilla, V.F. and Geloneze Neto, B. (2006) Mecanismos de funcionamento das cirurgias anti-obesidade. Einstein , 4, S120-S124.
Melo, P.R.E., Braga, T.C., Minari, D.F. and Resende, J.H.C. (2022) Transit Bipartition with Duodeno-Ileal Anastomosis, without Duodenal Exclusion, as a First Stage of Bariatric Surgery in Severely Obese Patients: Case Report. Surgical Sciences , 13, 497-505. https://doi.org/10.4236/ss.2022.131158
Melo, P.R.E., Braga, T.C., Moura, N.M., Gonçalves Junior, J.C., Oliveira, M.V.M., Gava-Brandolis, M.G. and Homar, D.G. (2019) Evaluation of the Scopinaro Modified Technique in the Surgical Treatment of Obesity Compared to the Classic Scopinaro Surgery—Results after an 18-Month Randomized Clinical Trial. Intern a tional Journal of Nutrology , 12, 71-80. https://doi.org/10.1055/s-0039-3402030
Melo, P.R.E., Gava-Brandolis, M.G., Braga, T.C., Minari, D.F., Costa, R.A.M.B., Sampaio Neto, J.G.M., Silva, L.F. and Resende, J.H.C. (2022) Gastric Bypass with Long Pouch and Transit Bipartition for Endoscopic Access to the Remaining Stomach. Surgical Sciences , 13, 353-366. https://doi.org/10.4236/ss.2022.138044
Moreira, P.R.S. and Kelly, E.O. (2014) Implicações do consumo de proteína e da prática de atividade física na massa corporal magra de mulheres submetidas ao Bypass gástrico. Revista Brasileira de Obesidade, Nutrição e Emagrecimento , 8, 97-105.
Bastos, E.C.L., Barbosa, E.M.W.G., Soriano, G.M.S., Santos, E.A. and Vasconcelos, S.M.L. (2013) Fatores determinantes do reganho ponderal no pósoperatório de cirurgia bariátrica. Arquivos Brasileiros de Cirurgia Digestiva , 26, 26-32. https://doi.org/10.1590/S0102-67202013000600007
Barhouch, A.S. (2010) Variação do percentual da perda do excesso de peso no pós-operatório tardio dos pacientes obesos mórbidos submetidos ao Bypass gastrointestinal em Y de ROUX. Dissertação de mestrado, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre.
Pacheco, C.N.M. (2022) Efeitos das hormonas do apetite na gastrectomia Sleeve. Dissertação de mestrado, Faculdade de Medicina Coimbra, Coimbra.
Santoro, S., Lacombre, A., Aquino, C.G., Malzoni, C.E. (2014) Sleeve Gastrectomy with Anti-Reflux Procedures. Einstein , 12, 287-294. https://doi.org/10.1590/s1679-45082014ao2885
Ramkumar, D. and Schulze, K.S. (2005) The Pylorus. Neurogastroenterology & M o tility , 17, 22-30. https://doi.org/10.1111/j.1365-2982.2005.00664.x
Sanioto, S.M.L. (2008) Motilidade do Trato Gastrintestinal. In: Aires, M.M., Ed., F i siologia , Guanabara Koogan, Rio de Janeiro, Chapter 57, 804-826.
Silva, L.G.R., Cunha, D.N., Ferreira, I.N., Vargas, J.R., Lopes, J.R., Saraiva, N.B., Campos, V.A.E., Thomaz, Y.B., Leite, N.A.A. (2022) Gastroparesia em pacientes diabéticos: uma revisão narrativa. Brazilian Journal of Health Review , 5, 8000-8011. https://doi.org/10.34119/bjhrv5n2-348
Liberato, J.A. (1948) Anatomia dos “Piloros” (esfincteres) do sistema digestório (preleção). Revolution Medicines , 32, 273-280.
Friesen, S.R. and Rieger, E. (1960) A Study on the Role of the Pylorus in the Prevention of the “Dumping Syndrome”. Annals of Surgery , 151, 517-529. https://doi.org/10.1097/00000658-196004000-00011
Santoro, S. (2020) The Bipartition May be Better, and not Just for Super Obesity. Surgery for Obesity and Related Diseases , 16, E49-E50. https://doi.org/10.1016/j.soard.2020.04.002
Santoro, S., Aquino, C.G. and Mota, F.C. (2021) Exclusions May be Dismissed If the Ileum Is Early and Potently Stimulated. Obesity Surgery , 31, 5049-5050. https://doi.org/10.1007/s11695-021-05526-3
Widjaja, J., Chu, Y., Yang, J., Wang, J. and Gu, Y. (2022) Can We Abandon Foregut Exclusion for an Ideal and Safe Metabolic Surgery? Frontiers in Endocrinology , 13, Article 1014901. https://doi.org/10.3389/fendo.2022.1014901
Pereira, S.S., Guimarães, M., Almeida, R., Pereira, A.M., Lobato, C.B., Hartmann, B., Hilsted, L., Holst, J.J., Nora, M. and Monteiro, M.P. (2018) Biliopancreatic Diversion with Duodenal Switch (BPD-DS) and Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) Result in Distinct Post-Prandial Hormone Profiles. International Journal of Obesity , 43, 2518-2527. https://doi.org/10.1038/s41366-018-0282-z
Sánchez-Pernaute, A., Herrara Rubio, M.A., Perez-Aguirre, E., García Perez, J.J. Cabrezito, L., Valladares, L.D., Fernández, C., Talavera, P. and Torres, A. (2007) Proximal Duodoenal-Ileal End-to-Side Bypass with Sleeve Gastrectomy. Obesity Surgery , 17, 1614-1618. https://doi.org/10.1007/s11695-007-9287-8
Ganger, M., Cadiere, G.B., Sanchez-Pernaute, A., Abuladze, D, Krinke, T., Buchwald, J.N., Van Sante, N., Van Gossum, M., Dziakova, J., Koiava, L., Odovik, M., Poras, M., Almutlaq, L. and Torres, A.J. (2023) Side-to-Side Magnet Anastomosis System Duodeno-Ileostomy with Sleeve Gastrectomy: Early Multi-Center Results. Surgical Endoscopy , 37, 6452-6463. https://doi.org/10.1007/s00464-023-10134-6
Tinoco, A., Silva Netto, M., Benedito, H., DePaula, A. and Kadre, L. (2024) Five Year Follow up after Surgical Treatment of Type 2 Diabetes with Laparoscopic Sleeve Gastrectomy Associated with a Duodenal Ileal Interposition. Preprint, Research Square. https://doi.org/10.21203/rs.3.rs-3483212/v1
Cadière, G.B., Poras, M., Maréchal, M.T., Pau, L., Muteganya, R., van Gossum, M., Cadière, B., Van Sante, N. and Gagner, M. (2024) Sleeve Gastrectomy with Duodeno-Ileal Bipartition Using Linear Magnets: Feasibility and Safety at 1-Year Follow-up. Journal of Gastrointestinal Surgery , In Press. https://doi.org/10.1016/j.gassur.2024.02.001
Tardelli, B.C., Garcia, G., Lívia B. Gomes, L.B., Ribeiro, L.B. and Nunes, C.P. (2019) Síndrome de Dumping e sua relação com cirurgias bariátricas. Reviews in Card i ovascular Medicine , 2, 176-184.
Chaves, Y.S. and Destefani, A.C. (2016) Pathophysiology, Diagnosis and Treatment of Dumping Syndrome and Its Relation to Bariatric Surgery. Arquivos Brasileiros de Cirurgia Digestiva , 29, 116-119. https://doi.org/10.1590/0102-6720201600s10028
Sampaio-Neto, J., Branco-Filho, A.J., Nassif, L.S., Nassif, A.T., Masi, F.D.J. and Ximenez, D.R. (2015) Proposal of a Revisional Surgery to Treat Non-Insulinoma Hyperinsulinemic Hypoglicemia Postgastric Bypass. Arquivos Brasileiros de Ciru r gia Digestiva , 28, 278-281. https://doi.org/10.1590/s0102-6720201500040015
Sampaio-Neto, J., Branco-Filho, A.J., Nassif, L.S., Nassif, A.T., Masi, F.D.J. and Gasperin, G. (2016) Proposal of a Revisional Surgery to Treat Severe Nutritional Deficiency Post-Gastric Bypass. Arquivos Brasileiros de Cirurgia Digestiva , 29, 98-101. https://doi.org/10.1590/0102-6720201600s10024
Zeve, J.L.M., Novais, P.L. and Oliveira Junior, N. (2012) Bariatric Surgery Techniques: A Literature Review. Revista Ciência & Saúde Coletiva , 5, 132-140. https://doi.org/10.15448/1983-652X.2012.2.10966
Halluch, D. (2020) Metabolismo de carboidratos e emagrecimentos. In: Halluch, D., Ed., Metabolismo e emagrecimento , Letras Contemporâneas, Curitiba, 368.
Machado, U.F. (1998) Transportadores de glicose. Arq bras endocrinol metab , 42, 413-421. https://doi.org/10.1590/S0004-27301998000600003
Marzzoco, A. and Torres, B.B. (2022) Bioquímica Básica. Guanabara Koogan, Rio de Janeiro.
Vilar, L. (2020) Endocrinologia clínica. Guanabara Koogan, Rio de Janeiro.
Papamargaritis, D., Miras, D. and Roux, C.W. (2023) Influence of Diabetes Surgery on Gut Hormones and Incretins. Nutrición Hospitalaria , 28, 95-103.
Libaroni, H.T. and Malerbi, D.A. (2015) Estado atual da cirurgia metabólica. In: Mancini, M.C., Ed., Tratado de obesidade , Guanabara Koogan, Rio de Janeiro, 936.
Drucker, D.J. (2006) The Biology of Incretin. Cell Metabolism , 3, 153-165. https://doi.org/10.1016/j.cmet.2006.01.004
Cazzo, E., Gestic, M.A., Utrini, M.P., Chaim, F.D.M., Geloneze, B., Pareja, J.C., Chaim, E.A. and Magro, D.O. (2016) GLP-2: A Poorly Understood Mediator Enrolled in Various Bariatric/Metabolic Surgery-Related Pathophysiologic Mechanisms. Arquivos Brasileiros de Cirurgia Digestiva , 29, 272-275. https://doi.org/10.1590/0102-6720201600040014
Torres, A., Rubio, M.A., Ramos-Leví, A.M. and Sánchez-Pernaute, A. (2017) Cardiovascular Risk Factors after Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S): A New Effective Therapeutic Approach? Current Athero s clerosis Reports , 19, Article No. 58. https://doi.org/10.1007/s11883-017-0688-4
Jiménez, I., Ortega, I., Larrad, A., Barabash, A., Bordiu, E., Sánchez-Pernaute, A., Pérez-Ferre, N., Marcuello, C., Matía, P., Torres, A.J., Angeles, C.M., Calle-Pascual, A.L. and Rubio, M.A. (2020) Secretion of Bile Acids in Different Techniques of Bariatric Surgery. Endocrine Abstracts , 70, AEP285. https://doi.org/10.1530/endoabs.70.AEP285
Mendes, I.F.I. (2018) Da cirurgia bariátrica à metabólica: o reconhecimento das inter-relações endócrinas na obesidade e síndrome metabólica. Uma revisão. Mestrado, Faculdade de Medicina de Lisboa, Lisboa.
Lee, W.J., Almulaifi, A.M., Tsou, J.J., Ser, K.H., Lee, Y.C. and Chen, S.C. (2015) Duodenal-Jejunal Bypass with Sleeve Gastrectomy versus the Sleeve Gastrectomy Procedure Alone: The Role of Duodenal Exclusion. Surgery for Obesity and Related Diseases , 11, 765-770. https://doi.org/10.1016/j.soard.2014.12.017
Coelho, D., Godoy, E.P., Marreiros, I., Luz, V.F., Oliveira, A.M.G., Campos, J.M., Caldas Neto, S.S. and Freitas, M.P.C. (2018) Diabetes Remission Rate in Different BMI Grades Following Roux-en-Y Gastric Bypass. Arquivos Brasileiros de Cirurgia Digestiva , 31, e1343. https://doi.org/10.1590/0102-672020180001e1343
Liu, P., Widjaja, J., Dolo, P.R., Yao, L., Hong, G., Shao, Y. and Zhu, X. (2021) Comparing the Anti-Diabetic Effect of Sleeve Gastrectomy with Transit Bipartition against Sleeve Gastrectomy and Roux-en-Y Gastric Bypass Using a Diabetic Rodent Model. Obesity Surgery , 31, 2203-2210. https://doi.org/10.1007/s11695-021-05256-6
Ravacci, G.R., Ishida, R., Torrinhas, R.S., Sala, P., Machado, N.M., Fonseca, D.C., Canuto, G.A.,B., Pinto, E., Nascimento, V., Tavares, M.F.M., Sakai, P., Faintuch, J., Santo, M.A., Moura, E.G.H., Artigiani Neyo, R., Logullo, F. and Waitzberg, D.L. (2019) Potential Premalignant Status of Gastric Portion Excluded after Roux en-Y Gastric Bypass in Obese Women: A Pilot Study. Scientific Reports , 9, Article No. 5582. https://doi.org/10.1038/s41598-019-42082-4
Dib, V.R.M., Madalosso, C.A.S., Domene, C.E., Melo, P.R.E., Ribeiro, R., Scortegagna, G.T. and Chaim, E.A. (2023) Sleeve Gastrectomy Associated with Antral Lesion Resection and Roux-en-Y Antrojejunal Reconstruction. Surgical Sciences , 14, 360-376. https://doi.org/10.4236/ss.2023.145041