AIM: To investigate which surgical techniques and perioperative regimens yielded the best survival rates for diabetic rats undergoing gastric bypass. METHODS: We performed Roux-en-Y gastric bypass with reserved gastric volume, a procedure in which gastrointestinal continuity was reestablished while excluding the entire duodenum and proximal jejunal loop. We observed the procedural success rate, long-term survival, and histopathological sequelae associated with a number of technical modifications. These included: use of anatomical markers to precisely identify Treitz's ligament; careful dissection along surgical planes; careful attention to the choice of regional transection sites; reconstruction using full-thickness anastomoses; use of a minimally invasive procedure with prohemostatic pretreatment and hemorrhage control; prevention of hypothermic damage; reduction in the length of the procedure; and accelerated surgical recovery using fast-track surgical modalities such as perioperative permissive underfeeding and goal-directed volume therapy. RESULTS: The series of modifications we adopted reduced operation time from 110.02 ± 12.34 min to 78.39 ± 7.26 min (P < 0.01), and the procedural success rate increased from 43.3% (13/30) to 90% (18/20) (P < 0.01), with a long-term survival of 83.3% (15/18) (P < 0.01). CONCLUSION: Using a number of fast-track and damage control surgical techniques, we have successfully established a stable model of gastric bypass in diabetic rats.
AIM: To investigate which surgical techniques and perioperative regimens yielded the best survival rates for diabeticrats undergoing gastric bypass. METHODS: We performed Roux-en-Y gastric bypass with reserved gastric volume, a procedure in which gastrointestinal continuity was reestablished while excluding the entire duodenum and proximal jejunal loop. We observed the procedural success rate, long-term survival, and histopathological sequelae associated with a number of technical modifications. These included: use of anatomical markers to precisely identify Treitz's ligament; careful dissection along surgical planes; careful attention to the choice of regional transection sites; reconstruction using full-thickness anastomoses; use of a minimally invasive procedure with prohemostatic pretreatment and hemorrhage control; prevention of hypothermic damage; reduction in the length of the procedure; and accelerated surgical recovery using fast-track surgical modalities such as perioperative permissive underfeeding and goal-directed volume therapy. RESULTS: The series of modifications we adopted reduced operation time from 110.02 ± 12.34 min to 78.39 ± 7.26 min (P < 0.01), and the procedural success rate increased from 43.3% (13/30) to 90% (18/20) (P < 0.01), with a long-term survival of 83.3% (15/18) (P < 0.01). CONCLUSION: Using a number of fast-track and damage control surgical techniques, we have successfully established a stable model of gastric bypass in diabeticrats.
Entities:
Keywords:
Damage control surgery; Duodenal-jejunal bypass; Fast-track surgery; Goal-directed volume therapy; Minimally invasive surgery; Permissive underfeeding; Type 2 diabetes mellitus
Authors: Birgitte Brandstrup; Hanne Tønnesen; Randi Beier-Holgersen; Else Hjortsø; Helle Ørding; Karen Lindorff-Larsen; Morten S Rasmussen; Charlotte Lanng; Lene Wallin; Lene H Iversen; Christina S Gramkow; Mette Okholm; Tine Blemmer; Poul-Erik Svendsen; Henrik H Rottensten; Birgit Thage; Jens Riis; Inge S Jeppesen; Dorthe Teilum; Anne Mette Christensen; Ben Graungaard; Frank Pott Journal: Ann Surg Date: 2003-11 Impact factor: 12.969
Authors: Philip R Schauer; Bartolome Burguera; Sayeed Ikramuddin; Dan Cottam; William Gourash; Giselle Hamad; George M Eid; Samer Mattar; Ramesh Ramanathan; Emma Barinas-Mitchel; R Harsha Rao; Lewis Kuller; David Kelley Journal: Ann Surg Date: 2003-10 Impact factor: 12.969