Ahmed Hassn1,2, Andreas Luhmann3, Samir Rahmani1, Gareth Morris-Stiff1,4. 1. Department of Surgery, Princess of Wales Hospital, Bridgend, UK. 2. Department of Surgery, El Zayton Hospital, Cairo, Egypt. 3. Department of Surgery, Ninewells Hospital, Dundee, Scotland. andreasluhmann@hotmail.com. 4. Department of Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
Abstract
BACKGROUND: The ideal bariatric operation achieves 70-100 % maintained excess weight loss, is simple with low operative risks, and maintains absorption of trace elements. Our aim was to find a bariatric procedure that achieves the above while avoiding drawbacks of current options. METHODS: A standard sleeve gastrectomy was combined with a modified jejuno-ileal bypass dividing the small bowel 75 cm distal to the duodeno-jejunal flexure, anastomosing it to the ileum 75 cm proximal to the ileocaecal valve. Operative and follow-up data were collected prospectively between December 2004 and January 2013. RESULTS: One hundred sixty-eight procedures were analysed (110 female, 58 male). Mean patient age was 43 years (IQR 37-47), and median preoperative body mass index (kg/m(2)) was 52 (IQR 49-59). All operations were completed laparoscopically. Excess weight loss was 78 % (IQR 70-83 %, 12 months, n = 168), 79 % (IQR 70-85 %, 24 months), maintained at most recent follow-up with 77 % (IQR 68-84 %, n = 168), and for 8 year follow-up alone 75 % (IQR 66-84 %, n = 18). There was no operative mortality and 5.4 % morbidity. A 6.5 % of patients experienced transient vomiting. No symptoms of dumping or bacterial overgrowth were observed. All had normal liver enzymes. Hypocalcaemia (20.8 %) and zinc deficiency (25.6 %) resolved with oral supplementation. Type 2 diabetes mellitus resolved in 80.3 % and improved in the remainder of patients, hypertension resolved in 92.3 % and improved in the rest. CONCLUSIONS: Whilst currently an investigative procedure, and within the studies limitations combined sleeve gastrectomy with modified jejuno-ileal bypass is safe and effective, and evades many problems associated with current bariatric operations whilst offering maintained excess weight loss.
BACKGROUND: The ideal bariatric operation achieves 70-100 % maintained excess weight loss, is simple with low operative risks, and maintains absorption of trace elements. Our aim was to find a bariatric procedure that achieves the above while avoiding drawbacks of current options. METHODS: A standard sleeve gastrectomy was combined with a modified jejuno-ileal bypass dividing the small bowel 75 cm distal to the duodeno-jejunal flexure, anastomosing it to the ileum 75 cm proximal to the ileocaecal valve. Operative and follow-up data were collected prospectively between December 2004 and January 2013. RESULTS: One hundred sixty-eight procedures were analysed (110 female, 58 male). Mean patient age was 43 years (IQR 37-47), and median preoperative body mass index (kg/m(2)) was 52 (IQR 49-59). All operations were completed laparoscopically. Excess weight loss was 78 % (IQR 70-83 %, 12 months, n = 168), 79 % (IQR 70-85 %, 24 months), maintained at most recent follow-up with 77 % (IQR 68-84 %, n = 168), and for 8 year follow-up alone 75 % (IQR 66-84 %, n = 18). There was no operative mortality and 5.4 % morbidity. A 6.5 % of patients experienced transient vomiting. No symptoms of dumping or bacterial overgrowth were observed. All had normal liver enzymes. Hypocalcaemia (20.8 %) and zinc deficiency (25.6 %) resolved with oral supplementation. Type 2 diabetes mellitus resolved in 80.3 % and improved in the remainder of patients, hypertension resolved in 92.3 % and improved in the rest. CONCLUSIONS: Whilst currently an investigative procedure, and within the studies limitations combined sleeve gastrectomy with modified jejuno-ileal bypass is safe and effective, and evades many problems associated with current bariatric operations whilst offering maintained excess weight loss.
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