Seh-Huang Chao1,2, Chia-Lin Lin3, Wei-Jei Lee4, Jung-Chien Chen5,6, Ju Jun Chou5. 1. Department of Bariatric and Metabolic Surgery, Jen-Ai Hospital, No. 483, Dongrong Rd., Dali Dist., Taichung City 412, Taiwan, Republic of China. sec2177@mail.jah.org.tw. 2. Department of Surgery, Central Clinic Hospital, Taipei, Taiwan. sec2177@mail.jah.org.tw. 3. Department of Bariatric and Metabolic Surgery, Jen-Ai Hospital, No. 483, Dongrong Rd., Dali Dist., Taichung City 412, Taiwan, Republic of China. 4. Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Taoyuan, Taiwan, Republic of China. wjlee_obessurg_tw@yahoo.com.tw. 5. Department of Surgery, Central Clinic Hospital, Taipei, Taiwan. 6. Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Taoyuan, Taiwan, Republic of China.
Abstract
BACKGROUND: Laparoscopic gastric clip (GC), a novel pure restrictive procedure, is a safe and effective treatment for morbid obesity. However, whether adding a proximal jejunal bypass (PJB) to this procedure might increase the efficacy is unknown. METHODS: Outcomes of 74 (43 women and 31male) obese patients who had undergone PJB-GC (41) or GC (33) for the treatment of type 2 diabetes mellitus (T2D) with 1 year follow-up were assessed. GC consists of creating a transverse gastric partition with a metallic clip. PJB consists of a jejuno-ileostomy between 20 and 320 cm distal to the ligament of Treitz. Postoperative body mass index (BMI) reduction, total weight loss (TWL), and remission rates of T2D were evaluated. RESULTS: The preoperative clinical characters in both groups were similar. The mean operative time was significantly longer in the PJB-GC group than in the GC group. At 24 months after surgery, the BMI was lower (32.5 ± 6.2 vs. 37.0 ± 5.9 kg/m2, p = 0.002) and weight loss higher in PJB-GC than GC (TWL 31.3 ± 14.8 vs. 23.5 ± 10.4%, p = 0.011). Remission of T2D was greater in the PJB-GC group (90.2 vs. 57.2%; p < 0.001). CONCLUSIONS: In this study, PJB-GC was superior to GC in weight loss and T2D remission at 1 and 2 years after surgery. Adding PJB to GC increased the effect of weight loss and diabetic control.
BACKGROUND: Laparoscopic gastric clip (GC), a novel pure restrictive procedure, is a safe and effective treatment for morbid obesity. However, whether adding a proximal jejunal bypass (PJB) to this procedure might increase the efficacy is unknown. METHODS: Outcomes of 74 (43 women and 31male) obese patients who had undergone PJB-GC (41) or GC (33) for the treatment of type 2 diabetes mellitus (T2D) with 1 year follow-up were assessed. GC consists of creating a transverse gastric partition with a metallic clip. PJB consists of a jejuno-ileostomy between 20 and 320 cm distal to the ligament of Treitz. Postoperative body mass index (BMI) reduction, total weight loss (TWL), and remission rates of T2D were evaluated. RESULTS: The preoperative clinical characters in both groups were similar. The mean operative time was significantly longer in the PJB-GC group than in the GC group. At 24 months after surgery, the BMI was lower (32.5 ± 6.2 vs. 37.0 ± 5.9 kg/m2, p = 0.002) and weight loss higher in PJB-GC than GC (TWL 31.3 ± 14.8 vs. 23.5 ± 10.4%, p = 0.011). Remission of T2D was greater in the PJB-GC group (90.2 vs. 57.2%; p < 0.001). CONCLUSIONS: In this study, PJB-GC was superior to GC in weight loss and T2D remission at 1 and 2 years after surgery. Adding PJB to GC increased the effect of weight loss and diabetic control.
Authors: Francesco Rubino; Antonello Forgione; David E Cummings; Michel Vix; Donatella Gnuli; Geltrude Mingrone; Marco Castagneto; Jacques Marescaux Journal: Ann Surg Date: 2006-11 Impact factor: 12.969
Authors: Ralph Peterli; Bettina Wölnerhanssen; Thomas Peters; Noémie Devaux; Beatrice Kern; Caroline Christoffel-Courtin; Juergen Drewe; Markus von Flüe; Christoph Beglinger Journal: Ann Surg Date: 2009-08 Impact factor: 12.969