C Palanivelu, MCH FACS FRCS, P Praveen Raj, MS, P Senthilnathan, MS DNB, S Rajapandian, MS DNB, C Chandramaliteeswaran, MS. GEM Hospital
INTRODUCTIONBariatric surgeries are now redefined as metabolic surgeries given the excellent resolution of metabolic derangements accompanying obesity. Duodenojejunal bypass (DJB) is a novel metabolic surgery based on foregut hypothesis. Duodenojejunal bypass as a standalone procedure has been reported for treating diabetes in non-obese subjects. Sleeve gastrectomy is combined for obese subjects.
DJB with sleeve gastrectomy is proposed as an ideal alternative to RYBG with the stated advantages –
1.Presence of difficult to access gastric remnant in RYGB is at risk of cancer development in high endemic regions. Endoscopic surveillance is easy in sleeve gastrectomy.
2.Preservation of pyloric mechanism prevents dumping syndrome.
3.Reduced alimentary limb tension.
AIM: The aim of this study to analyze the short term outcomes of laparoscopic duodenojejunal bypass with sleeve gastrectomy for morbidly obese patients.
PATIENTS AND METHODS: Data from 38 patients who underwent laparoscopic duodenojejunal bypass with sleeve gastrectomy at our institute were taken up for analysis. Inclusion criteria was following the Asian Pacific Bariatric Surgery Society guidelines including those with a BMI > 37 or BMI > 32 in the presence of diabetes mellitus or another two significant comorbidities related to obesity.
TECHNIQUE : Sleeve gastrectomy performed and D1 transected. Jejunum divided 50cm distal to DJ flexure. 75-100cm alimentary limb fashioned retrocolic and hand sewn end to end duodendojejunostomy done. Intestinal continuity restored with stapled jejuno-jejunostomy. Mesenteric rents closed.
RESULTS : Study population included 38 patients with 23 males and 15 female patients. Age ranged from 31- 48 years. Following a mean follow-up of 9 months, the excess body weight loss was 72% with a 92% resolution of diabetes, 88% resolution of hypertension and 86% resolution of dyslipidemia. There was no mortality.
CONCLUSION:Laparoscopic duodenojejunal bypass with sleeve gastrectomy is safe and effective in achieving durable weight loss and excellent resolution of co-morbidities. Long term follow up studies are needed.
Program Number: S061