Skip to main content

Advertisement

SpringerLink
Log in

Laparoscopic duodenojejunal bypass with sleeve gastrectomy: preliminary results of a prospective series from India

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Bariatric 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. Reports describe DJB as a stand-alone procedure for the treatment of diabetes in nonobese subjects. For obese subjects, DJB is combined with sleeve gastrectomy. This combination of DJB and sleeve gastrectomy is proposed as an ideal alternative to Roux-en-Y gastric bypass (RYGB) with these advantages: (1) easy postoperative endoscopic surveillance, (2) preservation of the pyloric mechanism, which prevents dumping syndrome, and (3) reduced alimentary limb tension. This study aimed to analyze the short-term outcomes of laparoscopic DJB with sleeve gastrectomy for morbidly obese patients.

Methods

At our institution, 38 patients who underwent laparoscopic DJB with sleeve gastrectomy were followed up. The inclusion criteria for the study were according to the Asian Pacific Bariatric Surgery Society guidelines. Sleeve gastrectomy was performed over a 36-Fr bougie, with the first part of the duodenum mobilized and transected. The jejunum was divided 50 cm distal to duodenojejunal flexure. A 75- to 150-cm alimentary limb was fashioned and brought in a retrocolic manner. End-to-end hand-sewn duodenojejunostomy was performed. Intestinal continuity was restored with a stapled jejunojejunostomy, and mesenteric rents were closed.

Results

The study population consisted of 38 patients (15 men and 23 women) ranging in age from 31 to 48 years. During a mean follow-up period of 17 months, the excess body weight loss was 72%, with a 92% resolution of diabetes. One patient presented with internal herniation through the retrocolic window 1 month after the operation and was managed surgically without any complication. No other minor or major complications occurred, and there was no mortality.

Conclusion

Laparoscopic DJB with sleeve gastrectomy is safe and effective in achieving durable weight loss and excellent resolution of comorbidities. Long-term follow-up studies are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Shaw JE, Sicree RA, Zimmet PZ (2010) Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 87:4–14

    Article  PubMed  CAS  Google Scholar 

  2. Beckman LM, Beckman TR, Earthman CP (2010) Changes in gastrointestinal hormones and leptin after Roux-en-Y gastric bypass procedure: a review. J Am Diet Assoc 110:571–684

    Article  PubMed  CAS  Google Scholar 

  3. Rubino F et al (2010) Metabolic surgery to treat type 2 diabetes: clinical outcomes and mechanisms of action. Annu Rev Med 61:393–411

    Article  PubMed  CAS  Google Scholar 

  4. Pories WJ, Albrecht RJ (2001) Etiology of type II diabetes mellitus: role of the foregut. World J Surg 25:527–631

    Article  PubMed  CAS  Google Scholar 

  5. Wittgrove AC, Clark GW (2000) Laparoscopic gastric bypass, Roux-en-Y—500 patients: technique and results, with 3–60 month follow-up. Obes Surg 10(3):233–239

    Article  PubMed  CAS  Google Scholar 

  6. Higa KD, Boone KB, Ho T (2000) Complications of the laparoscopic Roux-en-Y gastric bypass: 1,040 patients: what have we learned? Obes Surg 10:509–513

    Article  PubMed  CAS  Google Scholar 

  7. Higa KD, Ho T, Boone KB (2001) Laparoscopic Roux-en-Y gastric bypass: technique and 3-year follow-up. J Laparoendosc Adv Surg Tech A 11:377–382

    Article  PubMed  CAS  Google Scholar 

  8. Schauer PR, Ikramuddin S, Gourash W et al (2000) Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 232:515–529

    Article  PubMed  CAS  Google Scholar 

  9. National Cancer Registry Programme (India). Consolidated report of hospital-based cancer registries 2001–2003. Indian Council of Medical Research. http://www.icmr.nic.in/ncrp/cancer_reg.htm

  10. Sambasivaiah K (2004) Clinical profile of carcinoma stomach at a tertiary care hospital in South India. Trop Gastroenterol 25:21–26

    PubMed  CAS  Google Scholar 

  11. Swaminathan R (2009) Cancer pattern and survival in a rural district in South India. Cancer Epidemiol 33:325–331

    Article  PubMed  Google Scholar 

  12. Ramos AC et al (2009) Laparoscopic duodenal-jejunal exclusion in the treatment of type 2 diabetes mellitus in patients with BMI <30 kg/m2 (LBMI). Obes Surg 19:307–312

    Article  PubMed  Google Scholar 

  13. Cohen RV et al (2007) Duodenal-jejunal bypass for the treatment of type 2 diabetes in patients with body mass index of 22–34 kg/m2: a report of 2 cases. Surg Obes Relat Dis 3:195–197

    Article  PubMed  Google Scholar 

  14. Rubino F (2008) Is type 2 diabetes an operable intestinal disease? A provocative yet reasonable hypothesis. Diabetes Care 31(Suppl 2):S290–S296

    Article  PubMed  Google Scholar 

  15. Kasama K et al (2009) Laparoscopic sleeve gastrectomy with duodenojejunal bypass: technique and preliminary results. Obes Surg 19:1341–1345

    Article  PubMed  Google Scholar 

  16. Lee WJ, Wang W (2005) Bariatric surgery: Asia-Pacific perspective. Obes Surg 15:751–757

    Article  PubMed  Google Scholar 

  17. Stefanidis D, Kuwada TS, Gersin KS (2011) The importance of the length of the limbs for gastric bypass patients: an evidence-based review. Obes Surg 21:119–124

    Article  PubMed  Google Scholar 

  18. Praveen RP, Chandramaliteeswaran C, Senthilnathan P, Asokan S, Palanivelu C (2010) Bariatric to metabolic surgery: management options and experience at a tertiary centre. J Indian Med Assoc 108:645–647

    Google Scholar 

  19. American Diabetes Association (2008) Standards of medical care in diabetes—2008. Diabetes Care 31(Suppl 1):S12–S54

    Article  Google Scholar 

  20. Buchwald H (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292:1724–1737

    Article  PubMed  CAS  Google Scholar 

  21. Buchwald H et al (2009) Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 122:248–256

    Article  PubMed  Google Scholar 

  22. Gagner M (2010) Laparoscopic sleeve gastrectomy with duodenojejunal bypass for severe obesity and/or type 2 diabetes may not require duodenojejunal bypass initially. Obes Surg 20(9):1323–1324

    Article  PubMed  Google Scholar 

  23. Csendes A et al (2005) Results of gastric bypass plus resection of the distal excluded gastric segment in patients with morbid obesity. J Gastrointest Surg 9:121–131

    Article  PubMed  Google Scholar 

  24. Khitin L, Roses RE, Birkett DH (2003) Cancer in the gastric remnant after gastric bypass: a case report. Curr Surg 60:521–523

    Article  PubMed  Google Scholar 

  25. Escalona A et al (2005) Gastric cancer after Roux-en-Y gastric bypass. Obes Surg 15:423–427

    Article  PubMed  Google Scholar 

  26. Loss AB et al (2009) Analysis of the dumping syndrome on morbid obese patients submitted to Roux-en-Y gastric bypass. Rev Col Bras Cir 36:413–419

    Article  PubMed  Google Scholar 

  27. Padoin AV et al (2009) Obese patients with type 2 diabetes submitted to banded gastric bypass: greater incidence of dumping syndrome. Obes Surg 19:1481–1484

    Article  PubMed  Google Scholar 

  28. Navarrete SA, Leyba JL, Llopis SN (2011) Laparoscopic sleeve gastrectomy with duodenojejunal bypass for the treatment of type 2 diabetes in nonobese patients: technique and preliminary results. Obes Surg 21(5):663–667

    Article  PubMed  Google Scholar 

Download references

Disclosures

Raj P. Praveen, R. Kumaravel, C. Chandramaliteeswaran, V. Vaithiswaran, and C. Palanivelu have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Minimal Access Bariatric and Metabolic Surgery, Gem Hospital and Research Centre, 45 Pankaja Mill Road, Coimbatore, 641045, Tamil Nadu, India

    P. Praveen Raj, R. Kumaravel, C. Chandramaliteeswaran, V. Vaithiswaran & C. Palanivelu

Authors
  1. P. Praveen Raj
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Kumaravel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Chandramaliteeswaran
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. V. Vaithiswaran
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Palanivelu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Praveen Raj.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Praveen Raj, P., Kumaravel, R., Chandramaliteeswaran, C. et al. Laparoscopic duodenojejunal bypass with sleeve gastrectomy: preliminary results of a prospective series from India. Surg Endosc 26, 688–692 (2012). https://doi.org/10.1007/s00464-011-1938-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-011-1938-0

Keywords

Search

Navigation