Exclusions May Be Dismissed if the Ileum Is Early and Potently Stimulated

Santoro, Sérgio; Aquino, Caio G G; Mota, Filippe

doi:10.1007/s11695-021-05526-3

Cited by 3 publications

(1 citation statement)

References 11 publications

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“…Although procedures such as SG-JJB, SG-II, and SG-TB, differ in intestinal reconfiguration, they have common consequences: 1) foregut inclusion and 2) expediting nutrient flow to the distal intestine (hindgut theory). It has been recently proposed that foregut exclusions may not be necessary as long as strong stimulus to the ileum is provided ( 59 ). However, we need better comparative studies to understand not only the metabolic efficacy but also the safety of these foregut inclusion procedures.…”

Section: Discussionmentioning

confidence: 99%

Can we abandon foregut exclusion for an ideal and safe metabolic surgery?

et al. 2022

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Foregut (foregut exclusions) and hindgut (rapid transit of nutrients to the distal intestine) theories are the most commonly used explanations for the metabolic improvements observed after metabolic surgeries. However, several procedures that do not comprise duodenal exclusions, such as sleeve with jejunojejunal bypass, ileal interposition, and transit bipartition and sleeve gastrectomy were found to have similar diabetes remission rates when compared with duodenal exclusion procedures, such as gastric bypass, biliopancreatic diversion with duodenal switch, and diverted sleeve with ileal interposition. Moreover, the complete exclusion of the proximal intestine could result in the malabsorption of several important micronutrients. This article reviews commonly performed procedures, with and without foregut exclusion, to better comprehend whether there is a critical need to include foregut exclusion in metabolic surgery.

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Section: Discussionmentioning

confidence: 99%

Can we abandon foregut exclusion for an ideal and safe metabolic surgery?

et al. 2022

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Sleeve Gastrectomy Associated with Antral Lesion Resection and Roux-en-Y Antrojejunal Reconstruction

Dib¹,

Madalosso²,

Domene³

et al. 2023

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Obesity has been growing worldwide, reaching epidemic proportions. Bariatric surgery is the most effective and durable treatment for severe obesity and related diseases. Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) are the most frequently performed bariatric operations, with long-term good results, in terms of weight loss and comorbidities control. Gastroesophageal Reflux Disease (GERD) is commonly associated with obesity. In general, it precludes the indication of sleeve gastrectomy, since this technique has a refluxogenic potential, as shown in many studies. In such cases, RYGB is considered the best surgery, reaching good weight loss and gastroesophageal reflux disease control. The drawback of this technique is that it leaves the remnant stomach, the duodenum, and the proximal part of the jejunum inaccessible. Besides, RYGB makes transoral endoscopic access to the biliary tree impossible. For all these reasons, this bariatric technique is not indicated in cases of gastric polyposis, gastric dysplasia, or strong family history of cancer, among others. We report a case of a morbidly obese patient with intense GERD, for whom a RYGB was precluded due to her strong family history of cancer, even knowing that it would be the best choice for reflux disease control. Instead, SG was chosen, even knowing it could worsen the gastroesophageal reflux disease. The patient signed an informed consent, after being fully enlightened about the risks. During the surgery, a small subserosal whitish le-

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Sleeve Gastrectomy with Duodenal Transit Bipartition (S-DTB): Preliminary Results and Technical Aspects of Its Metabolic Structure

Melo,

Zorron,

Dib

et al. 2024

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Exclusions May Be Dismissed if the Ileum Is Early and Potently Stimulated

Cited by 3 publications

References 11 publications

Can we abandon foregut exclusion for an ideal and safe metabolic surgery?

Can we abandon foregut exclusion for an ideal and safe metabolic surgery?

Sleeve Gastrectomy Associated with Antral Lesion Resection and Roux-en-Y Antrojejunal Reconstruction

Sleeve Gastrectomy with Duodenal Transit Bipartition (S-DTB): Preliminary Results and Technical Aspects of Its Metabolic Structure

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