Surgical Treatment of Morbid Obesity: Mid-term Outcomes of the Laparoscopic Ileal Interposition Associated to a Sleeve Gastrectomy in 120 Patients

Abstract

The aim of this study was to evaluate the mid-term outcomes of the laparoscopic ileal interposition associated to a sleeve gastrectomy (LII-SG) for the treatment of morbid obesity. The procedure was performed in 120 patients: 71 women and 49 men with mean age of 41.4 years. Mean body mass index (BMI) was 43.4 ± 4.2 kg/m². Patients had to meet requirements of the 1991 NIH conference criteria for bariatric operations. Associated comorbidities were observed in all patients, including dyslipidemia in 51.7%, hypertension in 35.8%, type 2 diabetes in 15.8%, degenerative joint disease in 55%, gastroesophageal reflux disease in 36.7%, sleep apnea in 10%, and cardiovascular problems in 5.8%. Mean follow-up was 38.4 ± 10.2 months, range 25.2-61.1. There was no conversion to open surgery nor operative mortality. Early major complications were diagnosed in five patients (4.2%). Postoperatively, 118 patients were evaluated. Late major complications were observed in seven patients (5.9%). Reoperations were performed in six (5.1%). Mean postoperative BMI was 25.7 ± 3.17 kg/m², and 86.4% were no longer obese. Mean %EWL was 84.5 ± 19.5%. Hypertension was resolved in 88.4% of the patients, dyslipidemia in 82.3%, and T2DM in 84.2%. The LII-SG provided an adequate weight loss and resolution of associated diseases during mid-term outcomes evaluation. There was an acceptable morbidity with no operative mortality. It seems that chronic ileal brake activation determined sustained reduced food intake and increased satiety over time. LII-SG could be regularly used as a surgical alternative for the treatment of morbid obesity.

Effect of Sleeve Gastrectomy Plus Side-to-Side Jejunoileal Anastomosis for Type 2 Diabetes Control in an Obese Rat Model

“…A number of new bariatric surgeries have been developed to obtain an optimal procedure for those with type 2 diabetes [10,22,23]. It has been hypothesized that the stomach size and small bowel length are evolutionary remnants of a low-calorie, fiber-rich diet.…”

Does the ileal brake mechanism contribute to sustained weight loss after bariatric surgery?

“…The limited rodent and human data suggest a role for the PYY‐mediated ileal brake mechanism in effecting weight loss following bariatric surgery (especially RYGB and LSG) and, more importantly, in maintaining this weight loss. Further research is needed to test this hypothesis by determining the effects of (i) surgeries that enable a chronic activation of the ileal brake mechanism (the manuscript by DePaula et al . has only been highlighted here as ‘proof of principle’ for such physiologically guided modifications to existing surgeries – an area that is fertile for surgical innovation), (ii) dietary strategies (e.g.…”

“…In 2011, DePaula et al . achieved sustained weight loss in 87% of 120 morbidly obese patients after a mean follow‐up of 38 ± 10 months by anastomosing an ileal loop of 170–200 cm (transected distally 30 cm from the ileocaecal junction) to the jejunum transected 50 cm from the duodenojejunal flexure in a patient undergoing a LSG . The weight loss was hypothesized to be due to a chronic activation of the ileal brake mechanism …”

Ileal transposition in surgical treatment for type 2 diabetes mellitus

“…1А). В дальнейшем были опубликованы результаты ряда небольших наблюдательных исследований, в которых операция ИТ-ПРЖ выполнялась пациентам с СД2, имею-щим среднее значение ИМТ от 28,2 до 43,4 кг/м 2 [38][39][40][41]. Практически во всех исследованиях в послеоперацион-ном периоде было документировано снижение ИМТ, наличие ремиссии СД2 (в 47-84% случаев, см.…”