SLEEVE GASTRECTOMY + JEJUNOILEAL INTERPOSITION VE DUODENOILEAL INTERPOSITION

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SLEEVE GASTRECTOMY + JEJUNOILEAL INTERPOSITION VE DUODENOILEAL INTERPOSITION

In 2006, de Paula introduced the SG-II in a pilot study in 19 severely obese adults. After the jejunum was divided 50 cm from the ligament of Treitz, a 100–150-cm segment of ileum was created 50 cm proximal to the ileocecal valve, peristaltically interposing it in the proximal jejunum. The SG-JII is typically used in low-BMI patients, and the SG-DII version of the technique in obese patients. Animal studies show that SG-JII delayed the onset of diabetes, an effect possibly related to increased nutrient-stimulated secretion of PYY and GLP-17–36 and improvements of beta-cell function, insulin sensitivity, and lipid metabolism.

SLEEVE GASTRECTOMY + JEJUNOILEAL INTERPOSITION VE DUODENOILEAL INTERPOSITION

 

Origin, Advantages

The concept of an isolated ileal transposition in rats was first published by Koopmans et al. in 1982 . Combined with SG, Gagner reported it in humans in 2005.

 

In 2006, de Paula introduced the SG-II in a pilot study in 19 severely obese adults. After the jejunum was divided 50 cm from the ligament of Treitz, a 100–150-cm segment of ileum was created 50 cm proximal to the ileocecal valve, peristaltically interposing it in the proximal jejunum. The SG-JII is typically used in low-BMI patients, and the SG-DII version of the technique in obese patients. Animal studies show that SG-JII delayed the onset of diabetes, an effect possibly related to increased nutrient-stimulated secretion of PYY and GLP-17–36 and improvements of beta-cell function, insulin sensitivity, and lipid metabolism.

Indications/Contraindications, Weight Loss, Diabetes Resolution

SG-JII is indicated for morbidly obese and low-BMI patients with T2DM. Mean BMI in low-BMI patients decreased from 29.7 to 23.5 kg/m2. A 2017 systematic review of bariatric procedures for diabetes reported six studies of SG-JII (n = 474 patients, 381 with T2DM). Variable rates of T2DM remission (47.0–95.7%) were reported. Defining remission as HbA1C level ≥ 7 with no medicines, the cumulative remission rate was 77.8%.

Operative Mortality/Morbidity, Postoperative Complications, Reversal/Revision

Early mortality in low-BMI patients was 0.99% and late 1.0% as reported by de Paula et al.. In the short term, the reported leak rate is 0.8%. The most frequent long-term SG-II complication is intestinal obstruction, 2.5% reoperation rate, relative to that reported for RYGBP, 4.0% (0.6–10.4%) in a review of 3464 patients. Although the crura are closed routinely in hiatal hernia and GERD patients, postoperative symptoms were seen in 13.4%. New reflux symptoms were present in 5.1%. Other major complications reported are fistulas requiring reoperation and GI bleed.