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Laparoscopic revolution in bariatric surgery

World Journal of Gastroenterology 2014年第41期20卷 15135-15143页

作者： Magnus Sundbom Department of Surgical Sciences Uppsala University

The history of bariatric surgery is investigational. Dedicated surgeons have continuously sought for an ideal procedure to relieve morbidly obese patients from their burden of comorbid conditions, reduced life expectancy and low quality of life. The ideal procedure must have low complication risk, both in short- and long term, as well as minimal impact on daily life. The revolution of laparoscopic techniques in bariatric surgery is described in this summary. Advances in minimal invasive techniques have contributed to reduced operative time, length of stay, and complications. The development in bariatric surgery has been exceptional, resulting in a dramatic increase of the number of procedures performed world wide during the last decades. Although, a complex bariatric procedure can be performed with operative mortality no greater than cholecystectomy, specific procedure-related complications and other drawbacks must be taken into account. The evolution of laparoscopy will be the legacy of the 21st century and at present, day-care surgery and further reduction of the operative trauma is in focus. The impressive effects on comorbid conditions have prompted the adoption of minimal invasive bariatric procedures into the field of metabolic surgery.

关键词： Laparoscopy Bariatric surgery Minimal invasive surgery Gastric bypass duodenal switch Gastric banding Metabolic surgery

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

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Surgical Science 2024年第4期15卷 244-264页

作者： Paulo Reis Esselin de Melo Ricardo Zorron Victor Ramos Mussa Dib Carlos Augusto Scussel Madalosso Rui Ribeiro Thonya Cruz Braga Paula Volpe Carlos Eduardo Domene Paulo Reis Institute Goiania GO Brazil Alfredo Nasser University Center (UNIFAN) Goiania GO Brazil Department of Bariatric and Metabolic Surgery CUF Descobertas Hospital Lisbon Portugal Victor Dib Institute Manaus AM Brazil Gastrobese Clinic Passo Fundo RS Brazil Lusiadas Amadora Hospital Lisbon Portugal Clianest Group Renaissance Hospital Goiania GO Brazil Integrated Center for Advanced Medicine (CIMAMED) Sao Paulo Brazil

Obesity is a significant and escalating health issue both in Brazil and globally, with over 650 million overweight adults worldwide. The treatment of obesity can be performed clinically, endoscopically or surgically;surgical treatment proves to be safe and more effective in terms of weight loss and long-term maintenance. Objective: This study aimed to monitor the progress of weight loss and comorbidity control in patients undergoing sleeve gastrectomy with duodenal bipartition. Methods: This pilot project involved 8 patients divided into 2 arms. In the first arm, patients underwent sleeve gastrectomy with Roux-en-Y duodenoileal transit bipartition (S-RYDITB), while in the second arm, patients underwent sleeve gastrectomy with Roux-en-Y duodenojejunal transit bipartition (S-RYDJTB). Both procedures involved Roux-en-Y reconstruction without duodenal exclusion. In S-RYDITB, the duodenal-ileal anastomosis was performed 300 cm from the ileocecal valve (ICV), creating a 250 cm common channel and a 50 cm alimentary channel. In S-RYDJTB, a biliopancreatic loop was created 200 cm from the angle of Treitz, with a 1 m alimentary channel. Results: Five patients underwent the procedures, with one undergoing S-RYDITB and four undergoing S-RYDJTB. No adverse events such as hospitalizations, readmissions, reoperations, fistulas, bleeding, pulmonary embolism, diarrhea, dumping syndrome, or hypoglycemia occurred during the study period. The mean length of hospital stay was 2 days. The average BMI decreased from 37.27 kg/m2 preoperatively to 29.48 kg/m2 after 6 months. The significant percentage of weight loss was 21.22%, with excess weight loss of 63.6%. Ninety-five percent remission of comorbidities, including hypercholesterolemia, hypertriglyceridemia, diabetes, hypertension, steatosis, and pre-diabetes. Two patients underwent sleeve gastrectomy with duodenal bipartition using a single anastomosis. Conclusion: duodenal switch surgery has gained worldwide recog

关键词： Obesity Bariatric Surgery Metabolic Surgery duodenal switch

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Hybrid duodenal Transit Bipartition: An Endoscopic and Laparoscopic Metabolic Procedure

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Surgical Science 2024年第10期15卷 547-564页

作者： Paulo Reis Rizzo Esselin de Melo Anna Carolina Hoff Ricardo Zorron Victor Ramos Mussa Dib Carlos Augusto Scussel Madalosso Rui Ribeiro Thonya Cruz Braga Fernando Reis Esselin Melo Paula Volpe Carlos Eduardo Domene Antonio Torres Paulo Reis Institute Goinia Brazil Alfredo Nasser University Center (UNIFAN) Goinia Brazil Angioskope International Interventional Endoscopy Training Center So Paulo Brazil Department of Bariatric and Metabolic Surgery CUF Descobertas Hospital Lisbon Portugal Victor Dib Institute Manaus Brazil Gastrobese Clinic Passo Fundo Brazil Lusadas Amadora Hospital Lisboa Portugal Clianest Group Renaissance Hospital Goinia Brazil IOM-Intraoperative Medical Services Paulo Reis Institute Braslia Brazil Integrated Center for Advanced Medicine (CIMAMED) So Paulo Brazil Department of Surgery Hospital Clnico San Carlos Madrid Spain Department of Surgery School of Medicine Complutense University Madrid Spain San Carlos Health Research Institute (IdISSC) Madrid Spain

Obesity has been increasing significantly in Brazil and worldwide, becoming a major public health issue. Traditional prevention and treatment strategies, including behavioral interventions, nutritional modifications, physical activity, pharmacotherapy, and metabolic/bariatric procedures, have proven insufficient to reverse this trend. Bariatric surgery is recognized as the most effective treatment for obesity and its comorbidities, but it carries potential long-term risks. Hybrid duodenal Transit Bipartition is proposed as a minimally invasive “endobariatric” procedure combining endoscopic sleeve gastroplasty (ESG) with laparoscopic duodenoileal or distal duodenojejunal anastomosis. The main objective of this study is to demonstrate the importance of the intestinal metabolic component of hybrid duodenal transit bipartition. This intestinal component is responsible for optimizing and attempting to maintain weight loss and control comorbidities from an ESG through the incretin stimulus generated by the early arrival of food in the ileum or distal jejunum (duodenoileal or distal duodenojejunal anastomosis). Additionally, it is a minimally invasive procedure that preserves the entire digestive system and does not involve gastrointestinal exclusion, allowing for endoscopic and nutritional access. To date, only one patient has undergone the hybrid duodenal bipartition procedure, with satisfactory early postoperative results at 60 days and weight loss exceeding the scientific literature on patients who underwent isolated endoscopic sleeve gastroplasty. Further studies are needed to validate these results and assess the long-term metabolic benefits of this new approach.

关键词： duodenal switch duodenal Transit Bipartition Bariatric Surgery Metabolic Surgery Endoscopic Gastroplasty Endobariatric

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Transit Bipartition with Duodeno-Ileal Anastomosis, without duodenal Exclusion, as a First Stage of Bariatric Surgery in Severely Obese Patients: Case Report

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Surgical Science 2022年第11期13卷 497-505页

作者： Paulo Reis Esselin de Melo Thonya Cruz Braga Danilo Fossalussa Minari José Humberto Cardoso Resende Instituto Paulo Reis Goi&#226nia Brazil UNIFAN-Centro Universitário Alfredo Nasser Aparecida de Goi&#226nia Goi&#225s Brazil

Obesity is a difficult disease to control;bariatric surgery is one of the tools used to treat obesity and its comorbidities. The present case was chosen because it concerns a very obese patient whose proposed surgery—duodenal switch—resulted in traoperatively difficult to the medical team because the esophagogastric junction could not be reached due to the presence of hepatomegaly. Due to this unfavorable condition, we decided to perform a duodeno-ileal anastomosis with gastric preservation and without duodenal exclusion. The patient has been under follow-up for 14 years. She has lost 55 kg and maintains the comorbidities controlled to date.

关键词： Bariatric Surgery Biliopancreatic Diversion Gastric Bypass duodenal switch

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