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Obesity Surgery

, Volume 29, Issue 4, pp 1148–1153 | Cite as

Proximal Jejunal Bypass Improves the Outcome of Gastric Clip in Patients with Obesity and Type 2 Diabetes Mellitus

  • Seh-Huang ChaoEmail author
  • Chia-Lin Lin
  • Wei-Jei LeeEmail author
  • Jung-Chien Chen
  • Ju Jun Chou
Original Contributions
  • 133 Downloads

Abstract

Background

Laparoscopic gastric clip (GC), a novel pure restrictive procedure, is a safe and effective treatment for morbid obesity. However, whether adding a proximal jejunal bypass (PJB) to this procedure might increase the efficacy is unknown.

Methods

Outcomes of 74 (43 women and 31male) obese patients who had undergone PJB-GC (41) or GC (33) for the treatment of type 2 diabetes mellitus (T2D) with 1 year follow-up were assessed. GC consists of creating a transverse gastric partition with a metallic clip. PJB consists of a jejuno-ileostomy between 20 and 320 cm distal to the ligament of Treitz. Postoperative body mass index (BMI) reduction, total weight loss (TWL), and remission rates of T2D were evaluated.

Results

The preoperative clinical characters in both groups were similar. The mean operative time was significantly longer in the PJB-GC group than in the GC group. At 24 months after surgery, the BMI was lower (32.5 ± 6.2 vs. 37.0 ± 5.9 kg/m2, p = 0.002) and weight loss higher in PJB-GC than GC (TWL 31.3 ± 14.8 vs. 23.5 ± 10.4%, p = 0.011). Remission of T2D was greater in the PJB-GC group (90.2 vs. 57.2%; p < 0.001).

Conclusions

In this study, PJB-GC was superior to GC in weight loss and T2D remission at 1 and 2 years after surgery. Adding PJB to GC increased the effect of weight loss and diabetic control.

Keywords

Gastric clip Morbid obesity Bariatric surgery Metabolic surgery T2D remission Jejunal bypass 

Notes

Compliance with Ethical Standards

Conflict of Interest

Author 1 is the inventor and owner of gastric clip. The other authors have no conflicts of interest to declare.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

This article does not contain any studies with human participants or animal performed by any of the authors. For this type of study, formal consent is not required. Informed consent does not apply to the submission.

References

  1. 1.
    Flegal KM, Carroll MD, Kit BK, et al. Prevalence of obesity and trends in the distribution of body mass index among US adults. 1999-2010. JAMA. 2012;307:491–7.CrossRefGoogle Scholar
  2. 2.
    International Diabetes Federation. IDF diabetes atlas. 7th ed. International Diabetes Federation: 2015. http://www.diabetesatlas/. Accessed 15 Apr 2016.
  3. 3.
    Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23:427–36.CrossRefPubMedGoogle Scholar
  4. 4.
    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25:1822–32.CrossRefPubMedGoogle Scholar
  5. 5.
    Chao SH. Gastric clipping for morbid obesity: the initial results of a clinical trial. World J Surg. 2010;34:303–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Rubino F, Marescaux J. Effect of duodenal-jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease. Ann Surg. 2004;239:1–11.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Rubino F, Forgione A, Cummings DE, et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small in the pathophysiology of type 2 diabetes. Ann Surg. 2006;244:741–9.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Alamo M, Sepulveda M, Gellona J, et al. Sleeve gastrectomy with jejunal bypass for the treatment of type 2 diabetes mellitus in patiennts with body mass index <35 kg/m2: a cohort study. Obes Surg. 2012;22(7):1097–103.CrossRefPubMedGoogle Scholar
  9. 9.
    Melissas J, Peppe A, Askoxilakis J, et al. Sleeve gastrectomy plus side-to-side jejunoileal anastomosis for the treatment of morbid obesity and metabolic diseases: a promising operation. Obes Surg. 2012;22(7):1104–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Huang CK, Mahendra R, Hsin MC, et al. Novel metabolic surgery: first Asia series and short-term results of laparoscopic proximal jejunal bypass with sleeve gastrectomy. Ann Laparosc Endosc Surg. 2016;1:37.CrossRefGoogle Scholar
  11. 11.
    Melissas J, Taskin HE, Peirasmakis D, et al. A simple food-diverting operation for type 2 diabetes treatment. Preliminary results in human with BMI 28-32 kg/m2. Obes Surg. 2017;27(1):22–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Lee WJ, Huang MT, Wang W, et al. Bariatric surgery: Asia-pacific perspective. Obes Surg. 2005;15:751–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Peterli R, Wolnerhanssen B, Peters T, et al. Improvement in glucose metabolism after bariatric surgery: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a prospective randomized trial. Ann Surg. 2009;250:234–41.CrossRefPubMedGoogle Scholar
  14. 14.
    Karamanakos SN, Vagenas K, Kalfarentzos F, et al. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008;247:401–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Thaler JP, Cummings DE. Minireview: hormononal and metabolic mechanisms of diabetes remission after gastrointestinal surgery. Endocrinology. 2009;150(6):2518–25.CrossRefPubMedGoogle Scholar
  16. 16.
    Escalona A, Guzmán S, Ibáñez L, et al. Gastric cancer after Roux-en-Y gastric bypass. Obes Surg. 2005;15:423–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Corsini D, Simoneti C, Moreira G, et al. Cancer in the excluded stomach 4 years after gastric bypass. Obes Surg. 2006;16:932–4.CrossRefPubMedGoogle Scholar
  18. 18.
    Harper J, Beech D, Tichansky D, et al. Cancer in the bypassed stomach presenting early after gastric bypass. Obes Surg. 2007;17:1268–71.CrossRefPubMedGoogle Scholar
  19. 19.
    Wu CC, Lee WJ, Ser KH, et al. Gastric cancer after mini-gastric bypass surgery: a case report and literature review. Asian J Endosc Surg. 2013;6:303–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Felsenreich DM, Kefurt R, Schermann M, et al. Reflux, sleeve dilatation, and Barrett’s esophagus after laparoscopic sleeve gastrectomy: long-term follow-up. Obes Surg. 2017;27:3092–101.CrossRefPubMedGoogle Scholar
  21. 21.
    Genco A, Soricelli E, Casella G, et al. Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated longterm complication. Surg Obes Relat Dis. 2017;13(4):568–74.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Bariatric and Metabolic SurgeryJen-Ai HospitalTaichung City 412Taiwan, Republic of China
  2. 2.Department of SurgeryCentral Clinic HospitalTaipeiTaiwan
  3. 3.Department of SurgeryMin-Sheng General HospitalTaoyuanTaiwan, Republic of China

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