Original Article
Novel metabolic surgery: first Asia series and short-term results of laparoscopic proximal jejunal bypass with sleeve gastrectomy
Abstract
Background: There has been a rapid rise in incidence of obesity and its associated metabolic consequences in Asia where 60% of the world population resides and who are already at an elevated risk of developing diabetes. Though laparoscopic Roux-en-Y gastric bypass (LRYGB) has established itself as a standard, considering its technical difficulty and long term morbidity, there are possible alternatives being developed for equally effective but less morbid. Laparoscopic proximal jejunal bypass with sleeve gastrectomy (LPJB-SG) was first described by de Menezes in 2004 and further studies had shown it to be effective in weight loss and in remission of type 2 diabetes mellitus.
Methods: Sixty five patients with obesity/uncontrolled type 2 diabetes underwent LPJB-SG between October 30th, 2014 and April 15th, 2016. This is an ongoing prospective study on Asian patients. All surgeries were performed by a single surgeon and consisted of a sleeve gastrectomy and bypassing proximal jejunum about 250–300 cm in length. Intra and post-surgical data were collected and operation time, length of hospital stay (LOS) and early complications were documented. BMI, percentage of excess weight loss (%EWL), fasting sugar and HbA1c, were assessed at 1 month and 3 monthly follow-up visits thence for a year. Surgical complications were recorded.
Results: All surgeries were completed laparoscopically. The operation time was 93.13 minutes on average with a mean hospital stay of 2.2 days. The average EWL was 26.49, 44.77 and 65.87 percentages at 1, 3 and 6 months respectively. The percentage of diabetic patients achieving an HBA1c of <6.0 without medicines was 11.5, 60.56 and 66.66 at 1, 3 and 6 months respectively. There were 3 (6.5%) complications developed (1 bleeding, 1 dehydration and 1 gastric stenosis).The gastric stenosis required a conversion to a Roux-en-Y bypass and the patients with bleeding and dehydration were successfully managed conservatively.
Conclusions: LPJB-SG is a feasible, safe and effective surgery for treatment of obesity and diabetes in this first Asia short-term result. It is technically simpler to perform and is easily reproducible. Long term and randomized controlled studies comparing with other surgical procedures would be required to assess it further.
Methods: Sixty five patients with obesity/uncontrolled type 2 diabetes underwent LPJB-SG between October 30th, 2014 and April 15th, 2016. This is an ongoing prospective study on Asian patients. All surgeries were performed by a single surgeon and consisted of a sleeve gastrectomy and bypassing proximal jejunum about 250–300 cm in length. Intra and post-surgical data were collected and operation time, length of hospital stay (LOS) and early complications were documented. BMI, percentage of excess weight loss (%EWL), fasting sugar and HbA1c, were assessed at 1 month and 3 monthly follow-up visits thence for a year. Surgical complications were recorded.
Results: All surgeries were completed laparoscopically. The operation time was 93.13 minutes on average with a mean hospital stay of 2.2 days. The average EWL was 26.49, 44.77 and 65.87 percentages at 1, 3 and 6 months respectively. The percentage of diabetic patients achieving an HBA1c of <6.0 without medicines was 11.5, 60.56 and 66.66 at 1, 3 and 6 months respectively. There were 3 (6.5%) complications developed (1 bleeding, 1 dehydration and 1 gastric stenosis).The gastric stenosis required a conversion to a Roux-en-Y bypass and the patients with bleeding and dehydration were successfully managed conservatively.
Conclusions: LPJB-SG is a feasible, safe and effective surgery for treatment of obesity and diabetes in this first Asia short-term result. It is technically simpler to perform and is easily reproducible. Long term and randomized controlled studies comparing with other surgical procedures would be required to assess it further.
