Introduction: Current effective bariatric procedures such as gastric bypass include duodenal-jejunal exclusion wich has been implicated in the resolution of co/morbid conditions. The aim of this study was to develop a new technique based on food restriction and early stimulation on the distal gut maintaining the alimentary tract continuity.
Methods: Thirty five obese Zucker rats , weight 571 + 151 g were assigned into 4 procedures : Ileal Transposition (IT, n=7); Sleeve Gastrectomy with Ileal Transposition (SGIT, n=11); Roux-en-Y gastric Bypass (RYGB, n=7); Sham operation (SHAM=10). Sleeve gastrectomy was performed by firing one 30mm linear stapler resecting the greater curvature and fundus. Ileal transposition was performed by isolating a 10 cm ileal segment proximal to the ileocecal valve and reanastomosed by dividing the proximal jejunum 3 cm distal to the ligament of treitz. Gastric Bypass was performed by transecting the stomach using a 30 mm linear stapler leaving a small gastric pouc and a 5 cm alimentaary limb. Sham operation was performed by bowel transections and reanastomosis in the ileum and proximal jejunum together with gastrotomy and closure. Animals were followed evaluating weekly weight increase and food intake. We performed an insulin torerance test after 8 weeks and measured PYY 3-36 and ghrelin levels. We used ANOVA and Bonferrroni (Dunn) tests to detect differences between groups.
Results:We observed significat differences in mean percentage change of initial weight after 7 weeks between SGIT (0.7 % weight increase) and SHAM (21.9% increase) (p=0.0048), No differences were observed between RYGB (2.3% increase) and SGIT nor between IT (30.6% increase) and SHAM . We observed significant differences in food intake (grams per day) 2 weeks after surgery between IT (19.5 + 1.6 g) and SHAM (30 + 3.5 g) (p: 0.0015), RYGB (8.9 + 2.6 g) versus SHAM (p<0.0001) , and SGIT (13.7+ 5.3 g) versus SHAM (p<0001). No differences were observed between SGIT and RYGB. Mean plasmatic glucose level after 0.25 U/kg of intraperitoneal insulin revealed significant differences between RYGB(172 + 33 mg/dl) and SGIT (87.4 + 32.4 mg/dl) (p=0,0014).PYY 3-36 levels were significantly higher in SGIT compared to SHAM and RYGB (216.4 pm/l versus 72 pm/l and 98 pm/l , respectively). No difference were observed for ghrelin among groups.
Conclusion: SGIT proved to be as effective as RYGB on rats as a weight loss procedure. Also, better insulin sensitivity is seen with SGIT than with RYGB, in spite of the absence of duodenal-jejunal exclusion. This obeservation does not support the theory that RYGB reversal of diabetes is due to duodenal-jejunal exclusion.