Pylorus Preserving Loop Duodeno-Enterostomy With Sleeve Gastrectomy

Preliminary Results

Jodok Matthias Grueneberger; Iwona Karcz-Socha; Goran Marjanovic; Simon Kuesters; Krystyna Zwirska-Korczala; Katharina Schmidt; W Konrad Karcz

Disclosures

BMC Surg. 2014;14(20) 

In This Article

Background

Bariatric surgery has proven to be the most effective treatment for long-term weight loss and metabolic rebalancing in obese patients.[1,2] Most procedures combine a restrictive gastric component with a rerouting of the intestinal passage. Prominent examples are the Roux-en-Y gastric bypass (RYGB) or the biliopancreatic diversion (BPD). Gastric restriction either involves the entire stomach therefore preserving the pylorus when reconstructing the intestinal passage, or only the proximal part of the stomach is used to form a gastric pouch thus leaving a remnant stomach. Passage reconstruction then requires a gastro-enterostomy.

Preserving the pylorus when bypassing the duodenum has led to important technical changes in bariatric surgery. In order to avoid a dumping syndrome and marginal ulcers that occasionally occurred after Scopinaro's initial BPD, Marceau et al. successfully changed the technique to perform a biliopancreatic diversion with duodenal switch (BPD/DS) with similar limb variations, using however a postpyloric reconstruction.[3]

The RYGB generally is one of the best established procedures in bariatric surgery.[4] However the failure rate with weight regain due to a dilatation of the gastric pouch, gastro-jejunostomy and proximal jejunum is up to 35%.[5] Recently, bile reflux was identified as one important cause of postoperative pain.[6] Again, a postpyloric reconstruction seems tempting for this procedure.

We here present perioperative data of a proximal (similar to RYGB) and distal (similar to BPD/DS) postpyloric loop duodeno-enterostomy with sleeve gastrectomy. The distal duodeno-enterostomy, based on the earlier described single anastomosis duodeno-ileostomy associated to a sleeve gastectomy (SADI-S) operation,[7] was performed as revisionary bariatric operation.

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