Bariatric Surgery Technique May Benefit from New Surgical Device, Procedure

Bariatric Surgery Technique May Benefit from New Surgical Device, Procedure

An early weight loss surgery procedure that was revisited using a novel surgical device and technique has led to an improvement in weight loss outcomes in a recent animal study. The results could lead to advancements in bariatric surgeries that help obese people lose weight easier and more effectively.

The jejunoileal bypass (JIB) was one of the first types of bariatric surgery, where the size of the small intestine is reduced, leading to less absorption of nutrients and a consequent weight loss and even a resolution of diabetes type-2. But this type of surgery was found to lead to several complications, such as liver insufficiency associated with blind segments being resected during the procedure. In order to overcome these problems, the researchers designed a partial bypass model that consists of a side-to-side anastomosis (surgical connection) between the 3rd portion of the duodenum (first section of the small intestine) and the last 50 cm of the ileum (final part of the small intestine) using a new compressive anstomosis device. The study, entitled “Safety and efficacy of a side-to-side duodeno-ileal anastomosis for weight loss and type-2 diabetes: duodenal bipartition, a novel metabolic surgery procedure,” was published in the Annals of Surgical Innovation and Research and reports on the evaluation of safety and efficacy of this new surgical method.

The research, conducted at the Department of Surgery, Herbert Wertheim School of Medicine, Hopital du Sacre Coeur, Florida International University, is based on surgeries done on seven female Yorkshire pigs. The animals were subjected to the duodeno-ileal anastomosis (DIA) and its effects were evaluated for 56 days, compared to a control group. The physiological results were also assessed through collection of blood samples, gastroscopy at 28 days, and autopsy analysis of the liver, duodenum, and ileum.

At 28 days, one of the pigs presented a hernia that had to be corrected but overall the animals presented good health, and gastroscopy results indicate there were no ulcerations or inflammation in the gastrointestinal tract and that the anastomosis was successful. Weight progression was recorded consistently, and revealed that while the DIA animals had a weight loss of 6.8%, the control group registered a 33.2% gain of weight.  Blood analysis revealed that serum potassium, sodium, chloride, and bicarbonate remained within normal values, while there was a decrease in serum calcium and phosphorus. Moreover, the levels of the liver enzyme measured remained normal. Histology analysis of tissues found no evidence of fibrosis, inflammation, infection, or other damage to the sections examined. Two of the four liver samples showed small changes of glycogen accumulation, a feature also observed in animals undergoing fasting.

Overall, researchers conclude that in this short post-operative observation study that side-to-side duodeno-ileal anastomosis resulted in significant weight loss with no serious nutritional losses or histological defects. As various types of weight loss surgery approaches continue to reveal their safety and efficacy in helping obese patients lose weight, this update to an early bariatric surgical procedure could give surgeons new means of further improving patient outcomes.

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