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Sleeve gastrectomy with bipartition a “metabolic intervention” for obesity

NEW YORK (Reuters Health) – Sleeve gastrectomy with transit bipartition appears to be an effective “metabolic intervention” for obesity, Brazilian researchers have found.

The approach creates a shortcut to the ileum while maintaining access to the duodenum.

“Classic bariatric procedures were designed to cause mechanical restriction and malabsorption; neither of them is physiological,” said Dr. Sergio Santoro, lead author of a new report, in an email to Reuters Health. “This procedure was originally designed to avoid restriction (minimal stomachs, prosthetic rings) and malabsorption (excluded digestive segments, blind endoscopic areas). It aims to adapt our digestive system to high caloric food by correcting the secretion of gut hormones. It’s pure metabolic surgery.”

For their paper, published online May 17 in Annals of Surgery, Dr. Santoro and colleagues reviewed their data on 1,020 obese patients who underwent this type of surgery between 2004 and 2011. Except for early postoperative outcomes, they analyzed information only on the 603 patients for whom they had adequate follow-up (range, four months to five years).

Prior to surgery, body mass index (BMI) ranged from 33 to 72. After the procedure, excess BMI dropped by an average of 91% at one year, 85% at three years and 74% at five years.

There were two deaths (0.2%), and 60 of the 1,020 patients (6%) had significant 30-day postoperative complications. Nineteen required reoperation. There were late complications in 132 patients.

However, patients experienced early satiety and major improvement in preoperative comorbidities. For example, 86% had remission of diabetes, and the remainder had improvements. Respiratory problems resolved in 91% of patients and pain associated with orthopedic problems was resolved in 83%.

Overall, say the investigators, “Transit bipartition is an excellent complement to sleeve gastrectomy.” It results in rapid weight loss and remission or major improvement of comorbidities.

The whole procedure, concluded Dr. Santoro, “costs a little more than just a sleeve gastrectomy; same cost as Roux en Y; a little less than a duodenal switch.”


Ann Surg 2012.