Department of Minimal Access Bariatric and Metabolic Surgery, Gem Hospital and Research Centre, 45 Pankaja Mill Road, Coimbatore, 641045, Tamil Nadu, India.
Surg Endosc. 2012 Mar;26(3):688-92. doi: 10.1007/s00464-011-1938-0. Epub 2011 Oct 13.
Bariatric surgeries are now redefined as metabolic surgeries given the excellent resolution of metabolic derangements accompanying obesity. Duodenojejunal bypass (DJB) is a novel metabolic surgery based on foregut hypothesis. Reports describe DJB as a stand-alone procedure for the treatment of diabetes in nonobese subjects. For obese subjects, DJB is combined with sleeve gastrectomy. This combination of DJB and sleeve gastrectomy is proposed as an ideal alternative to Roux-en-Y gastric bypass (RYGB) with these advantages: (1) easy postoperative endoscopic surveillance, (2) preservation of the pyloric mechanism, which prevents dumping syndrome, and (3) reduced alimentary limb tension. This study aimed to analyze the short-term outcomes of laparoscopic DJB with sleeve gastrectomy for morbidly obese patients.
At our institution, 38 patients who underwent laparoscopic DJB with sleeve gastrectomy were followed up. The inclusion criteria for the study were according to the Asian Pacific Bariatric Surgery Society guidelines. Sleeve gastrectomy was performed over a 36-Fr bougie, with the first part of the duodenum mobilized and transected. The jejunum was divided 50 cm distal to duodenojejunal flexure. A 75- to 150-cm alimentary limb was fashioned and brought in a retrocolic manner. End-to-end hand-sewn duodenojejunostomy was performed. Intestinal continuity was restored with a stapled jejunojejunostomy, and mesenteric rents were closed.
The study population consisted of 38 patients (15 men and 23 women) ranging in age from 31 to 48 years. During a mean follow-up period of 17 months, the excess body weight loss was 72%, with a 92% resolution of diabetes. One patient presented with internal herniation through the retrocolic window 1 month after the operation and was managed surgically without any complication. No other minor or major complications occurred, and there was no mortality.
Laparoscopic DJB with sleeve gastrectomy is safe and effective in achieving durable weight loss and excellent resolution of comorbidities. Long-term follow-up studies are needed.
鉴于肥胖伴随的代谢紊乱得到极好的解决，减重手术现在被重新定义为代谢手术。十二指肠空肠旁路术（DJB）是一种基于前肠假说的新型代谢手术。有报道称，DJB 可作为非肥胖受试者糖尿病的独立治疗手段。对于肥胖受试者，DJB 与袖状胃切除术相结合。DJB 与袖状胃切除术的结合被提议作为 Roux-en-Y 胃旁路术（RYGB）的理想替代方案，具有以下优点：（1）术后内镜监测方便，（2）保留幽门机制，防止倾倒综合征，以及（3）减少消化道支张力。本研究旨在分析腹腔镜 DJB 联合袖状胃切除术治疗病态肥胖患者的短期疗效。
在我们的机构中，对 38 例行腹腔镜 DJB 联合袖状胃切除术的患者进行了随访。该研究的纳入标准符合亚太减重与代谢外科学会指南。袖状胃切除术通过 36Fr 探条进行，游离并横断十二指肠第一段。距十二指肠空肠曲 50cm 处横断空肠。制作 75-150cm 的消化道支，并以反袢方式引入。进行端对端手工缝合的空肠空肠吻合术。使用吻合器行空肠空肠吻合术，关闭肠系膜裂孔。
研究人群包括 38 例患者（15 名男性和 23 名女性），年龄 31-48 岁。在平均 17 个月的随访期间，多余体重减轻 72%，糖尿病的缓解率为 92%。1 例患者在术后 1 个月出现经结肠后窗口的内疝，通过手术治疗，无任何并发症。没有出现其他轻微或严重的并发症，也没有死亡。
腹腔镜 DJB 联合袖状胃切除术在实现持久减重和极好的合并症缓解方面是安全有效的。需要进行长期随访研究。
