Ileal Interposition with Gastric Bipartition and a Weight-Adjusted Sleeve Gastrectomy: A New Model of Metabolic Surgery

Abstract

Background: Metabolic surgery for the treatment of type 2 diabetes patients, with body mass index (BMI) less than 35 kg/m2 has been found to be increasing every year. Duodenoileal interposition with sleeve gastrectomy and transit bipartition (TB) has strong effects on control of type 2 diabetes mellitus. However, both procedures may have long-term problems. Due to duodenal exclusion, endoscopic evaluation of the duodenum and biliary tract becomes impossible after duodenoileal interposition. The TB may have the risk of severe malabsorption due to enlargement of the gastroileostomy. We performed ileal interposition and TB in patients with class 1 obesity having type 2 diabetes, with ethical approval. The new modification included in this paper, was performed in 3 patients, one of whom had a BMI of 30 kg/m2. The aim of this innovation is to treat obese (BMI >30 kg/m2), type 2 diabetes patients with an effective, but less
malabsorptive procedure.
Objectives: The modification that we propose, aims to preserve normal duodenal anatomy and prevent possible duodenal transection related surgical problems and secure the absorptive component of proximal intestines without the need of an adjustment in gastroileostomy anastomosis.
Materials and Methods: All patients underwent total laparoscopic ileal interposition with gastric bipartition and a weight-adjusted sleeve gastrectomy.
Results: All tree patients stopped insulin use after surgery. No complications occurred.
Conclusions: Ileal interposition with gastric bipartition and a weight-adjusted sleeve gastrectomy is a safe and effective procedure for treatment of type 2 diabetes patients with or withoutobesity.