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Sleeve Gastrectomy with Ileal Transposition (SGIT) Induces a Significant Weight Loss and Diabetes Improvement Without Exclusion of the Proximal Intestine

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Current effective bariatric procedures such as gastric bypass generate a duodenal–jejunal exclusion, which has been implicated in the resolution of type 2 diabetes. The aim of this study was to test the hypothesis that sleeve gastrectomy with ileal transposition (SGIT), a new procedure, is as effective as Roux-en-Y gastric bypass (RYGB) to induce glucose control on an obese rat model of type 2 diabetes mellitus.

Methods

Twenty eight obese diabetic Zucker rats, weighing 571 ± 151 g were assigned into three procedures: SGIT (n = 11), RYGB (n = 7), and sham operation (n = 10). Animals were followed, evaluating weekly weight increase and food intake. We performed an insulin tolerance test after 8 weeks and measured serum peptide tyrosine–tyrosine (PYY 3-36) and ghrelin levels.

Results

Nine weeks after surgery, sham-operated animals increased their body weight by 24%. In far contrast, SGIT and RYGB rats weighed 21% and 18% less than sham animals, respectively (sham, 884 ± 15 g; SGIT, 720 ± 19 g; RYGB, 754 ± 14 g; p < 0.001). No significant differences were found between SGIT and RYGB. Cumulative food intake in SGIT and RYGB procedures decreased by 29.6% and 32.9%, respectively (sham, 576.3 ± 33 g; SGIT, 405.8 ± 10 g; RYGB, 386.4 ± 21 g; p < 0.001). No differences were found between SGIT and RYGB rats. Sixty minutes after oral gavage, PYY levels were increased by 185% and 74% in SGIT and RYGB, respectively (sham, 63.4 ± 2.1 pg/ml; SGIT, 192.7 ± 17 pg/ml; RYGB, 117.7 ± 4.8 pg/ml; p < 0.001). Glucose tolerance was improved after SGIT and RYGB surgery demonstrated by area under the curve analysis (sham, 27,090 ± 1,424; SGIT, 17,704 ± 1,288 mg/dl; p < 0.018; RYGB, 16,212 ± 2,522; p < 0.01).

Conclusion

SGIT proved to be as effective as RYGB on obese diabetic rats as a weight loss procedure. Also, glucose homeostasis improved in SGIT, similar to RYGB, in spite of the absence of duodenal–jejunal exclusion. This observation does not support the theory that RYGB reversal of diabetes is due to duodenal–jejunal exclusion.

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Authors and Affiliations

  1. Division of Laparoscopic and Bariatric Surgery, Department of Surgery, NewYork-Presbyterian Hospital, Weill Medical College of Cornell University, New York, NY, USA

    Camilo Boza, Elliot Yung, Luca Milone & Michel Gagner

  2. Department of Digestive Surgery, Division of Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile

    Camilo Boza & Rodrigo Muñoz

  3. Departamento Cirugía Digestiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 350, Santiago, Chile

    Camilo Boza

Authors
  1. Camilo Boza
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  2. Rodrigo Muñoz
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  3. Elliot Yung
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  4. Luca Milone
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  5. Michel Gagner
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Correspondence to Camilo Boza.

Additional information

This work was supported in part by a research grant from Covidien (Norwalk, CT).

This paper was presented at the Society for Surgery of the Alimentary Tract (SSAT) Meeting during Digestive Disease Week (DDW).

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Boza, C., Muñoz, R., Yung, E. et al. Sleeve Gastrectomy with Ileal Transposition (SGIT) Induces a Significant Weight Loss and Diabetes Improvement Without Exclusion of the Proximal Intestine. J Gastrointest Surg 15, 928–934 (2011). https://doi.org/10.1007/s11605-010-1369-6

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  • DOI: https://doi.org/10.1007/s11605-010-1369-6

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