Journal of Gastrointestinal Surgery

, Volume 15, Issue 6, pp 928–934

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

  • Camilo Boza
  • Rodrigo Muñoz
  • Elliot Yung
  • Luca Milone
  • Michel Gagner
Original Article

DOI: 10.1007/s11605-010-1369-6

Cite this article as:
Boza, C., Muñoz, R., Yung, E. et al. J Gastrointest Surg (2011) 15: 928. doi:10.1007/s11605-010-1369-6

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.

Keywords

Sleeve gastrectomy Ileal transposition Diabetes Bariatric surgery 

Copyright information

© The Society for Surgery of the Alimentary Tract 2010

Authors and Affiliations

  • Camilo Boza
    • 1
    • 2
    • 3
  • Rodrigo Muñoz
    • 2
  • Elliot Yung
    • 1
  • Luca Milone
    • 1
  • Michel Gagner
    • 1
  1. 1.Division of Laparoscopic and Bariatric Surgery, Department of Surgery, NewYork-Presbyterian HospitalWeill Medical College of Cornell UniversityNew YorkUSA
  2. 2.Department of Digestive Surgery, Division of SurgeryPontificia Universidad Católica de ChileSantiagoChile
  3. 3.Departamento Cirugía Digestiva, Facultad de MedicinaPontificia Universidad Católica de ChileSantiagoChile

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