Obesity Surgery

, Volume 29, Issue 2, pp 593–600 | Cite as

Technical Feasibility of a Murine Model of Sleeve Gastrectomy with Ileal Transposition

  • Lee D. Ying
  • Gregory A. Breuer
  • Matthew O. Hubbard
  • Geoffrey S. Nadzam
  • John Hwa
  • Kathleen A. MartinEmail author
Original Contributions



Sleeve gastrectomy with ileal transposition has been shown to be superior to sleeve gastrectomy alone for promoting weight loss in rat and porcine models. The absence of a mouse model for this procedure has impeded efforts to understand the molecular physiology underlying its efficacy. This study demonstrates the long-term survivability of sleeve gastrectomy with ileal transposition in mice.

Materials and Methods

In this study of technical feasibility, a sleeve gastrectomy with ileal transposition (SGIT), sleeve gastrectomy (SG), or sham surgery (SH) was performed on 7- to 8-week-old C57Bl/6J mice (n = 8 for each). To evaluate long-term survivability, mice were placed on an obesogenic diet and weighed weekly for 10 weeks. The intestinal identity of the transposed segment was assessed with gene expression analysis of duodenal-, jejunal-, and ileal-specific hormones using quantitative polymerase chain reaction.


Overall, SGIT better prevented weight gain than the SG or sham procedures (10-week post-operative weight: SH 45.3 ± 1.0 g, SG 41.25 ± 1.6 g, SGIT 35.4 ± 0.8 g). Gene expression pattern analysis of three markers of intestinal identity (gastrin, cholecystokinin, and peptide YY) suggests that the ileal identity of the transposed segment is maintained 10 weeks after transposition.


We demonstrate for the first time a reproducible mouse model of sleeve gastrectomy with ileal transposition. Future studies utilizing this model will expand our understanding of the molecular pathways through which the hindgut regulates satiety.


Mouse metabolic surgery Sleeve gastrectomy with ileal transposition 


Author Contributions

L.D.Y. conceived of, performed, and interpreted the research, and wrote and edited the manuscript.

G.B., M.O.H., G.S.N., J.H., and K.A.M. conceived of and interpreted the research, and wrote and edited the manuscript.


Lee D. Ying is supported by the NIH NIDDK (1F30DK112569-01).

Kathleen A. Martin is supported by the NIH NHLBI (HL091013, HL118430, RHL119529).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All applicable institutional and/or national guidelines for the care and use of animals were followed.


  1. 1.
    Flegal KM, Kruszon-Moran D, Carroll MD, et al. Trends in obesity among adults in the United States, 2005 to 2014. JAMA. 2016;315(21):2284–91. Scholar
  2. 2.
    Kelly T, Yang W, Chen CS, et al. Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond). 2008;32:1431. CrossRefGoogle Scholar
  3. 3.
    Mendez MA, Monteiro CA, Popkin BM. Overweight exceeds underweight among women in most developing countries. Am J Clin Nutr. 2005;81(3):714–21.CrossRefGoogle Scholar
  4. 4.
    Haslam DW, James WPT. Obesity. Lancet. 2005;366(9492):1197–209. Scholar
  5. 5.
    Andersen JR, Aasprang A, Karlsen T-I, et al. Health-related quality of life after bariatric surgery: a systematic review of prospective long-term studies. Surg Obes Relat Dis. 2015;11(2):466–73. Scholar
  6. 6.
    Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222(3):339–52.CrossRefGoogle Scholar
  7. 7.
    Picot J, Jones J, Colquitt JL, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess (Winch. Eng.). 2009;13(41):1–190,215–357, iii-iv. Scholar
  8. 8.
    Lopes EC, Heineck I, Athaydes G, et al. Is bariatric surgery effective in reducing comorbidities and drug costs? A systematic review and meta-analysis. Obes Surg. 2015;25(9):1741–9. Scholar
  9. 9.
    Maciejewski ML, Arterburn DE. Cost-effectiveness of bariatric surgery. JAMA. 2013;310(7):742–3. Scholar
  10. 10.
    Chang S, Stoll CT, Song J, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg. 2014;149(3):275–87. Scholar
  11. 11.
    Almogy G, Crookes PF, Anthone GJ. Longitudinal gastrectomy as a treatment for the high-risk super-obese patient. Obes Surg. 2004;14(4):492–7. Scholar
  12. 12.
    Silecchia G, Boru C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg. 2006;16(9):1138–44. Scholar
  13. 13.
    Surgery ASfMaB. Estimate of bariatric surgery numbers, 2011–2015. Am Soc Metab Bariatric Surg. 2016.Google Scholar
  14. 14.
    Mann JP, Jakes AD, Hayden JD, et al. Systematic review of definitions of failure in revisional bariatric surgery. Obes Surg. 2015;25(3):571–4. Scholar
  15. 15.
    Brethauer SA, Kothari S, Sudan R, et al. Systematic review on reoperative bariatric surgery: American Society for Metabolic and Bariatric Surgery Revision Task Force. Surg Obes Relat Dis. 2014;10(5):952–72. Scholar
  16. 16.
    Chansaenroj P, Aung L, Lee W-J, et al. Revision procedures after failed adjustable gastric banding: comparison of efficacy and safety. Obes Surg. 2017;27(11):2861–7. Scholar
  17. 17.
    Kellogg TA. Revisional bariatric surgery. Surg Clin N Am. 2011;91(6):1353–71. Scholar
  18. 18.
    Khoursheed MA, Al-Bader IA, Al-asfar FS, et al. Revision of failed bariatric procedures to Roux-en-Y gastric bypass (RYGB). Obes Surg. 2011;21(8):1157–60. Scholar
  19. 19.
    Noel P, Schneck A-S, Nedelcu M, et al. Laparoscopic sleeve gastrectomy as a revisional procedure for failed gastric banding: lessons from 300 consecutive cases. Surg Obes Relat Dis. 10(6):1116–22.
  20. 20.
    Nesset EM, Kendrick ML, Houghton SG, et al. A two-decade spectrum of revisional bariatric surgery at a tertiary referral center. Surg Obes Relat Dis. 2007;3(1):25–30. Scholar
  21. 21.
    Hallowell PT, Stellato TA, Yao DA, et al. Should bariatric revisional surgery be avoided secondary to increased morbidity and mortality? Am J Surg. 2009;197(3):391–6. Scholar
  22. 22.
    Knop FK, Taylor R. Mechanism of metabolic advantages after bariatric surgery: it’s all gastrointestinal factors versus it’s all food restriction. Diabetes Care. 2013;36(Suppl 2):S287–S91. Scholar
  23. 23.
    Madura JA, DiBaise JK. Quick fix or long-term cure? Pros and cons of bariatric surgery. F1000 Med Rep. 2012;4:19. Scholar
  24. 24.
    Ionut V, Bergman RN. Mechanisms responsible for excess weight loss after bariatric surgery. J Diabetes Sci Technol. 2011;5(5):1263–82.CrossRefGoogle Scholar
  25. 25.
    Barreto SG, Soenen S, Chisholm J, et al. Does the ileal brake mechanism contribute to sustained weight loss after bariatric surgery? ANZ J Surg. 2018;88(1–2):20–5. Epub 2017/06/09. Scholar
  26. 26.
    Meek CL, Lewis HB, Reimann F, et al. The effect of bariatric surgery on gastrointestinal and pancreatic peptide hormones. Peptides. 2016;77:28–37. Epub 2015/09/08. Scholar
  27. 27.
    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. 2011;15(6):928–34. Scholar
  28. 28.
    Nausheen S, Shah IH, Pezeshki A, et al. Effects of sleeve gastrectomy and ileal transposition, alone and in combination, on food intake, body weight, gut hormones, and glucose metabolism in rats. Am J Physiol Endocrinol Metab. 2013;305(4):E507–18. Scholar
  29. 29.
    de Paula AL, Macedo ALV, Prudente AS, et al. Laparoscopic sleeve gastrectomy with ileal interposition (“neuroendocrine brake”)--pilot study of a new operation. Surg Obes Relat Dis. 2006;2(4):464–7. Scholar
  30. 30.
    Çelik A, Ugale S, Ofluoğlu H. Laparoscopic diverted resleeve with ileal transposition for failed laparoscopic sleeve gastrectomy: a case report. Surg Obes Relat Dis. 2015;11(1):e5–7. Scholar
  31. 31.
    DePaula AL, Macedo ALV, Mota BR, et al. Laparoscopic ileal interposition associated to a diverted sleeve gastrectomy is an effective operation for the treatment of type 2 diabetes mellitus patients with BMI 21–29. Surg Endosc. 2009;23(6):1313–20. Scholar
  32. 32.
    Kotler DP, Koopmans H. Preservation of intestinal structure and function despite weight loss produced by ileal transposition in rats. Physiol Behav. 1984;32(3):423–7. Scholar
  33. 33.
    Boozer CN, Choban PS, Atkinson RL. Ileal transposition surgery attenuates the increased efficiency of weight gain on a high-fat diet. Int J Obes. 1990;14(10):869–78.Google Scholar
  34. 34.
    Gleeson MH, Cullen J, Dowling RH. Intestinal structure and function after small bowel by-pass in the rat. Clin Sci. 1972;43(6):731–42.CrossRefGoogle Scholar
  35. 35.
    Strader AD, Vahl TP, Jandacek RJ, et al. Weight loss through ileal transposition is accompanied by increased ileal hormone secretion and synthesis in rats. Am J Physiol Endocrinol Metab. 2005;288(2):E447.CrossRefGoogle Scholar
  36. 36.
    Boza C, Gagner M, Devaud N, et al. Laparoscopic sleeve gastrectomy with ileal transposition (SGIT): a new surgical procedure as effective as gastric bypass for weight control in a porcine model. Surg Endosc. 2008;22(4):1029–34. Scholar
  37. 37.
    Laboratories J. Body weight information for C57BL/6J.Google Scholar
  38. 38.
    River C. SAS Sprague Dawley rat growth chart.Google Scholar
  39. 39.
    Bruinsma BG, Uygun K, Yarmush ML, et al. Surgical models of Roux-en-Y gastric bypass surgery and sleeve gastrectomy in rats and mice. Nat Protoc. 2015;10(3):495–507. Scholar
  40. 40.
    Hao Z, Zhao Z, Berthoud H-R, et al. Development and verification of a mouse model for Roux-en-Y gastric bypass surgery with a small gastric pouch. PLoS One. 2013;8(1):e52922. Scholar
  41. 41.
    Ayer A, Borel F, Moreau F, et al. Techniques of sleeve gastrectomy and modified Roux-en-Y gastric bypass in mice. J Vis Exp. 2017;121
  42. 42.
    Seyfried F, Lannoo M, Gsell W, et al. Roux-en-Y gastric bypass in mice—surgical technique and characterisation. Obes Surg. 2012;22(7):1117–25. Scholar
  43. 43.
    Lutz TA, Bueter M. The use of rat and mouse models in bariatric surgery experiments. Front Nutr. 2016;3(25)
  44. 44.
    Hao Z, Townsend RL, Mumphrey MB, Morrison CD, Münzberg H, Berthoud H-R. RYGB produces more sustained body weight loss and improvement of glycemic control compared with VSG in the diet-induced obese mouse model 2017.Google Scholar
  45. 45.
    Seyfried F, Lannoo M, Gsell W, Tremoleda JL, Bueter M, Olbers T, et al. Roux-en-Y gastric bypass in mice-surgical technique and characterisation 2012. 1117–1125 p.Google Scholar
  46. 46.
    Du J, Tian J, Ding L, et al. Vertical sleeve gastrectomy reverses diet-induced gene-regulatory changes impacting lipid metabolism. Sci Report. 2017;7:5274. Scholar
  47. 47.
    Ding L, Sousa Kyle M, Jin L, et al. Vertical sleeve gastrectomy activates GPBAR-1/TGR5 to sustain weight loss, improve fatty liver, and remit insulin resistance in mice. Hepatology. 2016;64(3):760–73. Scholar
  48. 48.
    Wilson-Pérez HE, Chambers AP, Ryan KK, et al. Vertical sleeve gastrectomy is effective in two genetic mouse models of glucagon-like peptide 1 receptor deficiency. Diabetes. 2013;62(7):2380–5. Scholar
  49. 49.
    Pressler JW, Haller A, Sorrell J, et al. Vertical sleeve gastrectomy restores glucose homeostasis in apolipoprotein A-IV KO mice. Diabetes. 2015;64(2):498–507. Scholar
  50. 50.
    Shao Y, Shen Q, Hua R, et al. Effects of sleeve gastrectomy on the composition and diurnal oscillation of gut microbiota related to the metabolic improvements. Surg Obes Relat Dis. 2018;
  51. 51.
    Stearns AT, Balakrishnan A, Tavakkolizadeh A. Impact of Roux-en-Y gastric bypass surgery on rat intestinal glucose transport. Am J Physiol Gastrointest Liver Physiol. 2009;297(5):G950–7.CrossRefGoogle Scholar
  52. 52.
    Maljaars PJ, Keszthelyi D, Masclee AA. An ileal brake-through? Am J Clin Nutr. 2010;92(3):467–8. Scholar
  53. 53.
    Strader AD. Ileal transposition provides insight into the effectiveness of gastric bypass surgery. Physiol Behav. 2006;88(3):277–82. Scholar
  54. 54.
    Maljaars PW, Symersky T, Kee BC, et al. Effect of ileal fat perfusion on satiety and hormone release in healthy volunteers. Int J Obes (Lond). 2008;32(11):1633–9. Scholar
  55. 55.
    Cummings DE, Overduin J, Foster-Schubert KE. Gastric bypass for obesity: mechanisms of weight loss and diabetes resolution. J Clin Endocrinol Metab. 2004;89(6):2608–15. Scholar
  56. 56.
    Mason EE. The mechanisms of surgical treatment of type 2 diabetes. Obes Surg. 2005;15(4):459–61. Scholar
  57. 57.
    Rubino F, Forgione A, Cummings DE, et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg. 2006;244(5):741–9. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Lee D. Ying
    • 1
    • 2
  • Gregory A. Breuer
    • 1
  • Matthew O. Hubbard
    • 1
    • 3
  • Geoffrey S. Nadzam
    • 1
    • 3
  • John Hwa
    • 1
    • 2
  • Kathleen A. Martin
    • 1
    • 2
    Email author
  1. 1.Yale University School of MedicineNew HavenUSA
  2. 2.Yale Cardiovascular Research CenterNew HavenUSA
  3. 3.Department of Gastrointestinal SurgeryYale New Haven HealthNew HavenUSA

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