The Impact of Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass on Intestinal Microbiota Differs from that of Laparoscopic Sleeve Gastrectomy in Japanese Patients with Obesity
Background and Objectives
Bariatric surgery improves metabolic diseases and alters the intestinal microbiota in animals and humans, but different procedures reportedly have different impacts on the intestinal microbiota. We developed laparoscopic sleeve gastrectomy with duodenojejunal bypass (LSG-DJB) as an alternative to laparoscopic Roux-en-Y gastric bypass (LRYGB) in addition to laparoscopic sleeve gastrectomy (LSG) for Japanese patients with obesity. We investigated the precise change in the intestinal microbiota induced by these procedures in the present study.
A prospective observational study of 44 Japanese patients with obesity was conducted [22 patients underwent LSG, 18 underwent LSG-DJB, and 4 underwent laparoscopic adjustable gastric banding (LAGB)]. The patients’ clinical parameters and intestinal microbiota were investigated before and for 6 months after surgery. The microbiota was analyzed by a 16S rDNA method.
LSG and LSG-DJB significantly improved the metabolic disorders in the patients with obesity. The proportion of the phylum Bacteroidetes and order Lactobacillales increased significantly in the LSG group, and that of the order Enterobacteriales increased significantly in the LSG-DJB group.
LSG and LSG-DJB improved obesity and type 2 diabetes in Japanese patients with obesity, but the impact of LSG-DJB on the intestinal microbiota differed from that of LSG. This difference in the impact on the intestinal environment could explain the different efficacies of LSG and LSG-DJB in terms of their ability to resolve metabolic disorders in the clinical setting.
All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript. RK, JI, NYG, YS, KK, and HI designed the study. RK, JI, NYG, EK, and YS performed the study. RK, JI, and EK analyzed the data. RK, JI, YS, and HI wrote the manuscript. All authors participated in data interpretation, reviewed the manuscript, take responsibility for the integrity of the work as a whole, and approved the final version.
Compliance with Ethical Standards
This study was supported by research fellowships and grants from Keio University and AMED (17gm1010007h0001).
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964, as revised in 2013.
Informed consent was obtained from all patients for being included in the study.
Conflict of interest
Rieko Kikuchi, Junichiro Irie, Nobuko Yamada-Goto, Eri Kikkawa, Yosuke Seki, Kazunori Kasama, and Hiroshi Itoh declare no conflict of interest.
- 3.Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(248–56):e5.Google Scholar
- 27.Freedberg DE, Toussaint NC, Chen SP, et al. Proton pump inhibitors alter specific taxa in the human gastrointestinal microbiome: a crossover trial. Gastroenterology. 2015;149(883–5):e9.Google Scholar
- 37.Zachariah PJ, Chen CY, Lee WJ, et al. Compared to sleeve gastrectomy, duodenal-jejunal bypass with sleeve gastrectomy gives better glycemic control in T2DM patients, with a lower beta-cell response and similar appetite sensations: mixed-meal study. Obes Surg. 2016;26:2862–72.CrossRefPubMedGoogle Scholar