Case reportLaparoscopic sleeve gastrectomy with ileal interposition (“neuroendocrine brake”)—pilot study of a new operation
Section snippets
Methods
Between November 2003 and March 2005, the laparoscopic neuroendocrine brake procedure was performed in 19 patients (15 women and 4 men), with a mean age of 37.3 years (range 21–54) and a mean BMI of 40.2 kg/m2 (range 35–44). All 19 patients had at least one co-morbidity (Table 1).
The inclusion criteria conformed to the 1991 National Institutes of Health Consensus Development Panel on bariatric surgery [10]. The exclusion criteria included a history of upper abdominal surgery, age <18 years or
Results
Nineteen patients underwent laparoscopic sleeve gastrectomy and were followed up a mean of 11.6 months (range 1–17). The mean operating time was 197 minutes (range 170–265). No conversions to open surgery were required. The only intraoperative complication was a stapler malfunction in 1 case, resulting in leakage of gastric contents into the abdominal cavity, subsequently leading to pleural effusion. Intestinal function recovered after an average of 72 hours. Early postoperative complications
Discussion
This is the first description of laparoscopic ileal interposition plus sleeve gastrectomy, which we term the “neuroendocrine brake” operation, in 19 severely obese patients with manifest co-morbidities. Our preliminary and early results imply that the safety and efficacy of the procedure are equivalent to our own results in similar patients undergoing laparoscopic Roux-en-Y gastric bypass, an operation of comparable difficulty.
We hypothesize that this operation might have significant advantages
References (16)
- et al.
Laparoscopic adjustable gastric banding in the treatment of obesitya systematic literature review
Surgery
(2004) Metabolic risk of obesity surgery and long-term follow-up
Am J Clin Nutr
(1992)- et al.
Malabsorptive obesity surgery
Surg Clin North Am
(2001) - et al.
The effects of ileal transposition on food intake and body weight loss in VMH-obese rats
Am J Clin Nutr
(1982) - et al.
Control of body weight by lower gut signals
Int J Obes
(1981) Obesity surgery—state of the art
- et al.
Effects of ileal interposition on body weight and intestinal morphology in dogs
Int J Obes
(1986) Ilial transposition and enteroglucagon/GLP-1 in obesity (and diabetic?) surgery
Obes Surg
(1999)
Cited by (84)
Endoscopic Bariatric and Metabolic Therapies: Surgical Analogues and Mechanisms of Action
2017, Clinical Gastroenterology and HepatologyCitation Excerpt :A surgical procedure that is structurally different but may be mechanistically similar to BPD is the ileal transposition. Described by De Paula et al75 in 1999, the procedure involves resecting a 10- to 20-cm portion of the distal ileum and then transposing it into the proximal jejunum. This results in early delivery of food chyme to the ileum, while the total length of the small bowel remains unaffected.
Innovative Metabolic Operations
2017, Surgery for Obesity and Related DiseasesLetter to the editor on innovative metabolic operations
2017, Surgery for Obesity and Related DiseasesInnovative metabolic operations
2016, Surgery for Obesity and Related DiseasesIleal Interposition with Sleeve Gastrectomy for Type 2 Diabetes Mellitus and Metabolic Syndrome
2023, Obesity, Bariatric and Metabolic Surgery: A Comprehensive Guide: Second Edition