Abstract

Introduction: Bariatric surgery has evolved into multiple forms in the last decades, combining food restriction and malabsorption. The aim of this study was to develop a new technique based on food restriction and early stimulation of the distal gut, thus maintaining the alimentary tract continuity. Methods: Thirty-two Yorkshire pigs, weight 22.2 ± 5.4 kg (mean ± SD) were randomly assigned to four laparoscopic procedures: ileal transposition (IT, n = 8); sleeve gastrectomy with ileal transposition (SGIT, n = 8); Roux-en-Y gastric bypass (GBP, n = 8); sham operation (SHAM, n = 8). Firing 45-mm linear staplers over a 60-F bougie, resecting the greater curvature and fundus, constituted a sleeve gastrectomy. Ileal transposition was performed by isolating a 100-cm ileal segment proximal to the ileocecal valve and by dividing the proximal jejunum 15 cm distal to the ligament of Treitz and performing re-anastomosis. Gastric bypass consisted of creating a proximal gastric pouch and a 300 cm alimentary limb. Sham operation was performed by bowel transections and re-anastomosis in the ileum and proximal jejunum together with gastrotomy and closure. Animals were evaluated weekly for weight increase and food intake. We performed a logistic regression analysis to compare weight progression curves, and analysis of variance (ANOVA) and Bonferroni (Dunn) tests to detect differences in weight and food intake. Results: We observed significant differences in mean weight after 18 weeks between SGIT (30.9 ± 13.4 kg) and SHAM (72.5 ± 10.7 kg) (p = 0.0002), and GBP (28.6 ± 2.5 kg) and SHAM (p = 0.0001), and IT (56.1 ± 13.4 kg) and SHAM (p = 0.0081). No differences were observed between RYGB and SGIT. We also observed significant differences in food intake (grams per day) in the third month between SGIT (1668 ± 677 g) versus SHAM (3252 ± 476 g) (p = 0.0006), and GBP (2011 ± 565 g) versus SHAM (p = 0.039). No differences were observed in food intake between SGIT and GBP. Conclusion: SGIT proved to be as effective in the short term as GBP on weight progression with no bypass of the proximal gut. © 2008 Springer Science+Business Media, LLC.