Partial jejunal diversion – technical aspects and preliminary experience

Česká verzia

Authors: Holéczy P. ^1,2; Bužga M. ³; Macháčková J. ³; Bolek M. ²
Authors place of work: Katedra chirurgických oborů, LF OU v Ostravě ¹; Chirurgické oddělení, Vítkovická nemocnice, a. s., Ostrava ²; Katedra fyziologie a patofyziologie, LF OU v Ostravě ³
Published in the journal: Gastroent Hepatol 2018; 72(6): 490-494
Category:
doi: https://doi.org/10.14735/amgh2018490

Summary

Introduction:

Bariatric/metabolic surgery is a well-established way of treating severe obesity and comorbidities associated with it. There are also new types of procedures that focus on comorbidity treatment rather than weight reduction. Less invasive interventions are the preferred option. The aim of this study is to present the short-term results of a new surgical method – partial jejunal diversion (PJD) – and to describe its technical aspects.

Material and methods:

This is a prospective study in which 14 patients were operated on from September 2016 to February 2018. There were 8 women and 6 men in the studied group, whose average age was 47.3 years. Their BMI varied from 32.89 to 47.6 kg/sqm, and the average value was 43.5 kg/sqm. Diabetes mellitus type 2 was observed in 4 patients. Eight patients were evaluated after 12 months of follow-up. For the purpose of this study, we chose to evaluate weight changes, BMI changes, and changes in glycid metabolism. We also evaluated the incidence of complications.

Results:

The operation time ranged from 27 to 61 minutes, and no preoperative complications were recorded. Two (14.28%) patients had to be re-operated on for inner hernia in the follow-up period. The average weight loss was from 122.6 to 102.9 kg, i.e. BMI from 43.5 to 36.3 kg/sqm. Glycated haemoglobin decreased from 41.5 mmol/mol to 34.4 mmol/mol. All changes were statistically significant. Changes in fasting blood glucose were not statistically significant.

Discussion:

The long-term results of standard metabolic operations are well known. In order to minimize the invasivity new operations are sought; PJD is one of these. It is expected that PJD will have a metabolic effect, especially in type 2 diabetes, as has been suggested by the published results. Conclusion: Our results confirm that there has been significant weight reduction and improved glycide metabolism. It is clear that it will be necessary to evaluate the effect of the operation in the long term and in a larger cohort. The short-term results allow us to assume a positive effect, especially in type 2 diabetics.

Key words:

metabolic surgery – obesity – jejunal diversion – type 2 diabetes mellitus

Submitted: 19. 11. 2018

Accepted: 6. 12. 2018

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Zdroje

1. Buchwald H, Varco LR. Metabolic Surgery. New York: Grune & Stratton 1978.

2. Angrisani L, Santonicola A, Iovino P et al. Bariatric surgery and endoluminal procedures: IFSO Worldwide Survey 2014. Obes Surg 2017; 27(9): 2279–2289. doi: 10.1007/ s11695-017-2666-x.

3. Fried M, Pešková M, Kasalický M. The role of laparoscopy in the treatment of morbid obesity. Obes Surg 1998; 8(5): 520–523.

4. Obesity and overweight. WHO [online]. Available from: http:/ / www.who.int/ mediacentre/ factsheets/ fs311/ en.

5. Facts and figures on childhood obesity. WHO. [online] Available from: https:/ / www.who.int/ end-childhood-obesity/ facts/ en.

6. Global report on diabetes. WHO. Available from: http:/ / apps.who.int/ iris/ bitstream/ 10665/ 204871/ 1/ 9789241565257_eng.pdf.

7. Fried M, Hainer V, Basdevant A et al. Inter-disciplinary European quidelines on surgery of severe obesity. Int J Obes 2007; 31(4): 569–577. doi: 10.1038/ sj.ijo.0803560

8. Buchwald H. Evolution of bariatric/ metabolic surgery. Obes Surg 2014; 24(8): 1126–1135. doi: 10.1007/ s11695-014-1354-3.

9. Dargent J. Novel endoscopic management of obesity. Clin Endosc 2016; 49(1): 30–36. doi: 10.5946/ ce.2016.49.1.30.

10. Melissas J, Peppe A, Askoxilakis J et al. Sleeve gastrectomy plus side-to-side jejunoileal anastomosis for the treatment of morbid obesity and metabolic diseases: a promising operation. Obes Surg 2012; 22(7): 1104–1109. doi: 10.1007/ s11695-012-0637-9.

11. Melissas J, ErenTaskin H, Peirasmakis D et al. A simple food-diverting operation for type 2 diabetes treatment. Preliminary results in humans with BMI 28-32 kg/ m². Obes Surg 2017; 27(1): 22–29. doi: 10.1007/ s11695-016-2251-8.

12. Machytka E, Bužga M, Zonča P et al. Partial jejunal diversion using an incisionless magnetic anastomosis system: 1-year interim results in patients with obesity and diabetes. Gastrointest Endosc 2017; 86(5): 904–912. doi: 10.1016/ j.gie.2017.07.009.

13. Fried M, Dolezalova K, Chambers AP et al. A novel approach to glycemic control in type 2 diabetes mellitus, partial jejunal diversion: pre-clinical to clinical pathway. BMJ Open Diabetes Res Care 2017; 5(1): e000431. doi: 10.1136/ bmjdrc-2017-000431.