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Clinical Trial
. 2006 Jul 6;124(4):192-7.
doi: 10.1590/s1516-31802006000400004.

Preliminary results from digestive adaptation: a new surgical proposal for treating obesity, based on physiology and evolution

Sérgio Santoro  1 , Manoel Carlos Prieto Velhote, Carlos Eduardo Malzoni, Fábio Quirino Milleo, Sidney Klajner, Fábio Guilherme Campos
Affiliations
Clinical Trial

Preliminary results from digestive adaptation: a new surgical proposal for treating obesity, based on physiology and evolution

Sérgio Santoro et al. Sao Paulo Med J. .

Abstract
in English, Portuguese

Context and objective: Most bariatric surgical techniques include essentially non-physiological features like narrowing anastomoses or bands, or digestive segment exclusion, especially the duodenum. This potentially causes symptoms or complications. The aim here was to report on the preliminary results from a new surgical technique for treating morbid obesity that takes a physiological and evolutionary approach.

Design and setting: Case series description, in Hospital Israelita Albert Einstein and Hospital da Polícia Militar, São Paulo, and Hospital Vicentino, Ponta Grossa, Paraná.

Methods: The technique included vertical (sleeve) gastrectomy, omentectomy and enterectomy that retained three meters of small bowel (initial jejunum and most of the ileum), i.e. the lower limit for normal adults. The operations on 100 patients are described.

Results: The mean follow-up was nine months (range: one to 29 months). The mean reductions in body mass index were 4.3, 6.1, 8.1, 10.1 and 10.7 kg/m2, respectively at 1, 2, 4, 6 and 12 months. All patients reported early satiety. There was major improvement in comorbidities, especially diabetes. Operative complications occurred in 7% of patients, all of them resolved without sequelae. There was no mortality.

Conclusions: This procedure creates a proportionally reduced gastrointestinal tract, leaving its basic functions unharmed and producing adaptation of the gastric chamber size to hypercaloric diet. It removes the sources of ghrelin, plasminogen activator inhibitor-1 (PAI-1) and resistin production and leads more nutrients to the distal bowel, with desirable metabolic consequences. Patients do not need nutritional support or drug medication. The procedure is straightforward and safe.

CONTEXTO E OBJETIVO:: A maioria das técnicas de cirurgia bariátrica inclui anastomoses ou bandas ou exclusões de segmentos digestivos, principalmente o duodeno, que podem gerar sintomas ou complicações. O objetivo do estudo foi apresentar os resultados dos dois primeiros anos de uso de uma nova técnica no tratamento cirúrgico da obesidade: gastrectomia vertical com omentectomia e enterectomia segmentar.

TIPO DE ESTUDO E LOCAL:: Descrição de série de casos operados no Hospital Israelita Albert Einstein, Hospital da Polícia Militar, São Paulo, e Hospital Vicentino, Ponta Grossa, Paraná, Brazil.

MÉTODO:: A técnica utiliza a gastrectomia vertical, omentectomia maior e enterectomia segmentar (incluindo jejuno basicamente) que deixa três metros de intestino delgado (jejuno inicial e a maior parte do íleo), em comprimento no limite inferior do que se considera normal para humanos adultos. Os 100 primeiros pacientes são descritos.

RESULTADOS:: Com acompanhamento de até 29 meses pós-operatórios (média de oito meses) a redução no índice de massa corpórea foi de 4.3, 6.1, 8.1, 10.1, 10.7 kg/m2, respectivamente nos meses 1, 2, 4, 6 e 12 de pós-operatório. Todos os pacientes acusam saciedade precoce. Houve melhora acentuada das doenças associadas em especial a diabetes. Complicações cirúrgicas ocorreram em 7% dos pacientes todas resolvidas sem seqüelas. Não houve óbitos.

CONCLUSÕES:: O procedimento cria um trato gastrointestinal proporcionalmente reduzido, mas com suas funções digestivas intactas. O procedimento retira fontes de produção de grelina, inibidor do ativador do plasminogênio-1 (PAI-1), resistina e permite que mais nutrientes sejam absorvidos no intestino distal, com as desejáveis conseqüências metabólicas. Os pacientes não precisam de suporte nutricional ou de medicações. O procedimento é fácil e seguro.

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Conflict of interest statement

Conflict of interest: None

Figures

Figure 1
Figure 1. Sleeve gastrectomy being performed using a laparoscopic linear cutting stapler.
Figure 2
Figure 2. Final appearance of the proportionally reduced gastrointestinal tract by the proposed surgical technique.
See this image and copyright information in PMC

Comment in

  • Obesity surgery and satiety control.
    dos Santos JE. dos Santos JE. Sao Paulo Med J. 2006 Jul 6;124(4):179-80. doi: 10.1590/s1516-31802006000400001. Sao Paulo Med J. 2006. PMID: 17086296 Free PMC article. No abstract available.

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