Key details of the duodenal-jejunal bypass in type 2 diabetes mellitus rats

Abstract

Aim: To investigate which surgical techniques and perioperative regimens yielded the best survival rates for diabetic rats undergoing gastric bypass.

Methods: We performed Roux-en-Y gastric bypass with reserved gastric volume, a procedure in which gastrointestinal continuity was reestablished while excluding the entire duodenum and proximal jejunal loop. We observed the procedural success rate, long-term survival, and histopathological sequelae associated with a number of technical modifications. These included: use of anatomical markers to precisely identify Treitz's ligament; careful dissection along surgical planes; careful attention to the choice of regional transection sites; reconstruction using full-thickness anastomoses; use of a minimally invasive procedure with prohemostatic pretreatment and hemorrhage control; prevention of hypothermic damage; reduction in the length of the procedure; and accelerated surgical recovery using fast-track surgical modalities such as perioperative permissive underfeeding and goal-directed volume therapy.

Results: The series of modifications we adopted reduced operation time from 110.02 ± 12.34 min to 78.39 ± 7.26 min (P < 0.01), and the procedural success rate increased from 43.3% (13/30) to 90% (18/20) (P < 0.01), with a long-term survival of 83.3% (15/18) (P < 0.01).

Conclusion: Using a number of fast-track and damage control surgical techniques, we have successfully established a stable model of gastric bypass in diabetic rats.

Keywords: Damage control surgery; Duodenal-jejunal bypass; Fast-track surgery; Goal-directed volume therapy; Minimally invasive surgery; Permissive underfeeding; Type 2 diabetes mellitus.

Figure 1

Schematic diagram of Roux-en-Y duodenal-jejunal bypass. The duodenum was transected 2-3 mm distal to the pylorus, and the distal duodenal end was ligated and closed. After the jejunum was transected 8 cm distal to Treitz’s ligament, an end-to-end anastomosis was achieved between the distal jejunal loop and the proximal duodenum. The proximal jejunal loop was then anastomosed end-to-side to the distal jejunal loop at 12 cm distal to the gastrojejunal anastomosis.

Figure 2

Causes of mortality in the conventional duodenal-jejunal bypass group.