Transit Bipartition Empowers Sleeve Gastrectomy. Consistent Good Results over a Decade

Abstract

Background : Sleeve Gastrectomy (SG) becamea very frequent bariatric surgery but for some patients SG is not enough, even in the short term. Transit bipartition (TB), an easy surgical procedure, was designed to improve SG results mainly through neuroendocrine mechanisms, not through malabsorption. Method: Since2003, over3,000 patients were submitted to a SG+TB,with1,192 registered in an electronic databank for statistics. After a SG, a laterolateral gastroileal anastomosis is created in the antrum to obtain early distal bowel hormonal stimulation; the transit through the duodenum however is maintained, avoiding blind loops and minimizing malabsorption. A major part of duodenal flux is deviated to the ileum. The stomach remains with two exits. Jejunum is laterally anastomosed to ileum at 80cm to 120 cm from the ileocecal valve. Results: Follow-up: 1 to 103 months. For a SG+TB average EBMIL% is 75.5% in the fifth year, with major improvement in pre-surgical comorbidities, especially diabetes (85% of remission). Radiographic studies show nutrient transit preferentially through gastroileostomy. Three deaths occurred (3/1192-0.25%). Other surgical complications were 5.5%, all well resolved. Protein malabsorption does not occur; diarrhea and flatulence are not so frequent as in a classic BPD. Most patients present no symptoms at all. Conclusions: SG+TB is a simple procedure that provokes early nutrient stimulation to distal bowel, while simultaneously reduces duodeno jejunal activity. TB avoids blind loops and minimizes malabsorption. Weight and comorbidities are very much improved. Diabetes is improved significantly without duodenal exclusion. TB is an excellent way to empower a SG.