Is the Sleeve Gastrectomy with Jejunal Bypass as good as the Roux-en-Y Gastric Bypass for the treatment of morbid obesity? A comparative study Matías Sepúlveda, Munir Alamo, Jorge Saba, Cristián Astorga, Percy Brante, Andrea Sepúlveda

We have no conflict of interest Disclosure We have no conflict of interest

Introduction Roux-en-Y Gastric Bypass is the gold standard in bariatric surgery Secondary effects due to duodenal exclusion like ferropenic anemia, low calcium absorption, vitamin deficiencies, dumping, etc. Sleeve Gastrectomy have not shown results as good as RYGB in terms of weight loss (or diabetes resolution?) Excess weight loss 57% Probability of regaining weight 15-75% Surg Laparosc Endosc Percutan Tech. 2012 Dec;22(6):479-86

Introduction Year 2004: Dr. Munir Alamo, in Santiago, Chile, creates a new and more physiological surgical technique, the Sleeve Gastrectomy with Jejunal Bypass Based on: A restrictive component Delivering food to the ileum, known to produce GLP-1 when stimulated - Alamo et al. Obesity Surgery. 2006, Vol 16, # 3; 353-8 - Alamo et al. Obesity Surgery. 2012, Vol 22, #7; 1097-1103

Surgical Technique: Sleeve Gastrectomy with Jejunal Bypass 36 French Boogie Gastric section 2-3 cm from pylorous Section of jejunum 20 cm from Treitz Jejunum-ileum anastomosis 250-300 cm Due to 4 over 40 cases with anastomotic ulcer we decided to remove the remnant stomach wich was reported in the same year Alamo M et al. Obesity Surgery 2006, 16; 9:1263-6

Surgical Technique: Roux-en-Y Gastric Bypass 36 French Boogie Gastric pouch of 50 ml Gastroentero anastomosis of 25 mm Alimentary limb of 120-150 cm Biliary limb of 100 cm Due to 4 over 40 cases with anastomotic ulcer we decided to remove the remnant stomach wich was reported in the same year

Objective To compare both surgical techniques (SGYB vs. RYGB) for the treatment of morbid obesity.

Patients and Methods Centro de Cirugía de la Obesidad (CCO) Hospital DIPRECA, Santiago de Chile Prospective database Retrospective revision of patients with preoperative BMI >30 kg/m2 Patients operated on from february 2004 to june 2007.

Design Endpoints Follow-up Excel 2007 Data Base 1. Excess weight loss 2. Improvement of comorbidities Follow-up Month 1° - 3° - 6° - 12° yearly thereafter Phone calls and regular interviews Excel 2007 Data Base Statistical analysis STATA 12™ t-test, chi2 y fisher exact test. p value <0.05.

Design Multidisciplinary Team CCO Internists Dietitian Mental Health Surgeons All patients received Polivitaminic p.o. Vitamin B complex i.m.

Results

Results

% months SGJB 330 288 239 176 84 63 35 22 RYGB 133 75 47 54 17 10 8 5

Discussion Limitations and Bias: Retrospective Better follow-up in SGJB No adressing of complications as dumping, micronutrients levels or anemia 50% of patients undergo SGJB

Conclusion Due to bias towards SGJB, this technique is at least as good as RYGB in terms of excess weight loss and comorbidities resolution. This paper lead us to….

… these ongoing prospective trials from March 2012 SGJB vs. RYGB vs. SG in BMI >35 SGJB vs. RYGB in BMI >30 and Diabetes SGJB vs. SG in BMI >30 and Prediabetes SGJB vs SG in BMI 30-35