Laparoscopic duodenojejunal bypass with sleeve gastrectomy

Abstract

There has been a rapid rise in the number of laparoscopic sleeve gastrectomy (SG) for treating morbidly obese patients in the recent few years. This has eventually the most popular bariatric procedure to date. Being only anatomically restrictive, SG has limited effects on glucose homeostasis in type II diabetes mellitus (T2DM) for lack of foregut hormone modulation mechanism. Gastric bypass has been proposed and proven to remit T2DM better than SG due to the foregut exclusion. According to these findings, duodenojejunal bypass (DJB) has been developed to accompany SG to possibly give a better result of diabetes remission than SG alone. The technique DJB-SG involves SG, exclusion of duodenum except the first portion, and bypassing the proximal jejunum. Both the Roux-en-Y and loop fashion for anastomosis of duodenum and jejunum have been adopted. In this chapter, we present both methods of combined SG with DJB as a treatment for morbid obesity and obesity with T2DM.