The Effects of Adding Gastrojejunostomy to Sleeve Gastrectomy on GERD, Food Tolerance, and Weight Loss: A Randomized Study

Introduction

Overweight and obesity are significant and increasing public health challenges in both economically developed and developing regions of the world, with 33% of the world's adult population being overweight or obese.¹ Treatments for severe obesity include lifestyle interventions, pharmacotherapy, and bariatric surgical procedures.

Metabolic and bariatric surgery is the only intervention that has been shown to have consistent, long-term weight loss results and significant improvements for comorbid conditions in the severely obese population.²

Surgical solutions are rapidly increasing, and recent approaches start to replace the already established operations. Distinguished from other procedures, sleeve gastrectomy seems to be the leading procedure in the near future. This is attributed to many factors, including relative simplicity of the procedure, lower cost, reasonable outcome in terms of weight loss and improvement of the associated comorbidities, and the available conversion options in case of unsatisfactory outcome.³

Another procedure is the mini gastric bypass, which can be applied either as a primary procedure or as a secondary solution after a failed sleeve gastrectomy.⁴

Several studies discussed the combination of sleeve gastrectomy (as a restrictive element), with malabsorptive elements, to augment its metabolic and/or weight loss effects.

In 2010, Sánchez-Pernaute et al. published the 3-year postoperative results of their innovative single anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S technique). This operation entails transection of the first part of the duodenum after construction of a sleeve-like stomach. The transected duodenum is then anastomosed to an ileal loop, with the anastomosis lying 200 cm proximal to the ileocecal junction.⁵

In 2014, Lee et al.⁶ published results of 50 morbidly obese patients who underwent a similar procedure called single-anastomosis duodenal–jejunal bypass with sleeve gastrectomy (SADJB-SG). They referred to it also as a short or mini duodenal switch. It entails a duodenojejunal rather than the duodenoileal bypass performed by Sánchez-Pernaute et al.

In the same year, Mui et al. published 1-year follow-up results of a case report for a novel technique, involving a loop gastroileostomy, with the anastomosis constructed at 250 cm from the ileocecal junction. They claim that tailoring...