A New Paradigm in Metabolic Surgery: Jejunal Bipartition

Area of Science:

• Bariatric surgery
• Metabolic surgery
• Gastrointestinal surgery

Background:

• Laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB) are common bariatric procedures.
• LSG is linked to weight regain, and RYGB carries risks of micronutrient deficiencies.
• Interest exists in procedures preserving duodenal continuity for metabolic benefits.

Purpose of the Study:

• To introduce and evaluate jejunal bipartition associated with sleeve gastrectomy (JB + SG).
• To maintain duodenal continuity while incorporating a controlled hypoabsorptive component.
• To offer an alternative with improved metabolic and nutritional outcomes.

Main Methods:

• A novel technique, jejunal bipartition with sleeve gastrectomy (JB + SG), was developed.
• The ileum is divided based on BMI, creating two jejuno-ileal anastomoses.
• This ensures full intestinal continuity and individualized malabsorption.

Main Results:

• JB + SG preserves duodenal transit, aiding nutrient absorption (iron, calcium, vitamins).
• It enhances incretin release, potentially improving metabolic outcomes.
• JB + SG reduces risks associated with RYGB, such as ulcers and deficiencies.

Conclusions:

• Jejunal bipartition is a promising physiological alternative in bariatric surgery.
• It offers enhanced metabolic benefits and improved nutritional safety.
• Further long-term, multicenter studies are needed to confirm efficacy and safety.