Sleeve Gastroctomy With Loop Gastroileal Bypass(SG LGIB)

SG-LGIB
Technically it is similar to Single anastomosis duodenoileal bypass with sleeve (SADI S). Difference being duodenum is not disconnected and anastomosis is gastroileal instead of duodenoileal. Gastric sleeve is formed using staplers. Distal ileum (last part of small intestine) is anastomosed to pyloric antrum of gastric sleeve in a loop fashion 250 – 350 cm proximal to ileocecal junction (loop gastroileal anastomosis). 
Weight loss after SG LGIB surgery is mainly because of hormonal and genetic changes. Role of food restriction or malabsorption is secondary. After this operation Ghrelin hormone levels come down as fundus of the stomach is removed. GLP 1, Peptide YY hormone levels increase as food rapidly enters from 1st part of duodenum into distal ileum. There will be more than 200 hormone changes after surgery. Removal of body of stomach alters several genes involved in energy balance. These hormonal and genetic changes reduce appetite, increase energy expenditure and reset the ‘fat mass’ to a lower level, resulting in long lasting and effective weight loss. Same hormonal changes are responsible for long lasting type 2 diabetes remission. Ghrelin acts against insulin. As levels of Ghrelin hormone come down, insulin resistance comes down. GLP 1 increases insulin production and sensitivity. Since GLP 1 hormone is increased, insulin production increases and insulin resistance comes down. Partial diversion of biliopancreatic juices also contributes to the metabolic effects of this surgery.
Hormonal and genetic changes responsible for long lasting weight loss and durable diabetes remission are very high in SG LGIB (SASI Bypass) compared to Sleeve gastrectomy (SG), Roux en y gastric bypass (RYGB), Mini gastric bypass – One anastomosis gastric bypass (MGB – OAGB) and Sleeve gastrectomy with loop duodenojejunal bypass (SG LDJB) because bypassed bowel is relatively longer compared to these procedures. So weight loss is more effective & long lasting and diabetes remission is more & durable. Chances of weight regain and diabetes recurrence are very low. Effect of SG LGIB is comparable to that of SADI S and Biliopancreatic diversion with duodenal switch (BPD DS). It has several advantages compared to RYGB and MGB – OAGB. There is no ‘at risk’ stomach remnant, calcium and iron deficiency risk is low since some food enters duodenum and jejunum, risk of dumping syndrome is less because of increased gastric inhibitory peptide (GIP) compensating for hypoglycemia, risk of marginal ulcers and internal hernias is low. It is technically very simple surgery. Access to biliary tract is maintained.

Compared to BPD DS, risk of protein energy malnutrition, malabsorption and vitamin & mineral deficiencies is low because, it is partial bypass and part of the food enters natural duodenojejunal pathway leading to sufficient absorption of essential nutrients, vitamins and minerals.

Disadvantage of this surgery is risk of reflux of ileal contents into gastric sleeve. Long term consequences of this reflux is not known. Protein energy malnutrition, malabsorption, foul smelling oily stools, diarrhea and incontinence are high if common channel length is 250 cm or less. These problems are significantly reduced but efficacy remains same when common channel is increased to 300 – 350 cm.

 

LAPAROSCOPIC SLEEVE GASTRECTOMY WITH LOOP GASTROILEAL BYPASS

(Laparoscopic SG LGIB)  

(DRAWN BY Dr. V. AMAR)

 

SURGERY VIDEO :

PLEASE WATCH LAPAROSCOPIC SLEEVE GASTRECTOMY WITH LOOP GASTROILEAL BYPASS – SLEEVE GASTRECTOMY WITH LOOP BIPARTITION BY Dr. AMAR (SG LGIB, HD 1080P, AUDIO)

https://youtu.be/lw2245oWU9k

 

PLEASE WATCH LAPAROSCOPIC SLEEVE GASTRECTOMY WITH LOOP GASTROILEAL BYPASS – SINGLE ANASTOMOSIS SLEEVE ILEAL BYPASS BY Dr. AMAR (SG LGIB, HD 1080P, AUDIO)

https://youtu.be/I0YNQInWaYA 

 

CLICK HERE TO CONSULT BEST DIABETES SURGEON IN INDIA

 

PUBLICATION 

https://internationalsurgery.org/doi/pdf/10.9738/INTSURG-D-18-00007.1

Call Now ButtonCall Now