A novel weight-reducing operation: Lateral subtotal gastrectomy with silastic ring plus small bowel reduction with omentectomy

Background "The ideal bariatric operation should preserve normal gastroduodenal continuity, reduce food intake, and allow the addition of intestinal short-circuiting that would stimulate GLP-1 secretion" (Mason, Surg Obes Rel Dis, 1:123-125, 2005). Methods 246 obese patients underwent a subtotal lateral gastric resection with silastic gastric ring placement, plus a moderate mid-small-bowel resection with omentectomy. This configuration preserves the pylorus, duodenum, 50-200 cm of jejunum, and 200-300 cm of ileum. The residual gastric pouch is 5-10 times larger than that in a standard Roux-en-Y gastric bypass (RYGB), and the length of small bowel in digestive continuity is 4-8 times greater than that in current diversionary malabsorptive procedures. Results Weight loss and amelioration of comorbidities were similar to results following conventional RYGB. An average of 36% total body weight loss, with BMI decrease of 17 kg/m(2), was observed at 1.5 years and was largely maintained at 3 years, without eating problems or evidence of malabsorption. The rate of mortality was 0.8%, major morbidity 7.7%, and minor morbidity 4.1%-all of which are comparable to RYGB. Conclusion This procedure, which is technically less demanding than RYGB, preserves all or part of every segment of the gastrointestinal tract, including absorptive sites for iron and trace minerals. Despite substantially less gastric restriction than in RYGB, and less compromise of absorptive bowel than in biliopancreatic diversion, weight loss profiles are similar to those observed after these conventional bariatric operations. Favorable changes in gut hormones, including augmentation of ileal-brake peptides and reduction of ghrelin, may play a dominant role in affecting major, long-lasting weight loss.