Sleeve Gastrectomy with Ileal Transposition (SGIT) Induces a Significant Weight Loss and Diabetes Improvement Without Exclusion of the Proximal Intestine

Current effective bariatric procedures such as gastric bypass generate a duodenal-jejunal exclusion, which has been implicated in the resolution of type 2 diabetes. The aim of this study was to test the hypothesis that sleeve gastrectomy with ileal transposition (SGIT), a new procedure, is as effective as Roux-en-Y gastric bypass (RYGB) to induce glucose control on an obese rat model of type 2 diabetes mellitus. Twenty eight obese diabetic Zucker rats, weighing 571 +/- 151 g were assigned into three procedures: SGIT (n = 11), RYGB (n = 7), and sham operation (n = 10). Animals were followed, evaluating weekly weight increase and food intake. We performed an insulin tolerance test after 8 weeks and measured serum peptide tyrosine-tyrosine (PYY 3-36) and ghrelin levels. Nine weeks after surgery, sham-operated animals increased their body weight by 24%. In far contrast, SGIT and RYGB rats weighed 21% and 18% less than sham animals, respectively (sham, 884 +/- 15 g; SGIT, 720 +/- 19 g; RYGB, 754 +/- 14 g; p < 0.001). No significant differences were found between SGIT and RYGB. Cumulative food intake in SGIT and RYGB procedures decreased by 29.6% and 32.9%, respectively (sham, 576.3 +/- 33 g; SGIT, 405.8 +/- 10 g; RYGB, 386.4 +/- 21 g; p < 0.001). No differences were found between SGIT and RYGB rats. Sixty minutes after oral gavage, PYY levels were increased by 185% and 74% in SGIT and RYGB, respectively (sham, 63.4 +/- 2.1 pg/ml; SGIT, 192.7 +/- 17 pg/ml; RYGB, 117.7 +/- 4.8 pg/ml; p < 0.001). Glucose tolerance was improved after SGIT and RYGB surgery demonstrated by area under the curve analysis (sham, 27,090 +/- 1,424; SGIT, 17,704 +/- 1,288 mg/dl; p < 0.018; RYGB, 16,212 +/- 2,522; p < 0.01). SGIT proved to be as effective as RYGB on obese diabetic rats as a weight loss procedure. Also, glucose homeostasis improved in SGIT, similar to RYGB, in spite of the absence of duodenal-jejunal exclusion. This observation does not support the theory that RYGB reversal of diabetes is due to duodenal-jejunal exclusion.