Laparoscopic sleeve gastrectomy with duodenojejunal bypass: technique and preliminary results

Background: Obesity and metabolic disorders related to it have become a serious problem in Asia. Furthermore, gastric cancer in Asia is one of the frequent diseases on which to perform treatments. We introduced the technique of laparoscopic sleeve gastrectomy with duodenojejunal bypass (LSG/DJB) for patients with a risk of gastric cancer and compared the results of our initial series with those of other procedures. Methods: Twenty-one patients underwent a LSG/DJB from April 2007 to November 2008. The mean preoperative weight and body mass index (BMI) were 108.0 kg and 41.0 kg/m², respectively. High risks of gastric cancer were determined as having a Helicobacter pylori positive with atrophic change of mucosa or a family history of gastric cancer. Operations were performed with five ports. Initially, SG and dissection of posterior wall of duodenum were carried out. Subsequently, DJB was added with 50-100 cm of biliopancreatic tract and 150-200 cm of alimentally tract. DJB consisted of a jejunojejunostomy created by a linear stapler and hand sewing closure and duodenojujunostomy by hand sewing with two layers. Results: A LSG/DJB was performed successfully in all patients. The mean operation time was 217∈±∈38 min. The weight loss and percent excess BMI loss for LSG/DJB were similar to those for laparoscopic Roux-en-Y gastric bypasses. There was no mortality; however, one patient had leakage from a staple line of esophagogastric junction and reqiured drainage and stenting. No dumping, stenosis, marginal ulcer, or nutritional problems were observed during postoperative follow-up. All of the main comorbidities improved after this procedure. Conclusion: LSG/DJB is a feasible, safe, and effective procedure for the treatment of morbidly obese patients with the risk of gastric cancer.