Prospective Randomized Comparison between Sleeve Gastrectomy with Side-to-Side Jejunoileal Anastomosis and Sleeve Gastrectomy in the Treatment of Morbid Obesity

Aim: The aim of the present research is to compare between sleeve gastrectomy with sideto-side jejunoileal anastomosis and sleeve gastrectomy in the treatment of morbid obesity in a prospective randomized manner. Patiens and methods: This study was performed in General Surgery Department, Tanta University Hospitals, Egypt on 32 patients with morbid obesity. Patients were randomly categorized into 2 groups through a computer randomization program. Group J included 17 patients operated by sleeve gastrectomy plus a side-to- side jejunoileostomy. This group was compared to 15 patients undergoing conventional sleeve gastrectomy (Group S). The mean length of follow up was 22.4 ± 5.68 months in Group J patients and 21.1 ± 5.05 months in Group S patients. Results: For group J, mean operative time was 111.0 ± 16.9 versus 79.0 ± 18.9 minutes for group S (p less than 0.0001). Mean hospitalization time was 5.35 ± 1.50 versus 3.73 ± 0.884 days (p: 0.0010).Time to return to normal activity was 19.6± 3.47 and 18.1 ± 3.28 days (p 0.21). There was no mortality. For Group J, 3 patients (17.65%) had superficial wound infection,2 patients (11.76%) developed postoperative atelectasis, 2 patients (11.76%) developed gallbladder stones and1 patient (5.88 %) developed incisional hernia. Reversing the anastomosis was not necessary in any patient. For Group S, splenic injury occurred in 1 patient (6.67%), 2 patients (13.33%) had superficial wound infection,1 patient (6.67%) had deep wound infection with partial disruption, 2 patients (13.33%) developed postoperative atelectasis,1 patient (6.67%) developed gallbladder stones and1 patient (6.67%) developed depression 6 months after surgery. Six months after operation, the mean BMI decreased by 23.35% and 12.89% (p: 0.058). Twelve months after operation, the mean BMI decreased by 29.19% and 18.68% (p: 0.039). Two years after operation, the mean BMI decreased by 32.74% and 17.63% (p: 0.026). Mean duodenum to cecum transit time was 17.6 ± 7.52 versus 43.7 ± 20.6 minutes (p less than 0.0001). Seven patients with preoperative diabetes in Group J had normal fasting glucose in the first 3 postoperative months. Five (83.33%) out 6 diabetic patients in Group S discontinued all diabetic medication within the first 9 postoperative months. Four (80%) out of 5 patients in group J with preoperative hypertension showed complete disease resolution within the first 6 postoperative months, compared to 3 (60%) out of 5 patients in the group S over the same period of time. All of 9 patients (100%) in Group J with preoperative dyslipidemia had normal lipid profiles within the first 6 postoperative months. Only 3 out of 7 (42.86 %) patients from group S had normal lipid profiles within the first 6 postoperative months and 5 out of 7 (71.43 %) at one year. Seven of the 8 patients in Group J with sleep apnea (87.5 %) and 7 out of 9 patients in Group S (77.78 %) showed complete improvement 1 year after surgery. The rest showed partial improvement. All of the patients were satisfied with the results of the procedure. The mean patient satisfaction score was 9.12 ±0.781 versus 8.80 ±0.775 (p: 0.26). Conclusions: The original design of sleeve gastrectomy with side-to-side jejunoileal anastomosis aims at adaptive and neuroendocrine goals as well as at restriction and malabsorption. Absence of prostheses or excluded segments, and easy feasibility associated with a metabolic corrective intervention in the context of adverse dietetic environments bring benefits to patients. Sleeve gastrectomy with side-to-side jejunoileal anastomosis may be a better procedure for the treatment of morbid obesity and an attractive alternative for the treatment of mildly obese patients with metabolic syndrome.