Sleeve gastrectomy with duodenoileal bipartition using linear magnets: feasibility and safety at 1-year follow-up

J Gastrointest Surg. 2024 May;28(5):640-650. doi: 10.1016/j.gassur.2024.02.001. Epub 2024 Feb 9.

Abstract

Background: Single-anastomosis metabolic/bariatric surgery procedures may lessen the incidence of anastomotic complications. This study aimed to evaluate the feasibility and safety of performing side-to-side duodenoileal (DI) bipartition using magnetic compression anastomosis (MCA). In addition, preliminary efficacy, quality of life (QoL), and distribution of food through the DI bipartition were evaluated.

Methods: Patients with a body mass index (BMI) of ≥35.0 to 50.0 kg/m2 underwent side-to-side DI bipartition with the magnet anastomosis system (MS) with sleeve gastrectomy (SG). By endoscopic positioning, a distal magnet (250 cm proximal to the ileocecal valve) and a proximal magnet (first part of the duodenum) were aligned with laparoscopic assistance to inaugurate MCA. An isotopic study assessed transit through the bipartition.

Results: Between March 14, 2022 to June 1, 2022, 10 patients (BMI of 44.2 ± 1.3 kg/m2) underwent side-to-side MS DI. In 9 of 10 patients, an SG was performed concurrently. The median operative time was 161.0 minutes (IQR, 108.0-236.0), and the median hospital stay was 3 days (IQR, 2-40). Paired magnets were expelled at a median of 43 days (IQR, 21-87). There was no device-related serious advanced event within 1 year. All anastomoses were patent with satisfactory diameters after magnet expulsion and at 1 year. Respective BMI, BMI reduction, and total weight loss were 28.9 ± 1.8 kg/m2, 15.2 ± 1.8 kg/m2, and 34.2% ± 4.1%, respectively. Of note, 70.0% of patients reported that they were very satisfied. The isotopic study found a median of 19.0% of the meal transited through the ileal loop.

Conclusion: Side-to-side MCA DI bipartition with SG in adults with class II to III obesity was feasible, safe, and efficient with good QoL at 1-year follow-up. Moreover, 19% of ingested food passed directly into the ileum.

Keywords: Duodenoileal; Isotopic study of bipartition; Linear magnets; Magnetic compression anastomosis; Metabolic/bariatric surgery.

MeSH terms

  • Adult
  • Anastomosis, Surgical* / methods
  • Bariatric Surgery / methods
  • Body Mass Index
  • Duodenum* / surgery
  • Feasibility Studies*
  • Female
  • Follow-Up Studies
  • Gastrectomy* / methods
  • Gastrointestinal Transit
  • Humans
  • Ileum / surgery
  • Laparoscopy / methods
  • Magnets*
  • Male
  • Middle Aged
  • Obesity, Morbid / surgery
  • Operative Time
  • Quality of Life
  • Treatment Outcome