Obesity surgery · 2025
Gastric Bypass Via Natural Orifice Trans-Luminal Endoscopic Surgical (NOTES) Approach: A Surviving Porcine Study.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Lim Chin Hong, Chong Wei Min, Chee Samantha Su Hui, Lye Tiffany Jian Ying, Lee Zhen Jin, Yeung Baldwin Po Man, Lin Jin Lin, Ong Lester Wei Lin, Eng Alvin Kim Hock, Lim Eugene Kee Wee, Chan Weng Hoong, Tan Jeremy Tian Hui
Аннотация
BACKGROUND: Bariatric surgery has transformed metabolic outcomes for individuals with type 2 diabetes mellitus (DM) and obesity. While traditional Roux-en-Y gastric bypass (RYGB) shows significant efficacy, only 1% of eligible North Americans undergo this surgery, largely due to associated morbidity and mortality. Endoscopic bariatric therapies (EBT), offering incisionless options, have emerged but demonstrate limited long-term efficacy. This study introduces the Natural Orifice Transluminal Endoscopic Gastric Bypass (NOTES-GB) as a potential advancement in bariatric treatments.
METHODS: Nine adolescent male pigs were acclimated and fed a customized obesogenic diet for 3 months to induce obesity. The NOTES-GB procedure was performed under general anesthesia, utilizing an endoscopic approach to create a gastrojejunal anastomosis and pyloric exclusion.
RESULTS: All procedures were technically successful, with a mean operation time of 215.4 min. Complications included one case of stent migration and one sudden death due to ischemic bowel. A staged approach combining single anastomosis sleeve jejunal (SASJ) followed by conversion to one-anastomosis gastric bypass (OAGB) minimized the risk of severe malnutrition. Our findings suggest that NOTES-SASJ followed by OAGB may effectively replicate the metabolic benefits of traditional bypass surgery while ensuring animal safety as a staged procedure. This novel approach could potentially enhance patient acceptance of bariatric procedures.
CONCLUSIONS: The staged NOTES-GB technique demonstrates promise in managing DM and obesity, warranting further investigation in clinical settings. Future studies will assess its efficacy in human trials, aiming to revolutionize minimally invasive bariatric surgery.
METHODS: Nine adolescent male pigs were acclimated and fed a customized obesogenic diet for 3 months to induce obesity. The NOTES-GB procedure was performed under general anesthesia, utilizing an endoscopic approach to create a gastrojejunal anastomosis and pyloric exclusion.
RESULTS: All procedures were technically successful, with a mean operation time of 215.4 min. Complications included one case of stent migration and one sudden death due to ischemic bowel. A staged approach combining single anastomosis sleeve jejunal (SASJ) followed by conversion to one-anastomosis gastric bypass (OAGB) minimized the risk of severe malnutrition. Our findings suggest that NOTES-SASJ followed by OAGB may effectively replicate the metabolic benefits of traditional bypass surgery while ensuring animal safety as a staged procedure. This novel approach could potentially enhance patient acceptance of bariatric procedures.
CONCLUSIONS: The staged NOTES-GB technique demonstrates promise in managing DM and obesity, warranting further investigation in clinical settings. Future studies will assess its efficacy in human trials, aiming to revolutionize minimally invasive bariatric surgery.