Digestive adaptation: A new surgical proposal to treat obesity based on physiology and evolution

• Main Authors: Sérgio Santoro, Manoel Carlos Prieto Velhote, Carlos Eduardo Malzoni, Alexandre Sérgio Gracia Mechenas, Victor Strassmann, Morton Scheinberg
• Format: Article
• Language: English
• Published: Instituto Israelita de Ensino e Pesquisa Albert Einstein 2003-06-01
• Series: Einstein (São Paulo)
• Subjects: Obesity; morbid/surgery; Plasminogen activator inhibitor 1; Omentum/physiology; Adipose tissue/physiopathology; Gastrectomy/methods; Peptide hormones; Citokines/physiology
• Online Access: http://www.einstein.br/biblioteca/artigos/digestive%20adaptation%20original.pdf

Objective: To report on a new surgical technique to treat obesity -Digestive Adaptation - and to present its preliminary results.Method: The technique includes a vertical (sleeve) gastrectomy,omentectomy and enterectomy maintaining the initial 150-cmportionof the jejunum and the final 150-cm-portion of the ileum.The three first obese patients operated on are described. Results:With a minimum follow-up of 6 months, all patients refer earlysatiety, are free of symptoms and have a BMI <31 Kg/m2.Conclusions: This procedure does not use prostheses and doesnot cause exclusion of gastrointestinal segments. It does notcreate subocclusions neither malabsorption nor blind endoscopicareas and above all, it causes no harm to important digestivefunctions. Conversely, it aims at moderate restriction with earlysatiety by distension, and at interfering in the neuroendocrineprofile, resulting in slow gastric emptying, early and prolongedsatiety, as well as positive changes in the metabolic profile. Basedon recent physiological data, the procedure aims at decreasingthe production of ghrelin, plasminogen activator inhibitor-1 (PAI-1)and resistin, and at raising the levels of glucagon-like peptide-1(GLP-1). The patients operated on do not need nutritional supportor to take drugs because of the procedure, which is easy and safeto perform.