Brief Article
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Dec 7, 2011; 17(45): 5021-5027
Published online Dec 7, 2011. doi: 10.3748/wjg.v17.i45.5021
Key details of the duodenal-jejunal bypass in type 2 diabetes mellitus rats
Li-Ou Han, Li-Hong Zhou, Su-Jun Cheng, Chun Song, Chun-Fang Song
Li-Ou Han, Chun Song, Chun-Fang Song, Department of General Surgery, Harbin Medical University First Affiliated Hospital, Harbin 150001, Heilongjiang Province, China
Li-Hong Zhou, Su-Jun Cheng, Department of Endocrinology, Harbin Medical University First Affiliated Hospital, Harbin 150001, Heilongjiang Province, China
Author contributions: Song CF and Song C designed the research and contributed equally to this work; Han LO, Zhou LH and Cheng SJ performed the research; Han LO and Zhou LH analyzed the data and wrote the paper.
Supported by Scientific Research Fund of Heilongjiang Provincial Education Department, No. 11541200; and Harbin Medical University First Affiliated Hospital, No. 2007098
Correspondence to: Dr. Chun-fang Song, Department of General Surgery, Harbin Medical University First Affiliated Hospital, 23 Youzheng St, Harbin 150001, Heilongjiang Province, China. songchunfang3210@126.com
Telephone: +86-451-85555735 Fax: +86-451-85555735
Received: January 12, 2011
Revised: April 26, 2011
Accepted: May 3, 2011
Published online: December 7, 2011
Abstract

AIM: To investigate which surgical techniques and perioperative regimens yielded the best survival rates for diabetic rats undergoing gastric bypass.

METHODS: We performed Roux-en-Y gastric bypass with reserved gastric volume, a procedure in which gastrointestinal continuity was reestablished while excluding the entire duodenum and proximal jejunal loop. We observed the procedural success rate, long-term survival, and histopathological sequelae associated with a number of technical modifications. These included: use of anatomical markers to precisely identify Treitz’s ligament; careful dissection along surgical planes; careful attention to the choice of regional transection sites; reconstruction using full-thickness anastomoses; use of a minimally invasive procedure with prohemostatic pretreatment and hemorrhage control; prevention of hypothermic damage; reduction in the length of the procedure; and accelerated surgical recovery using fast-track surgical modalities such as perioperative permissive underfeeding and goal-directed volume therapy.

RESULTS: The series of modifications we adopted reduced operation time from 110.02 ± 12.34 min to 78.39 ± 7.26 min (P < 0.01), and the procedural success rate increased from 43.3% (13/30) to 90% (18/20) (P < 0.01), with a long-term survival of 83.3% (15/18) (P < 0.01).

CONCLUSION: Using a number of fast-track and damage control surgical techniques, we have successfully established a stable model of gastric bypass in diabetic rats.

Keywords: Duodenal-jejunal bypass; Type 2 diabetes mellitus; Minimally invasive surgery; Fast-track surgery; Damage control surgery; Permissive underfeeding; Goal-directed volume therapy