{"title":"Gastro-Jejunal Ileal Interposition with Bipartition: A Salvage Procedure for Severe Protein-Energy Malnutrition After Transit Bipartition.","authors":"Tugrul Demirel, Ulku Korkmaz, Surendra Ugale","doi":"10.1007/s11695-025-07825-5","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Intractable diarrhea or excess weight loss associated with protein-energy malnutrition (PEM) can occur after Transit Bipartition (TB). This study evaluates the effect of transposing the alimentary limb to the proximal intestines.</p><p><strong>Methods: </strong>Between 2017 and 2024, ten patients with malnutrition and diarrhea underwent Gastro-Jejunal Ileal Interposition (GJIB) surgery after TB. We prospectively monitored protein-energy malnutrition postoperatively and retrospectively analyzed demographic data, laboratory findings, and anthropometric measurements. Gastric transit scintigraphy was performed on symptomatic and asymptomatic patients to evaluate gastric evacuation diversity between the pylorus and the gastro-ileostomy.</p><p><strong>Results: </strong>Ten patients (male/female, 6/4) were operated on. The preoperative mean age was 49.4 ± 9.19 years. The mean body mass index (BMI) was 22.19 ± 1.13 kg/m<sup>2</sup>, the mean excess BMI loss (%EBMIL) percentage was 123.26 ± 14.85%, and the total weight loss percentage (%TWL) was 42.35 ± 0.33. Eighty percent of food passed through the gastroileostomy in all patients. The mean follow-up period was 50.56 ± 57.28 months. Postoperatively, the mean BMI increased to 28.16 ± 2.2 kg/m<sup>2</sup> (p = 0.001), %EBMIL decreased to 79.88 ± 21.53% (p = 0.001), and %TWL decreased to 27.31 ± 10.1. Albumin levels rose from a median of 2.1 mg/dl to an average of 3.8 ± 0.78 mg/dl (p = 0.001), and stool frequency decreased from 11.56 ± 0.71 to 2.1 ± 2.12 per day (p = 0.001). The excluded bowel length percentage (Exl.B%) decreased significantly from 72.4 ± 3.18% to 12.3 ± 1.99% after conversion (p = 0.005). All patients were diabetic before and had remission after TB. Glycemic control was preserved after the conversion, with a median HbA1c of 5.4% compared to 5.8% before conversion.</p><p><strong>Conclusions: </strong>GJIB may be a viable revision procedure for resolving PEM and related complications without compromising the metabolic benefits of the initial surgery on diabetes resolution by decreasing the Exl.B%.</p>","PeriodicalId":19460,"journal":{"name":"Obesity Surgery","volume":" ","pages":""},"PeriodicalIF":2.9000,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Obesity Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11695-025-07825-5","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Intractable diarrhea or excess weight loss associated with protein-energy malnutrition (PEM) can occur after Transit Bipartition (TB). This study evaluates the effect of transposing the alimentary limb to the proximal intestines.
Methods: Between 2017 and 2024, ten patients with malnutrition and diarrhea underwent Gastro-Jejunal Ileal Interposition (GJIB) surgery after TB. We prospectively monitored protein-energy malnutrition postoperatively and retrospectively analyzed demographic data, laboratory findings, and anthropometric measurements. Gastric transit scintigraphy was performed on symptomatic and asymptomatic patients to evaluate gastric evacuation diversity between the pylorus and the gastro-ileostomy.
Results: Ten patients (male/female, 6/4) were operated on. The preoperative mean age was 49.4 ± 9.19 years. The mean body mass index (BMI) was 22.19 ± 1.13 kg/m2, the mean excess BMI loss (%EBMIL) percentage was 123.26 ± 14.85%, and the total weight loss percentage (%TWL) was 42.35 ± 0.33. Eighty percent of food passed through the gastroileostomy in all patients. The mean follow-up period was 50.56 ± 57.28 months. Postoperatively, the mean BMI increased to 28.16 ± 2.2 kg/m2 (p = 0.001), %EBMIL decreased to 79.88 ± 21.53% (p = 0.001), and %TWL decreased to 27.31 ± 10.1. Albumin levels rose from a median of 2.1 mg/dl to an average of 3.8 ± 0.78 mg/dl (p = 0.001), and stool frequency decreased from 11.56 ± 0.71 to 2.1 ± 2.12 per day (p = 0.001). The excluded bowel length percentage (Exl.B%) decreased significantly from 72.4 ± 3.18% to 12.3 ± 1.99% after conversion (p = 0.005). All patients were diabetic before and had remission after TB. Glycemic control was preserved after the conversion, with a median HbA1c of 5.4% compared to 5.8% before conversion.
Conclusions: GJIB may be a viable revision procedure for resolving PEM and related complications without compromising the metabolic benefits of the initial surgery on diabetes resolution by decreasing the Exl.B%.
期刊介绍：
Obesity Surgery is the official journal of the International Federation for the Surgery of Obesity and metabolic disorders (IFSO). A journal for bariatric/metabolic surgeons, Obesity Surgery provides an international, interdisciplinary forum for communicating the latest research, surgical and laparoscopic techniques, for treatment of massive obesity and metabolic disorders. Topics covered include original research, clinical reports, current status, guidelines, historical notes, invited commentaries, letters to the editor, medicolegal issues, meeting abstracts, modern surgery/technical innovations, new concepts, reviews, scholarly presentations and opinions.
Obesity Surgery benefits surgeons performing obesity/metabolic surgery, general surgeons and surgical residents, endoscopists, anesthetists, support staff, nurses, dietitians, psychiatrists, psychologists, plastic surgeons, internists including endocrinologists and diabetologists, nutritional scientists, and those dealing with eating disorders.
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