technically simpler to perform than the short-limb GB. A question that remains is the incidence
of bypass enteritis and subsequent liver failure
after these operations.
The DJB is strictly a metabolic operation to control
T2DM. It entails a transection of the duodenum
beyond the pylorus with a duodeno-jejunostomy
100–200 cm from the ligament of Treitz (see
Figure 14, page 44). Minimal weight loss is associated with this operation. The procedure is based
on the foregut hypothesis of control of T2DM by
bypassing the duodenojejunal axis. Rubino demonstrated the effectiveness of this procedure in
controlling T2DM in rats, and Cohen reported use
of the operation in humans with T2DM who are
not obese. 33, 34 It is a common operation in the Asia-Pacific region, where T2DM is relatively common.
In Brazil, surgeons have demonstrated that if the
procedure is not combined with an SG, the metabolic results are insufficient. Hence, many surgeons
no longer perform this operation.
II and II-SG
Ileal interposition (II) was described initially as a
metabolic operation for T2DM because stimulation
of the ileum by ingested foods results in release of
glucagon-like peptide 1 (GLP- 1), which enhances
insulin sensitivity and control of T2DM. The original concept was proposed by Mason. 35 Gagner and
his colleagues performed original animal research
with this operation and published outcomes of the
first patients. 36-38 De Paula popularized II operations
for treatment of T2DM or for T2DM treatment in
morbidly obese patients by adding the SG to the II
(see Figure 15A–B, page 44). 39-41 The reported outcomes for treatment of T2DM are similar to those
reported with the standard GBP; however, the operations are technically demanding and entail multiple
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