TITLE:
Hybrid Duodenal Transit Bipartition: An Endoscopic and Laparoscopic Metabolic Procedure
AUTHORS:
Paulo Reis Rizzo Esselin de Melo, Anna Carolina Hoff, Ricardo Zorron, Victor Ramos Mussa Dib, Carlos Augusto Scussel Madalosso, Rui Ribeiro, Thonya Cruz Braga, Fernando Reis Esselin Melo, Paula Volpe, Carlos Eduardo Domene, Antonio Torres
KEYWORDS:
Duodenal Switch, Duodenal Transit Bipartition, Bariatric Surgery, Metabolic Surgery, Endoscopic Gastroplasty, Endobariatric, Hybrid Duodenal Transit Bipartition, Duodenal Bipartition, Hybrid Surgery
JOURNAL NAME:
Surgical Science,
Vol.15 No.10,
October
31,
2024
ABSTRACT: Obesity has been increasing significantly in Brazil and worldwide, becoming a major public health issue. Traditional prevention and treatment strategies, including behavioral interventions, nutritional modifications, physical activity, pharmacotherapy, and metabolic/bariatric procedures, have proven insufficient to reverse this trend. Bariatric surgery is recognized as the most effective treatment for obesity and its comorbidities, but it carries potential long-term risks. Hybrid Duodenal Transit Bipartition is proposed as a minimally invasive “endobariatric” procedure combining endoscopic sleeve gastroplasty (ESG) with laparoscopic duodenoileal or distal duodenojejunal anastomosis. The main objective of this study is to demonstrate the importance of the intestinal metabolic component of hybrid duodenal transit bipartition. This intestinal component is responsible for optimizing and attempting to maintain weight loss and control comorbidities from an ESG through the incretin stimulus generated by the early arrival of food in the ileum or distal jejunum (duodenoileal or distal duodenojejunal anastomosis). Additionally, it is a minimally invasive procedure that preserves the entire digestive system and does not involve gastrointestinal exclusion, allowing for endoscopic and nutritional access. To date, only one patient has undergone the hybrid duodenal bipartition procedure, with satisfactory early postoperative results at 60 days and weight loss exceeding the scientific literature on patients who underwent isolated endoscopic sleeve gastroplasty. Further studies are needed to validate these results and assess the long-term metabolic benefits of this new approach.