Gastric Bipartition with Functional Duodenum Exclusion (GBp-FDE) as a Possible Surgical Conversion of Sleeve Gastrectomy in Patients with De Novo GERD and Obesity Recidivism: Preliminary Results of a Case Series.
| Title: | Gastric Bipartition with Functional Duodenum Exclusion (GBp-FDE) as a Possible Surgical Conversion of Sleeve Gastrectomy in Patients with De Novo GERD and Obesity Recidivism: Preliminary Results of a Case Series. |
|---|---|
| Authors: | Dib VRM; Victor Dib Institute, Manaus, AM, Brazil.; Madalosso CAS; Gastrobese Clinic, Passo Fundo, RS, Brazil.; De Melo PRRE; Paulo Reis Institute, Goiânia, GO, Brazil.; Alfredo Nasser University Center (UNIFAN), Goiânia, GO, Brazil.; Metabolic Surgery Service, Dr. Alberto Rassi State Hospital, Goiânia, GO, Brazil.; Ramos AC; Gastro Obeso Center, São Paulo, SP, Brazil.; D'Almeida LAV; Department of Bariatric and Metabolic Surgery, Pro-Cardiac Hospital, Rio de Janeiro, RJ, Brazil.; Antozzi L; Center for Special Surgery, Bahia Blanca, Argentina.; Balibrea Del Castillo JM; Endocrine, Metabolic and Bariatric Surgery Unit, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.; Noel P; Bariatric Department, Private Hospital Bouchard, Marseille, France.; Bariatric Department, PHI Medcare Hospital, Lusail, Doha, Qatar.; Galvão Neto MP; Weight Loss and Bariatric Surgery Institute, Orlando Health, Orlando, FL, USA.; Chiappetta S; Department of General and Laparoscopic Surgery, Ospedale Evangelico Betania, Naples, Italy.; de Barros F; Department of General and Specialized Surgery, Faculty of Medicine, Fluminense Federal University, Niterói, RJ, Brazil.; Teixeira A; Weight Loss and Bariatric Surgery Institute, Orlando Health, Orlando, FL, USA.; Chaim EA; Department of Surgery, Faculty of Medical Sciences (FCM) , Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil.; Zorron R; Department of Bariatric and Metabolic Surgery, CUF Descobertas Hospital, Lisbon, Portugal.; de Godoy EP; Obesity and Related Diseases Surgery Service - Surgery Unit, Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal, RN, Brazil.; de Aquino CGG; Einstein Surgery Program, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.; Baretta GAP; Giorgio Baretta Institute, Curitiba, PR, Brazil.; Kfouri DS; Digestive System Surgery and Bariatric Surgery, Paraná Obesity Treatment Center (OBEPAR), Curitiba, PR, Brazil.; Okano Júnior H; Centro Clínico Advance, Gastrocare Clinic, Brasília, DF, Brazil.; Kawahara NT; Hospital das Clínicas, University of São Paulo Medical School, Santa Cruz do Sul, Brazil.; Tinoco ACA; Department of General Surgery, Hospital São José do Avaí, Itaperuna - RJ, Brazil.; Kruel NT; Dr. Nicholas Kruel Institute (Nkbariatrics), Florianópolis, Brazil.; Waltrick Junior JJ; Video Clinic of the Digestive System, Jaraguá do Sul, Brazil.; Frota Dillenburg C; Bariatric and Metabolic Surgery, Obese and Metabolic Patient Care Service (SAO), Novo Hamburgo, RS, Brazil.; Dos Santos FAI; Department of Surgery, Faculty of Medicine, Federal University of Pelotas (UFPEL), Pelotas, RS, Brazil.; Abaid RA; Department of Surgery, Abaid Institute, Santa Cruz do Sul, RS, Brazil.; Da Costa CEA; Victor Dib Institute, Manaus, AM, Brazil.; Scortegagna GT; Gastrobese Clinic, Passo Fundo, RS, Brazil.; Silva GF; Victor Dib Institute, Manaus, AM, Brazil.; Taskin HE; Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University Cerrahpasa, Istanbul, Turkey.; Nassar RM; Department of Surgery, Fundación Santa Fe de Bogota University Hospital, Bogotá, Colombia.; Layani LA; HOD Surgical Bariatric Department, Al Sharq Hospital, Fujairah, United Arab Emirates.; Caiña DO; Dr. Alberto Cormillot Municipal Center for Obesity and Metabolic Diseases, Buenos Aires, Argentina.; Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina.; Avalos MA; Bariatric and Advanced Laparoscopic Surgery, Hospital Puerta de Hierro Sur, Zapopan, Jalisco, Mexico.; Bravo Lópes J; Asis Surgery U. de Chile, Universidad de Chile, Santiago, Chile.; Sotelo JSV; Department of Surgery, Obesity Goodbye Center, Tijuana, Baja California, Mexico.; Vilallonga Puy R; Endocrine-Metabolic and Bariatric Surgery Unit, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.; Stier CK; Department of Surgery, Interdisciplinary Endoscopy, University Medicine Mannheim, Heidelberg University, Mannheim, Germany.; Domene CE; Integrated Center for Advanced Medicine (CIMAMED), São Paulo, SP, Brazil.; Volpe P; Integrated Center for Advanced Medicine (CIMAMED), São Paulo, SP, Brazil.; García Ruiz de Gordejuela A; Endocrine-Metabolic and Bariatric Surgery Unit, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.; Poggi L; Department of Surgery, Gastrointestinal and Bariatric Surgery, Clinica Anglo Americana, Lima, Peru.; Torres A; Department of Surgery, Hospital Clinico San Carlos, Universidad Complutense de Madrid, Madrid, Spain.; Carbajo MÁ; Department of Surgery, Center of Excellence for the Study and Treatment of Obesity and Diabetes, Valladolid, Spain.; Braghetto I; Department of Surgery, Hospital José J. Aguirre, University of Chile, Santiago, Chile.; Ribeiro R; Department of Surgery, Lusíadas Amadora Hospital, Amadora, Portugal.; Parmar C; Department of Surgery, Whittington Health NHS Trust, London, United Kingdom. |
| Source: | The American journal of case reports [Am J Case Rep] 2025 Nov 27; Vol. 26, pp. e950798. Date of Electronic Publication: 2025 Nov 27. |
| Publication Type: | Journal Article; Case Reports |
| Language: | English |
| Journal Info: | Publisher: International Scientific Information, Inc Country of Publication: United States NLM ID: 101489566 Publication Model: Electronic Cited Medium: Internet ISSN: 1941-5923 (Electronic) Linking ISSN: 19415923 NLM ISO Abbreviation: Am J Case Rep Subsets: MEDLINE |
| Imprint Name(s): | Publication: : Smithtown, NY : International Scientific Information, Inc.; Original Publication: Albertson, NY : International Scientific Literature, Inc. |
| MeSH Terms: | Duodenum*/surgery ; Gastrectomy*/methods ; Gastroesophageal Reflux*/surgery ; Gastroesophageal Reflux*/complications ; Obesity*/surgery ; Obesity, Morbid*/surgery ; Obesity, Morbid*/complications; Humans ; Recurrence ; Reoperation ; Retrospective Studies |
| Abstract: | BACKGROUND Sleeve gastrectomy (SG) is widely used in obesity treatment, although it is associated with new onset of gastroesophageal reflux disease (de novo GERD) and weight regain. Roux-en-Y gastric bypass (RYGB) is the standard revisional procedure for GERD, though it offers limited additional weight loss. Ileal-based procedures have demonstrated superior outcomes regarding weight loss but have uncertain results in GERD. This study presents preliminary findings on gastric bipartition with functional duodenal exclusion (GBp-FDE) as a revisional approach following SG in this scenario. CASE REPORT A retrospective data analysis was conducted on 10 patients who underwent GBp-FDE due to de novo GERD and obesity recurrence after SG (mean BMI: 37.2±3.2 kg/m²). Nine patients presented with hiatal hernia and 8 with sleeve dilation. GERD was assessed pre- and postoperatively using a validated questionnaire, endoscopy, and contrast radiology. The surgical technique involved a pre-pyloric antroileostomy in Roux-en-Y configuration using a 40% proportion biliopancreatic limb. One-year postoperative findings included pyloric spasm (endoscopy), very preferential contrast flow to the ileum (radiology), and endoscopic access preservation to the duodenum. GERD symptoms resolved in 90% (P=0.0059) and esophagitis healed in 80% (P=0.008), likely due to gastric decompression. Mean percent total weight loss and percent excess weight loss were 35.2±6.6 and 108.0±11.14, respectively. CONCLUSIONS GBp-FDE seems to be a promising surgery for managing de novo GERD and obesity recurrence after SG, through SG pouch decompression and ileal stimuli, promoted by the antroileostomy. Further controlled studies with extended follow-up are necessary to validate these findings. |
| References: | Surg Endosc. 2022 Sep;36(9):6868-6877. (PMID: 35041054); J Endocrinol. 2016 Oct;231(1):11-22. (PMID: 27474690); Surg Obes Relat Dis. 2019 Jan;15(1):43-49. (PMID: 30501957); Surg Obes Relat Dis. 2015 Jul-Aug;11(4):765-70. (PMID: 25813754); Obes Surg. 2019 Nov;29(11):3743-3748. (PMID: 31522331); Obes Surg. 2016 Mar;26(3):672-8. (PMID: 26446491); Obes Surg. 2021 Dec;31(12):5148-5155. (PMID: 34599728); Surg Clin North Am. 2021 Apr;101(2):335-353. (PMID: 33743973); Am J Physiol. 1980 Aug;239(2):G71-6. (PMID: 6996495); Arq Bras Cir Dig. 2013;26 Suppl 1:79-82. (PMID: 24463905); Obes Surg. 2019 Nov;29(11):3769-3770. (PMID: 31254211); Ann Surg. 2020 Feb;271(2):201-209. (PMID: 31425292); Gut. 2024 Jan 5;73(2):361-371. (PMID: 37734911); Surg Laparosc Endosc Percutan Tech. 2010 Jun;20(3):148-53. (PMID: 20551811); Obes Surg. 2019 Sep;29(9):3062-3070. (PMID: 31209832); Ann Surg. 2016 Nov;264(5):871-877. (PMID: 27429035); JAMA Surg. 2022 Aug 1;157(8):656-666. (PMID: 35731535); Obes Surg. 2021 Oct;31(10):4528-4541. (PMID: 34363144); Surg Laparosc Endosc Percutan Tech. 2017 Jun;27(3):e28-e30. (PMID: 28520653); Curr Obes Rep. 2020 Sep;9(3):348-363. (PMID: 32462537); Ann N Y Acad Sci. 2020 Dec;1482(1):26-35. (PMID: 32893342); Obes Surg. 2021 Apr;31(4):1722-1732. (PMID: 33393001); Chin Med J (Engl). 1980 Sep;93(9):629-36. (PMID: 6775897); J Gastrointest Surg. 2005 Jan;9(1):121-31. (PMID: 15623453); Surg Today. 2018 May;48(5):558-565. (PMID: 29450656); Gut. 1999 Aug;45(2):172-80. (PMID: 10403727); Ann Surg. 2012 Jul;256(1):104-10. (PMID: 22609843); Surg Obes Relat Dis. 2020 Aug;16(8):1060-1066. (PMID: 32473786); Obes Surg. 2013 Jul;23(7):987-91. (PMID: 23460263); Arq Bras Cir Dig. 2021 Jan 25;33(4):e1553. (PMID: 33503113); Sci Rep. 2022 Jun 18;12(1):10304. (PMID: 35717435); Obes Surg. 2008 Sep;18(9):1083-8. (PMID: 18535864); World J Gastroenterol. 2012 Jul 7;18(25):3260-6. (PMID: 22783050); Curr Issues Mol Biol. 2023 Apr 18;45(4):3552-3572. (PMID: 37185756); Obes Surg. 2020 Jan;30(1):3-10. (PMID: 31444776); Sci Rep. 2019 Apr 3;9(1):5582. (PMID: 30944407); Surg Obes Relat Dis. 2013 Sep-Oct;9(5):660-6. (PMID: 23452922); Surg Laparosc Endosc Percutan Tech. 2019 Jun;29(3):155-161. (PMID: 30499891); Langenbecks Arch Surg. 2024 Apr 16;409(1):128. (PMID: 38627302); Gut Liver. 2025 May 15;19(3):327-345. (PMID: 40058793); Obes Surg. 2023 Sep;33(9):2884-2897. (PMID: 37526816); J Laparoendosc Adv Surg Tech A. 2003 Aug;13(4):229-39. (PMID: 14561251); Arq Gastroenterol. 2004 Oct-Dec;41(4):263-7. (PMID: 15806272); Surg Obes Relat Dis. 2010 May-Jun;6(3):296-304. (PMID: 20096647); Obes Surg. 2023 Nov;33(11):3362-3372. (PMID: 37770775); Diabetes Obes Metab. 2024 Jun;26(6):2017-2028. (PMID: 38433708); Obes Surg. 2016 Oct;26(10):2449-56. (PMID: 26956879); Obes Surg. 2019 Oct;29(10):3165-3173. (PMID: 31388962); Am J Physiol Endocrinol Metab. 2014 Feb 15;306(4):E424-32. (PMID: 24368666); Heliyon. 2020 Feb 29;6(2):e03496. (PMID: 32154399); Obes Surg. 2020 Nov;30(11):4339-4351. (PMID: 32592015); Ann Surg. 2010 Aug;252(2):319-24. (PMID: 20622654); Obes Surg. 2020 Jun;30(6):2108-2117. (PMID: 32207049); Obes Surg. 2020 Oct;30(10):3730-3734. (PMID: 32495077); Obes Surg. 2020 Aug;30(8):3178-3187. (PMID: 32424794); Surg Obes Relat Dis. 2022 Apr;18(4):546-554. (PMID: 34961735); Surg Obes Relat Dis. 2021 Aug;17(8):1425-1430. (PMID: 33952426); Obes Surg. 2019 Mar;29(3):782-795. (PMID: 30421326); Obes Surg. 2024 Aug;34(8):3129-3130. (PMID: 38969960); Obes Surg. 2019 Nov;29(11):3665-3671. (PMID: 31267476); Surg Obes Relat Dis. 2015 Mar-Apr;11(2):351-5. (PMID: 25543309); Obes Surg. 2022 Apr;32(4):1300-1311. (PMID: 35084611); Obes Surg. 2019 Nov;29(11):3712-3721. (PMID: 31309524); Surg Obes Relat Dis. 2020 Apr;16(4):457-463. (PMID: 32029370); J Am Coll Surg. 1996 Sep;183(3):217-24. (PMID: 8784314); World J Gastroenterol. 2010 Jul 14;16(26):3239-48. (PMID: 20614479); Br J Surg. 2024 Aug 30;111(9):. (PMID: 39213130); Nat Rev Endocrinol. 2019 May;15(5):288-298. (PMID: 30814686); Obes Surg. 2024 Sep;34(9):3509-3512. (PMID: 39042311); Curr Gastroenterol Rep. 1999 Oct;1(5):404-9. (PMID: 10980979); Expert Rev Gastroenterol Hepatol. 2023 May;17(5):451-459. (PMID: 37086270); Obes Surg. 2022 Mar;32(3):615-624. (PMID: 35048247); Obes Facts. 2019;12(6):639-652. (PMID: 31747662); J Gastrointest Surg. 2009 Dec;13(12):2170-5. (PMID: 19777312); J Physiol. 2006 Nov 1;576(Pt 3):675-82. (PMID: 16973700); Obes Surg. 2017 Jul;27(7):1651-1658. (PMID: 28063112); Surg Endosc. 2021 Oct;35(10):5698-5704. (PMID: 32989534); Obes Surg. 2021 Nov;31(11):4993-5004. (PMID: 34350533); Gastroenterology. 1996 Aug;111(2):279-88. (PMID: 8690192); Obes Surg. 2011 Jul;21(7):858-63. (PMID: 20730606); Obes Surg. 2019 Jun;29(6):1965-1975. (PMID: 30903425); Surg Endosc. 2022 Apr;36(4):2631-2642. (PMID: 34671822); Obes Surg. 2020 May;30(5):2003-2014. (PMID: 32077060); Surg Endosc. 2025 Jul;39(7):4533-4544. (PMID: 40490578); Obes Surg. 2021 Mar;31(3):1304-1312. (PMID: 33417100); Dis Esophagus. 2019 Jun 1;32(6):. (PMID: 31076757); Saudi J Gastroenterol. 2013 Jan-Feb;19(1):3-15. (PMID: 23319032); Ann Surg Open. 2021 Oct 01;2(4):e102. (PMID: 37637881); Sci Rep. 2017 Oct 13;7(1):13188. (PMID: 29030643); Ann Surg. 2014 Nov;260(5):909-14; discussion 914-5. (PMID: 25379861) |
| Entry Date(s): | Date Created: 20251127 Date Completed: 20251127 Latest Revision: 20260105 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC12758074 |
| DOI: | 10.12659/AJCR.950798 |
| PMID: | 41305867 |
| Database: | MEDLINE |
Journal Article; Case Reports