A new bariatric surgery procedure is being touted as the operation that replaces Roux-en-Y gastric bypass in the next few years. According to initial research studies, weight loss exceeded gastric bypass and sleeve gastrectomy with no suggestion of increased complication.
The procedure, named Stomach Intestinal Pylorus-Sparing Surgery or SIPS, is based on the work of two prominent bariatric surgeons, Dr. Mitchell Roslin of New York City and Dr. Daniel Cottam of Salt Lake City. The procedure is described as a modified duodenal switch.
The results were presented during Obesity Week 2014, an international medical meeting sponsored by the American Society for Bariatric and Metabolic Surgery and The Obesity Society, held last month in Boston, Mass, USA.
About the Procedure
The new procedure, Stomach Intestinal Pylorus-Sparing Surgery or SIPS, involves the formation of a sleeve gastrectomy that is slightly larger than the usual sleeve combined with a shortened amount of intestine that is attached below the pyloric valve, the natural outlet controlling the emptying of solid food from the stomach.
SIPS was developed as a modification of the duodenal switch surgery. The duodenal switch is an effective procedure for weight loss, but is not widely performed (less than 5% of all bariatric surgeries) due to its technical difficulty, risk of nutritional deficiencies, and unpleasant side effect of frequent and loose bowel movements.
In the SIPS procedure, the intestine is not divided (no distal anastomosis and avoids a roux limb) and not too much of the intestine is bypassed. Although a portion of the intestine is bypassed, it is not a mini gastric bypass because the attachment is placed after the stomach outlet and the extra portion of the stomach is cut out and removed.
According to the surgeons who developed the SIPS procedure, the modifications make it easier to perform than the duodenal switch and also reduces nutritional deficiencies and diarrhea while still helping patients achieve impressive levels of weight loss.
The potential advantages:
- By preserving three meters of intestine, nutritional needs are met.
- By preserving the pyloric valve, it does not cause an abrupt rise and fall of blood glucose.
- By not dividing the intestine with a distal anastomosis or a roux limb, it could potentially reduce risk of gastrointestinal symptoms and intestinal obstruction, and reduce the chance for surgical complications.
- By placing attachment after pyloric valve, it does not increase risk of bile reflux gastritits.
Initial results involve a study that enrolled 129 patients who underwent the SIPS procedure between January 2013 and July 2014. The average starting BMI (body mass index) was about 50 among the group of patients.
At one year, the following results were seen:
- Average weight loss of 40% total body weight; over 80% of excess weight lost.
- No obstructions, no marginal ulcers, no re-operations required.
The weight loss achieved by patients is at levels similar to that of duodenal switch and 30% greater than gastric bypass or gastric sleeve. The complication profile seems favorable and early complications seem lower compared to similar procedures according to initial study results.
The potential of SIPS is of great interest because there is a need for a safe and effective solution for sleeve patients who regain weight or have inadequate weight loss, and for patients with super-morbid obesity or severe metabolic syndrome.
While research is ongoing, Dr. Roslin thinks SIPS is going to be the operation that replaces Roux-en-Y gastric bypass in the next several years, and that patients will have either sleeve gastrectomy or SIPS.