马尔科Bueter和弗洛里安希耶福里德由德意志研究联合会（DFG）的支持。托马斯卢茨由瑞士国家研究基金会（SNF）的支持。马尔科Bueter和托马斯卢茨进一步收到来自美国国立卫生研究院（NIH）和从苏黎世中心（ZIHP）结合人体生理学的资金。卡雷尔W·勒鲁，由卫生部临床医师科学家奖部的支持。伦敦帝国学院收到从NIHR生物医学研究中心资助计划的支持。

1。术前护理<ol><li>从手术前大鼠过夜的食物。 </li><li>诱导麻醉室用4-5％的异氟醚和O2流量2升/分钟。 </li><li>从胸骨到骨盆使用电动剃须刀刮胡子腹部。 </li><li>放置在麻醉大鼠仰卧位温加热垫。 </li><li>申请之前放置在老鼠的头锥吻眼膏（Vitagel）。 </li><li>麻醉维持2-3％的异氟醚浓度和氧流量2升/分钟。 </li><li>解决方案与优碘消毒皮肤。 </li><li>确认麻醉深度，用钳子捏脚趾之间的后腿。 </li><li>围手术期预防性应用抗生素，1毫克/千克镇痛氟尼辛管理5.7毫克/千克恩诺沙星腹腔。 </li></ol> 2。中位数剖腹<ol><li>执行正中切口，用手术刀略低于xyphoid过程（刀片第10号）开始。 </li><li> Mobilise皮肤圆周从underl英梅岑鲍姆剪刀的腹部肌肉。 </li><li>打开腹腔。 </li><li>安装拉钩，以便尽可能暴露手术视野。 </li></ol> 3。胰和消化道肢体<ol><li>查明十二指肠或空肠近端结肠通过。 </li><li>横切小肠约10厘米aborally从这里结扎对肠道的两端（5-0的PDS）。 </li><li>放置在左上腹两两端，因为它会被后来形成空肠Roux-en-Ÿ重建的胰肢体近端残端。 </li><li>将右上腹两两端，因为它会被后来形成消化道，空肠Roux-en-Ÿ重建肢体远端残端。 </li></ol> 4。空肠，空肠造口<ol><li>确定与ileocoecal阀及回肠盲肠。 </li><li>按照回肠口头约25厘米。空肠，空肠造口将放在这里作为起点空肠Roux-en-Ÿ重建的共同通道。 </li><li>左上腹胰肢体检索和定位旁​​边的共同通道，你打算执行空肠，空肠。 </li><li>安全胰肢体保留缝合（6-0的PDS）的共同通道。 </li><li>采用微型剪刀切开约10毫米的两个循环。 </li><li>创建使用间断缝合（6-0的PDS）进行侧侧吻合，空肠，空肠造口。 </li><li>第一个完整的背侧和腹侧侧吻合。 </li></ol> 5。胃癌袋<ol><li>确定胃食管交界处。 </li><li> Mobilise这方面，通过解剖胃，肝和胃脾韧带，梅岑鲍姆剪刀。 </li><li>胃左动脉和左段食管丛的迷走神经纤维移至侧面，以防止重大出血和迷走神经损伤时创建的小胃袋。 </li><li>暴露胃食管菊nction由放置棉签复古oesophageally。 </li><li>使用市售的烧灼设备，凝聚正面胃小血管 - 还可以防止出血。 </li><li>横切胃胃食管交界处，创建一个大小不超过2-3％的原胃的大小，用细腻，弯剪刀胃癌袋下方约5毫米。 </li><li>关闭残胃（5-0的PDS）。 </li></ol> 6。胃，空肠造口<ol><li>右上腹检索消化道肢体定位胃癌袋。 </li><li>表演结束侧吻合（7-0的PDS）创建胃空肠造口。 </li><li>第一个完整的背面和前侧吻合。 </li></ol> 7。腹部闭幕<ol><li>减少麻醉异氟醚浓度减少1.5％。 </li><li>关闭腹壁肌肉层采用连续缝合（4-0的PDS）。 </li><li>管理100微升0.3毫克/毫升皮下镇痛丁丙诺啡的解决方案。 </li><li>进一步降低异氟醚的浓度下降到1％。 </li><li>使用（Vicryl 4-0）间断缝合关闭皮肤。 </li></ol> 8。术后护理<ol><li>停止异氟醚，并继续与O2。 </li><li>管理三个皮下车厂5毫升温生理盐水补液。 </li><li>位置大鼠下红灯，直到完全恢复。 </li><li>返回家笼老鼠。 </li></ol> 9。代表结果动物和住房雄性Wistar大鼠（哈伦Laboratories公司，黑刺李，英国; Elevage让维耶，乐Genest圣岛，法国）称重之间的350和500 g的12小时/ 12小时明暗周期下单独安置在一个房间里的温度21±2°C。水和标准饲料，自由采食，除非另有说明。所有实验均在由民政办事处发出的许可证CE，英国（PL70-6669），瑞士苏黎世州兽医办公室批准。所有大鼠被随机胃绕道手术或假手术前一个星期水土不服。手术后，大鼠接受流质饮食，进入正常饲养3天前被重新安装。 体重我们的大鼠胃旁路模式的数据与以前的研究结果是一致的，胃绕道手术是有效的减轻体重，尤其是保持体重下降（ 图2）。用于胃绕道手术，假操作大鼠手术前的平均体重是类似的（假：433.4±8.3Ğ与旁路：420.7±8.4Ğ，P = 0.28）。手术后假手术组的5天体重明显比胃绕道手术大鼠（假：422.2±8.3Ğ与旁路：374.7±7.6 G，P &lt;0.001）。术后第60天，体重差异几乎170克（假：533.2±8.1Ğ与旁路：366.2±10.8克，P &lt;0.001）。 食物摄入量食物的摄入遵循类似的模式作为体重，并减少对大鼠胃绕道相比，假手术广告随机喂养大鼠。 图3显示了两个组（术后1-60天）的平均每日食物摄入量。每日食物摄入量一直低于胃绕道手术后（假：29.9±0.2Ğ与旁路：25.7±0.3克，P &lt;0.001）。 胃肠激素从各组大鼠的血液收集研究终止8,16日。动物自由采食食物访问的前一天晚上，并在术后第60天开始光周期斩首。血，立即在4°C离心10分钟的转速在3000，并储存在-20°C，直到样品一式两份，在一个单一的运行检测。酪酪肽，像免疫是MEAsured与特定和敏感的放射免疫法，措施，都全长（PYY1-36）和片段（PYY3-36）。 GLP-1通过建立在内部放射免疫法17,18。食物摄入量的差异可能部分是通过增加餐后血浆酪酪肽（PYY）和胰高血糖素样肽1（GLP-1）对大鼠胃绕道解释显示显着较高水平的酪酪肽（假：26±2 pmol / L的比旁路：141±14 pmol / L的，P &lt;0.001）和GLP-1（假：40±5 pmol / L的对旁路：215±23 pmol / L的，P &lt;0.001; 图4）。 <img alt="图1" src="/files/ftp_upload/3940/3940fig1.jpg" /> 图1。胃绕道手术解剖。（A）和（二）胃搭桥手术后小肠的解剖示意图画像前。约深浅不同的红色代表较前肠与中红色的相应节段小肠（食道，胃十二指肠和近端空肠），淡红色，中肠（空肠近端和中期，近端回肠）和暗红色，代表肠（回肠，盲肠）。 <img alt="图2" src="/files/ftp_upload/3940/3940fig2.jpg" /> 图2。大鼠胃绕道手术后身体的减肥机构代表组的大鼠胃绕道手术后的体重变化（ - ）（N = 52）和假手术组（ - ）组（n = 52）在整个观察期60天。数据汇集从6,8-10以前的出版物和平均值±标准差（*** = P &lt;0.001）。 <img alt="图3" src="/files/ftp_upload/3940/3940fig3.jpg" /> 图3。胃绕道手术后的代表组大鼠（黑，N = 52）和假手术组（白色，N = 52），整个平均每日食物摄入量大鼠胃绕道手术后的平均食物摄入量。术后60天的期限。 6,8-10以前的出版物和资料汇集平均值±标准差显示。 <img alt="图3" src="/files/ftp_upload/3940/3940fig3.jpg" /> 图4。餐后PYY和GLP-1的血清后，大鼠的胃绕道手术。餐后PYY和GLP-1的血清对大鼠胃绕道（黑，N = 18）的水平和假手术组（白，N = 22）。从8,16以前的出版物和资料汇集平均值±标准差显示。

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J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+inhibitory+effects+of+peripheral+administration+of+peptide+YY(3-36)+and+glucagon-like+peptide-1+on+food+intake+are+attenuated+by+ablation+of+the+vagal-brainstem-hypothalamic+pathway.">The inhibitory effects of peripheral administration of peptide YY(3-36) and glucagon-like peptide-1 on food intake are attenuated by ablation of the vagal-brainstem-hypothalamic pathway.</a> Brain Res. 1044, 127-131 (2005).</li><li>Adrian, T. E., Ballantyne, G. H., Longo, W. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Deoxycholate+is+an+important+releaser+of+peptide+YY+and+enteroglucagon+from+the+human+colon.">Deoxycholate is an important releaser of peptide YY and enteroglucagon from the human colon.</a> Gut. 34, 1219-1224 (1993).</li><li>Nakatani, H., Kasama, K., Oshiro, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Serum+bile+acid+along+with+plasma+incretins+and+serum+high-molecular+weight+adiponectin+levels+are+increased+after+bariatric+surgery.">Serum bile acid along with plasma incretins and serum high-molecular weight adiponectin levels are increased after bariatric surgery.</a> Metabolism. 58, 1400-1407 (2009).</li><li>Ashrafian, H., le Roux, C. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Metabolic+surgery+and+gut+hormones+-+a+review+of+bariatric+entero-humoral+modulation.">Metabolic surgery and gut hormones - a review of bariatric entero-humoral modulation.</a> Physiol. Behav. 97, 620-631 (2009).</li><li>Choban, P. S., Flancbaum, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effect+of+Roux+limb+lengths+on+outcome+after+Roux-en-Y+gastric+bypass:+a+prospective,+randomized+clinical+trial.+Obes.">The effect of Roux limb lengths on outcome after Roux-en-Y gastric bypass: a prospective, randomized clinical trial. Obes.</a> Surg. 12, 540-545 (2002).</li><li>Gleysteen, J. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Five-year+outcome+with+gastric+bypass:+Roux+limb+length+makes+a+difference.">Five-year outcome with gastric bypass: Roux limb length makes a difference.</a> Surg. Obes. Relat. Dis. 5, 242-247 (2009).</li><li>Lee, S., Sahagian, K. G., Schriver, J. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Relationship+between+varying+Roux+limb+lengths+and+weight+loss+in+gastric+bypass.">Relationship between varying Roux limb lengths and weight loss in gastric bypass.</a> Curr. Surg. 63, 259-263 (2006).</li><li>Hayes, M. R., Kanoski, S. E., De Jonghe, B. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+common+hepatic+branch+of+the+vagus+is+not+required+to+mediate+the+glycemic+and+food+intake+suppressive+effects+of+glucagon-like-peptide-1.">The common hepatic branch of the vagus is not required to mediate the glycemic and food intake suppressive effects of glucagon-like-peptide-1.</a> Am. J. Physiol. Regul. Integr. Comp. Physiol. 301, R1479-R1485 (2011).</li></ol>

没有利益冲突的声明。

在人类空肠Roux-en-Y胃旁路手术的过程是由梅森在1967年首次描述，并修改其目前的形式由托雷斯在1983年19。目前，该程序包括胃小囊和近端小肠旁路。 图1给出了一个在术前和术后的解剖示意图。 在人类的胃绕道手术诱发和保持身体约15-30％的重量损失。期间减少食物的摄入量，改变食物的喜好和大概增加能源开支4-6,8-10部分原因是由于手术后的头?...

<table border="1"><tbody><tr><td> 通用名称 </td><td> 品牌名称 </td><td> 公司 </td><td> 目录编号 </td></tr><tr><td>恩诺沙星</td><td> baytril 2.5％ </td><td> provet公司</td><td> 1036 </td></tr><tr><td>氟尼辛</td><td> finadyne </td><td> graeub </td><td> 908040 </td></tr><tr><td> buprenorphin </td><td> temgesic </td><td>利洁时</td><td> 138976 </td></tr><tr><td>异氟醚</td><td> IsoFlo </td><td> graeub </td><td> 902035 </td></tr><tr><td>维生素A </td><td> vitagel </td><td>博士伦</td><td> 690 </td></tr><tr><td>碘溶液</td><td>优碘</td><td> mundipharma </td><td> 111141 </td></tr><tr><td>氯化钠0.9％ </td><td>氯化钠0.9％ </td><td>贝朗</td><td> 534534 </td></tr></tbody></table> 表1。药品。 <table border="1"><tbody><tr><td> 名称 </td><td> 大小 </td><td> 公司 </td><td> 目录编号 </td></tr><tr><td> PDS的二</td><td> 4-0 </td><td>爱惜康</td><td> Z924H </td></tr><tr><td> PDS的二</td><td> 5-0 </td><td>爱惜康</td><td> Z925H </td></tr><tr><td> PDS的二</td><td> 6-0 </td><td>爱惜康</td><td> PUU2971E </td></tr><tr><td> PDS的二</td><td> 7-0 </td><td>爱惜康</td><td> Z1370E </td></tr><tr><td> vicryl </td><td> 4-0 </td><td>爱惜康</td><td> V451H </td></tr></tbody></table> 表2。缝线。 <table border="1"><tbody><tr><td> 名称 </td><td> 公司 </td><td> 目录编号 </td></tr><tr><td>手术刀手柄第3号</td><td>蛇牌</td><td> BB073R </td></tr><tr><td>没有手术刀片。 10 </td><td>斯旺 - 莫顿</td><td> 0301 </td></tr><tr><td>持针器</td><td>蛇牌</td><td> BM124R </td></tr><tr><td>组织钳</td><td>蛇牌</td><td> BD555R </td></tr><tr><td>梅岑鲍姆剪刀，直</td><td>蛇牌</td><td> BC022R </td></tr><tr><td>梅岑鲍姆剪刀，弯曲</td><td>蛇牌</td><td> BC023R </td></tr><tr><td>精致的剪刀，弯曲</td><td>蛇牌</td><td> BC061R </td></tr><tr><td>动脉钳，弯曲</td><td>蛇牌</td><td> BH109R </td></tr><tr><td>动脉钳，弯曲，1X2的牙齿</td><td>蛇牌</td><td> BH121R </td></tr><tr><td>探头，双端</td><td>蛇牌</td><td> BN113R </td></tr><tr><td>微针座</td><td>蛇牌</td><td>调频541R </td></tr><tr><td>微型镊子</td><td>蛇牌</td><td> FM571R </td></tr><tr><td>微型剪刀</td><td> AESCulap </td><td> FM470R </td></tr><tr><td>一次性眼烧灼</td><td>约翰·维斯国际</td><td> 0111122 </td></tr><tr><td>棉花棒</td><td>哈特曼公司</td><td> 9679369 </td></tr></tbody></table> 表3。外科手术设备。

roux-en-y gastric bypass operation in rats

目前，最有效的疗法是治疗病态肥胖引起重大和维持身体消瘦，一个成熟的死亡率受益减肥手术1,2。因此，出现了近年来空肠Roux-en-Y胃旁路（胃绕道）是最常执行的操作3全球减肥行动的数量在稳步上升。在此背景下，重要的是要了解胃绕道诱导和保持身体消瘦的生理机制。这些机制还没有完全理解，但可能包括减少饥饿和增加的饱食4,5，能源开支增加6,7，改变食物中的脂肪和糖8,9高，改变盐和水的处理，肾脏10偏好以及在肠道菌群的改变11。胃绕道手术后见过这样的变化可能至少部分源于如何手术改变荷尔蒙的环境，因为胃绕道手术会增加餐后释放肽YY（PYY）和胰高血糖素样肽1（GLP-1），营养物质的存在是由肠道释放激素，减少吃12。 在过去二十年中已经开展了许多研究使用大鼠胃绕道手术后的生理变化，以进一步调查。胃绕道大鼠模型已被证明是一个有价值的实验工具并非最不重要的，因为它与模拟时间剖面和人类减肥的幅度，但也使研究人员能够控制和操纵关键的解剖和生理因素，包括使用适当的控制。因此，有各种各样的大鼠胃旁路模式在审查更多的细节13日至15日在其他地方的文学。这些模型的精确的手术技术的描述差别很大，并在袋大小不同，例如，肢体长度和迷走神经的保护。如果报道，死亡率似乎范围从0到35％，15。此外，手术已经进行了几乎完全不同品系和年龄的雄性大鼠。术前和术后的饮食也差异显着。 在公布的胃绕道手术大鼠模型和实验技术的变化复杂的胃绕道手术所涉及的潜在生理机制的比较和鉴别。有没有明确的证据，这些模型是优越的，但有一个标准化的程序的新兴需要取得一致和可比的数据。因此，本文旨在总结和讨论我们以前审定并公布的胃绕道手术大鼠模型的技术和实验的细节。

Watch this Scientific Journal Video about Roux-en-Y Gastric Bypass Operation in Rats at JoVE.com

Roux-en-Y Gastric Bypass Operation in Rats

最近大量使用胃绕道大鼠模型的研究已进行了揭露空肠Roux-en-Y胃绕道手术的基本生理机制。本文旨在展示和讨论我们公布的胃绕道手术大鼠模型的技术和实验的细节，以了解本实验工具的优势和局限性。

空肠Roux-en-Y胃搭桥手术大鼠

Currently, the most effective therapy for the treatment of morbid obesity to induce significant and maintained body weight loss with a proven mortality ...

roux-en-y-gastric-bypass-operation-in-rats

Research

JoVE Journal

Medicine

23.4K 次观看.  University Hospital Zürich. 最近大量使用胃绕道大鼠模型的研究已进行了揭露空肠Roux-en-Y胃绕道手术的基本生理机制。本文旨在展示和讨论我们公布的胃绕道手术大鼠模型的技术和实验的细节，以了解本实验工具的优势和局限性。

视频: Roux-en-Y Gastric Bypass Operation in Rats

Techniques of Sleeve Gastrectomy and Modified Roux-en-Y Gastric Bypass in Mice

Obesity is a major public health issue, with a prevalence of 4 to 28% for men and 6.2 to 36.5% for women in Europe (from 2003 to 2008). Morbid obesity is frequently associated with metabolic complications, such as type 2 diabetes, hypertension, and dyslipidemia, reducing life expectancy and quality. In the absence of any effective noninvasive treatments, bariatric surgery is a valuable therapeutic option for patients with morbid obesity (body mass index (BMI) &#62;40 kg/m2), leading to long-term, sustained weight loss and improvements in metabolic complications. However, the underlying cellular and molecular mechanisms sustaining the beneficial effects of bariatric surgery are not yet fully understood. Due to the numerous genetically-modified strains available, the mouse model is the most convenient animal model to explore the molecular mechanisms behind the pleiotropic beneficial effects of bariatric surgeries. Here, we detailed the optimized healthcare methods and surgical protocols in mice for the two most widely-used bariatric surgeries: the sleeve gastrectomy and the modified Roux-en-Y gastric bypass. Deciphering the molecular mechanisms underlying the therapeutic effects of bariatric surgeries offers the promise of identifying new therapeutics targets.

Bariatric surgery is the most efficient way to reduce body weight and the deadly metabolic complications (diabetes, obesity, and dyslipidemia) frequently associated with morbid obesity. Mouse models of bariatric surgery represent a unique asset for deciphering molecular mechanisms behind the beneficial effects of these surgeries on diabetes, hypertension, and dyslipidemia.

袖胃切除术的技术和改良的小鼠空肠Roux-en-Y胃旁路

Obesity is a major public health issue, with a prevalence of 4 to 28% for men and 6.2 to 36.5% for women in Europe (from 2003 to 2008). Morbid obesity is ...

科研

医学

Cardiopulmonary Bypass in a Mouse Model: A Novel Approach

As prolonged cardiopulmonary bypass becomes more essential during cardiac interventions, an increasing clinical demand arises for procedure optimization and for minimizing organ damage resulting from prolonged extracorporal circulation. The goal of this paper was to demonstrate a fully functional and clinically relevant model of cardiopulmonary bypass in a mouse. We report on the device design, perfusion circuit optimization, and microsurgical techniques. This model is an acute model, which is not compatible with survival due to the need for multiple blood drawings. Because of the range of tools available for mice (e.g., markers, knockouts, etc.), this model will facilitate investigation into the molecular mechanisms of organ damage and the effect of cardiopulmonary bypass in relation to other comorbidities.

This paper describes how to perform cardiopulmonary bypass in mice. This novel model will facilitate the investigation of the molecular mechanisms involved in organ damage.

小鼠体外循环模型: 一种新方法

As prolonged cardiopulmonary bypass becomes more essential during cardiac interventions, an increasing clinical demand arises for procedure optimization ...

One-anastomosis Gastric Bypass (OAGB) in Rats

The goal of this protocol is to set up a preclinical model of bariatric surgery and, more specifically, OAGB in obese rats. Based on this preclinical model, longitudinal studies can be carried out to provide an improved understanding of the mechanisms underlying the outcomes seen after bariatric surgery in humans. For this purpose, rats are operated on through a laparotomy under general anesthesia with isoflurane. First, the surgeon creates a long and tubular gastric pouch: after greater curve and hiatal dissection, the nonglandular stomach is stapled and removed. Then, the remaining stomach is also stapled in order to create a gastric tube and exclude the antrum of the stomach. After that, the surgeon performs a single end-to-side gastrojejunostomy 35 cm from the duodenojejunal angle. This limb length has been chosen in order to reproduce the same ratio between the biliopancreatic limb (BPL) and common limb (CL) length as in human bariatric surgery. The operation ends by aponeurotic and cutaneous closure. The early postoperative management consists of subcutaneous hydration, an intramuscular prophylactic antibiotic injection, a parietal injection of xylocaine, the administration of painkillers, and a progressive reintroduction of diet.

One-anastomosis Gastric Bypass OAGB in Rats

This protocol is for the performance of one-anastomosis gastric bypass (OAGB) on rat. The operator performs a long and tubular-stapled gastric pouch followed by hand-sewn anastomosis. For this model, the operator reproduces the same ratio between biliopancreatic and common limb in humans; therefore, the biliopancreatic limb measures 35 cm.

大鼠胃旁路 (oagb) 的一次吻合

The goal of this protocol is to set up a preclinical model of bariatric surgery and, more specifically, OAGB in obese rats. Based on this preclinical ...

A Protocol for Roux-en-Y Gastric Bypass in Rats using Linear Staplers

Roux-en-Y gastric bypass (RYGB) is commonly performed for the treatment of severe obesity and type 2 diabetes. However, the mechanism of weight loss and metabolic changes are not well understood. Multiple factors are thought to play a role, including reduced caloric intake, decreased nutrient absorption, increased satiety, the release of satiety-promoting hormones, shifts in bile acid metabolism, and alterations in the gut microbiota.
The rat RYGB model presents an ideal framework to study these mechanisms. Prior work on mouse models have had high mortality rates, ranging from 17 to 52%, limiting their adoption. Rat models demonstrate more physiologic reserve to surgical stimulus and are technically easier to adopt as they allow for the use of surgical staplers. One challenge with surgical staplers, however, is that they often leave a large gastric pouch which is not representative of RYGB in humans. 
In this protocol, we present a RYGB protocol in rats that result in a small gastric pouch using surgical staplers. Utilizing two stapler fires which remove the forestomach of the rat, we obtain a smaller gastric pouch similar to that following a typical human RYGB. Surgical stapling also results in better hemostasis than sharp division. Additionally, the forestomach of the rat does not contain any glands and its removal should not alter the physiology of RYGB.
Weight loss and metabolic changes in the RYGB cohort were significant compared to the sham cohort, with significantly lower glucose tolerance at 14 weeks. Furthermore, this protocol has an excellent survival of 88.9% after RYGB. The skills described in this protocol can be acquired without previous microsurgical experience. Once mastered, this procedure will provide a reproducible tool for studying the mechanisms and effects of RYGB.

Roux-en-Y gastric bypass (RYGB) is performed to treat obesity and diabetes. However, the mechanisms underlying RYGB's efficacy are not fully understood, and studies are limited by technical difficulty leading to high mortality in animal models. This article provides instructions on how to perform RYGB in rats with high success rates.

使用线性压花器在老鼠身上进行胃旁路的规程

Roux-en-Y gastric bypass (RYGB) is commonly performed for the treatment of severe obesity and type 2 diabetes. However, the mechanism of weight loss and ...

Robotic Central Pancreatectomy with Roux-en-Y Pancreaticojejunostomy

Central pancreatectomy is a parenchyma-sparing alternative to distal pancreatectomy in patients with a benign or low-grade malignant tumor in the body of the pancreas. The aim of central pancreatectomy is to prevent postoperative life-long endocrine and exocrine insufficiency. The downside of central pancreatectomy is the high rate of postoperative pancreatic fistula, which is the main reason that many surgeons do not routinely use central pancreatectomy in eligible patients. Most studies report open or laparoscopic central pancreatectomy with a pancreatico-gastrostomy anastomosis in adults. This is the first description of a standardized approach to robotic central pancreatectomy with Roux-en-Y pancreaticojejunostomy reconstruction in an adolescent (16-year-old boy) with a pseudopapillary tumor in the body of the pancreas. The operation time was 248 min with 20 mL of blood loss. The postoperative course was uneventful except for the short-term medical treatment for a grade B pancreatic fistula. Robotic central pancreatectomy can be safely applied in selected patients in experienced centers.

Robotic central pancreatectomy may be used in selected patients in experienced centers. This protocol presents all steps and the feasibility of a robotic central pancreatectomy with Roux-en-Y pancreaticojejunostomy in a 16-year-old adolescent patient.

机器人中央胰腺切除术与鲁恩-Y胰腺切除术

Central pancreatectomy is a parenchyma-sparing alternative to distal pancreatectomy in patients with a benign or low-grade malignant tumor in the body of ...

Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy Model in Mice

Obesity is a major health issue worldwide. As a response, bariatric surgeries have emerged to treat obesity and its related comorbidities (e.g., diabetes mellitus, dyslipidemia, non-alcoholic steatohepatitis, cardiovascular events, and cancers) through restrictive and malabsorptive mechanisms. Understanding the mechanisms by which these procedures allow such improvements often require their transposition into animals, especially in mice, because of the ease of generating genetically modified animals. Recently, the single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) has emerged as a procedure that uses both restrictive and malabsorptive effects, which is being used as an alternative to gastric bypass in case of major obesity. Thus far, this procedure has been associated with strong metabolic improvements, which has led to a marked increase in its use in daily clinical practice. However, the mechanisms underlying these metabolic effects have been poorly studied as a result of a lack of animal models. In this article, we present a reliable and reproducible model of SADI-S in mice, with a special focus on perioperative management. The description and use of this new rodent model will be helpful for the scientific community to better understand the molecular, metabolic, and structural changes induced by the SADI-S and to better define the surgical indications for clinical practice.

Single-anastomosis duodeno-ileal bypass (SADI-S) is an emerging bariatric procedure with important metabolic effects. In this article, we present a reliable and reproducible model of SADI-S in mice.

小鼠单吻合十二指肠回肠旁路与袖状胃切除术模型

Obesity is a major health issue worldwide. As a response, bariatric surgeries have emerged to treat obesity and its related comorbidities (e.g., diabetes ...

胃超声技术减轻围手术期误吸风险

Gastric Point of Care Ultrasound in Adults: Image Acquisition and Interpretation

Over the past two decades, diagnostic point-of-care ultrasound (POCUS) has emerged as a rapid and non-invasive bedside tool for addressing clinical inquiries related to gastric content. One emerging concern pertains to patients about to undergo sedation and/or endotracheal intubation: the elevated risk of aspiration from the patient&#39;s stomach contents. Aspiration of gastric contents into the lungs poses a serious and potentially life-threatening complication. This occurs more frequently when the stomach is considered &#34;full&#34; and can be affected by the techniques employed for airway management, making it potentially preventable. To mitigate the risk of peri-procedural aspiration, two distinct medical specialties (anesthesiology and critical care medicine) have independently developed techniques to utilize ultrasonography for identifying patients requiring &#34;full stomach&#34; precautions. Due to these separate specialties, the work of each group remains relatively unfamiliar outside its respective field. This article presents descriptions of both techniques for gastric ultrasound. Furthermore, it explains how these approaches can complement each other when one of them falls short. Regarding image acquisition, the article covers the following topics: indications and contraindications, selection of the appropriate probe, patient positioning, and troubleshooting. The article also delves into image interpretation, complete with example images. Additionally, it demonstrates how one of the two techniques can be employed to estimate gastric fluid volume. Lastly, the article briefly discusses medical decision-making based on the findings of this examination.

作者聚焦：用于围手术期护理中胃内容物评估和风险分层的床旁超声 

This protocol introduces two methods for image acquisition in gastric ultrasonography. Additionally, tips are provided for interpreting this information to assist in medical decision-making.

成人胃旁超声：图像采集和解释

Over the past two decades, diagnostic point-of-care ultrasound (POCUS) has emerged as a rapid and non-invasive bedside tool for addressing clinical ...