Name: one-anastomosis gastric bypass (oagb) in rats
Uploaded: 2018-11-10T13:00:00
Description: Watch this Scientific Journal Video about One-anastomosis Gastric Bypass OAGB in Rats at JoVE.com

The authors would like to thank Jean Pierre Marmuse for his constant help and support; Eglantine Voitellier, Jean-Baptiste Cavin, and Houneyda El Jindi for setting up the models and the illustrations; Anne-Charlotte Jarry and Andreia Goncalves for their help with the videos; Sara J. Zaat for editing the text in English. Matthieu A. Siebert and Lara Ribeiro-Parenti were recipients of sponsorships from the Fondation pour la recherch&#233; m&#233;dicale (FRM) and the Association fran&#231;aise de chirurgie (AFC).

All animal use conformed to the European Community guidelines and was approved by the local ethics committee (Comit&#233; d&#39;&#233;thique en exp&#233;rimentation animale N&#176; 121) and the Ministry of Higher Education and Research (Ref #02285.03).
1. Animals and Diets
<ol>
	<li>Rats
	<ol>
		<li>Use male Wistar rats weighing 260 - 320 g, started on a high-fat diet (HFD) at 7 weeks of age.</li>
	</ol>
	</li>
	<li>Diet
	<ol>
		<li>Induce a diet-induced obe...

<ol>
	<li>Ogden, C. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prevalence+of+overweight+and+obesity+in+the+United+States,+1999-2004.">Prevalence of overweight and obesity in the United States, 1999-2004.</a> Journal of American Medical Association. 295, 1549-1555 (2006).</li><li>Buchwald, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Consensus+Conference+Panel.+Consensus+conference+statement+bariatric+surgery+for+morbid+obesity:+health+implications+for+patients,+health+professionals,+and+third-party+payers.">Consensus Conference Panel. Consensus conference statement bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers.</a> Surgery for Obesity and Related Disease. 1, 371-381 (2005).</li><li>Mingrone, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bariatric-metabolic+surgery+versus+conventional+medical+treatment+in+obese+patients+with+type+2+diabetes:+5+year+follow-up+of+an+open-label,+single-centre,+randomised+controlled+trial.">Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial.</a> Lancet. 386, 964-973 (2015).</li><li>Nguyen, N. T., Varela, J. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bariatric+surgery+for+obesity+and+metabolic+disorders:+state+of+the+art.">Bariatric surgery for obesity and metabolic disorders: state of the art.</a> Nature Reviews. Gastroenterology &amp; Hepatology. 14, 160-169 (2017).</li><li>Rutledge, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+mini-gastric+bypass:+experience+with+the+first+1,274+cases.">The mini-gastric bypass: experience with the first 1,274 cases.</a> Obesity Surgery. 11, 276-280 (2001).</li><li>Lee, W. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+Roux-en-Y+vs.+mini-gastric+bypass+for+the+treatment+of+morbid+obesity:+a+10-year+experience.">Laparoscopic Roux-en-Y vs. mini-gastric bypass for the treatment of morbid obesity: a 10-year experience.</a> Obesity Surgery. 22, 1827-1834 (2012).</li><li>Victorzon, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Single-anastomosis+gastric+bypass:+better,+faster,+and+safer?.">Single-anastomosis gastric bypass: better, faster, and safer?.</a> Scandinavia Journal of Surgery. 104, 48-53 (2015).</li><li>Magouliotis, D. E., Tasiopoulou, V. S., Tzovaras, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=One+anastomosis+gastric+bypass+versus+Roux-en-Y+gastric+bypass+for+morbid+obesity:+a+meta-analysis.">One anastomosis gastric bypass versus Roux-en-Y gastric bypass for morbid obesity: a meta-analysis.</a> Clinical Obesity. 8, 159-169 (2018).</li><li>Seyfried, F., le Roux, C. W., Bueter, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lessons+learned+from+gastric+bypass+operations+in+rats.">Lessons learned from gastric bypass operations in rats.</a> Obesity Facts. 4 Suppl 1, 3-12 (2011).</li><li>Wang, F. G., Yu, Z. P., Yan, W. M., Yan, M., Song, M. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+safety+and+effectiveness+between+laparoscopic+mini-gastric+bypass+and+laparoscopic+sleeve+gastrectomy:+A+meta-analysis+and+systematic+review.">Comparison of safety and effectiveness between laparoscopic mini-gastric bypass and laparoscopic sleeve gastrectomy: A meta-analysis and systematic review.</a> Medicine (Baltimore). 96, e8924 (2017).</li><li>Hong, J., Park, S., Menzo, E. L., Rosenthal, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Midterm+outcomes+of+laparoscopic+sleeve+gastrectomy+as+a+stand-alone+procedure+in+super-obese+patients.">Midterm outcomes of laparoscopic sleeve gastrectomy as a stand-alone procedure in super-obese patients.</a> Surgery for Obesity and Related Disease. 14 (3), 297-303 (2017).</li><li>Abellan, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+influence+of+the+percentage+of+the+common+limb+in+weight+loss+and+nutritional+alterations+after+laparoscopic+gastric+bypass.">The influence of the percentage of the common limb in weight loss and nutritional alterations after laparoscopic gastric bypass.</a> Surgery for Obesity Related Disease. 10, 829-833 (2014).</li><li>Nora, M., Morais, T., Almeida, R., Guimar&#227;es, M., Monteiro, M. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Should+Roux-en-Y+gastric+bypass+biliopancreatic+limb+length+be+tailored+to+achieve+improved+diabetes+outcomes?.">Should Roux-en-Y gastric bypass biliopancreatic limb length be tailored to achieve improved diabetes outcomes?.</a> Medicine (Baltimore). 96, e8859 (2017).</li><li>Madan, A. K., Harper, J. L., Tichansky, D. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Techniques+of+laparoscopic+gastric+bypass:+on-line+survey+of+American+Society+for+Bariatric+Surgery+practicing+surgeons.">Techniques of laparoscopic gastric bypass: on-line survey of American Society for Bariatric Surgery practicing surgeons.</a> Surgery for Obesity and Related Disease. 4, 166-173 (2008).</li><li>Himpens, J. M., Vilallonga, R., Cadi&#232;re, G. B., Leman, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Metabolic+consequences+of+the+incorporation+of+a+Roux+limb+in+an+omega+loop+(mini)+gastric+bypass:+evaluation+by+a+glucose+tolerance+test+at+mid-term+follow-up.">Metabolic consequences of the incorporation of a Roux limb in an omega loop (mini) gastric bypass: evaluation by a glucose tolerance test at mid-term follow-up.</a> Surgical Endoscopy. 30, 2935-2945 (2016).</li><li>Parmar, C. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mini+Gastric+Bypass:+first+report+of+125+consecutive+cases+from+United+Kingdom.">Mini Gastric Bypass: first report of 125 consecutive cases from United Kingdom.</a> Clinical Obesity. 6, 61-67 (2016).</li><li>Chevallier, J. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=One+thousand+single+anastomosis+(omega+loop)+gastric+bypasses+to+treat+morbid+obesity+in+a+7-year+period:+outcomes+show+few+complications+and+good+efficacy.">One thousand single anastomosis (omega loop) gastric bypasses to treat morbid obesity in a 7-year period: outcomes show few complications and good efficacy.</a> Obesity Surgery. 25, 951-958 (2015).</li><li>Kular, K. S., Manchanda, N., Rutledge, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+6-year+experience+with+1,054+mini-gastric+bypasses-first+study+from+Indian+subcontinent.">A 6-year experience with 1,054 mini-gastric bypasses-first study from Indian subcontinent.</a> Obesity Surgery. 24, 1430-1435 (2014).</li><li>Tacchino, R. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bowel+length:+measurement,+predictors,+and+impact+on+bariatric+and+metabolic+surgery.">Bowel length: measurement, predictors, and impact on bariatric and metabolic surgery.</a> Surgery for Obesity Related Disease. 11, 328-334 (2015).</li><li>Bruinsma, B. G., Uygun, K., Yarmush, M. L., Saeidi, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+models+of+Roux-en-Y+gastric+bypass+surgery+and+sleeve+gastrectomy+in+rats+and+mice.">Surgical models of Roux-en-Y gastric bypass surgery and sleeve gastrectomy in rats and mice.</a> Nature Protocols. 10, 495-507 (2015).</li><li>Jeppsson, B., Mangell, P., Thorlacius, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+probiotics+as+prophylaxis+for+postoperative+infections.">Use of probiotics as prophylaxis for postoperative infections.</a> Nutrients. 3, 604-612 (2011).</li><li>Cavin, J. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Differences+in+Alimentary+Glucose+Absorption+and+Intestinal+Disposal+of+Blood+Glucose+After+Roux-en-Y+Gastric+Bypass+vs+Sleeve+Gastrectomy.">Differences in Alimentary Glucose Absorption and Intestinal Disposal of Blood Glucose After Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy.</a> Gastroenterology. 150, 454-464 (2016).</li><li>Bruzzi, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Long-Term+Evaluation+of+Biliary+Reflux+After+Experimental+One-Anastomosis+Gastric+Bypass+in+Rats.">Long-Term Evaluation of Biliary Reflux After Experimental One-Anastomosis Gastric Bypass in Rats.</a> Obesity Surgery. 27, 1119-1122 (2017).</li><li>Cavin, J. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Malabsorption+and+intestinal+adaptation+after+one+anastomosis+gastric+bypass+compared+with+Roux-en-Y+gastric+bypass+in+rats.">Malabsorption and intestinal adaptation after one anastomosis gastric bypass compared with Roux-en-Y gastric bypass in rats.</a> American Journal of Physiology-Gastrointestinal and Liver Physiology. 311, G492-G500 (2016).</li><li>Jacob, P. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Isocaloric+intake+of+a+high-fat+diet+promotes+insulin+resistance+and+inflammation+in+Wistar+rats.">Isocaloric intake of a high-fat diet promotes insulin resistance and inflammation in Wistar rats.</a> Cell Biochemistry and Function. 31, 244-253 (2013).</li></ol>

This protocol has the advantage of mimicking OAGB practiced routinely in humans. Its safety and reproducibility in rats have been demonstrated in clinical and metabolic results.
The anastomosis in this protocol poses a technical difficulty and is the main critical step. For this, it is necessary to use specific microsurgical tools, such as a microsurgery needle-holder or magnifying glasses. In order to realize a hermetic anastomosis without any stenosis, it is necessary to perform at least sev...

Morbid obesity is a major health issue in the western world, with increasing prevalence1. Bariatric surgery remains the only long-term effective therapy for morbid obesity2, with clear benefits on obesity-related comorbidities3. Roux-en-Y gastric bypass (RYGB) remains the gold standard as it is one of the oldest procedures and one of the most-performed worldwide with the longest follow-up4. OAGB is a more recent procedure first described in 2001 by Rutledge5. It has been described as an effective alternative to RYGB6 and has some advantages. Early data indicates a similar efficacy to RYGB with respect to weight-loss and the resolution of obesity-related comorbidities6,7. Furthermore, the risks of stenosis or leakage of the jejunojejunal anastomosis in RYGB are avoided, and the risk of an internal hernia may be lower than with RYGB8.
The physiological mechanisms underlying weight-loss after bariatric surgery remain controversial and can be difficult to study in humans9. Animal models are useful to understand how bariatric surgeries may impact glucose metabolism, neuroendocrine modifications, or satiety mechanisms. Comparative data between procedures are lacking and long-term effects of these surgeries need to be better understood10. It is not possible to fully standardize pre- and postoperative clinical care, and satisfactory follow-up can be difficult to achieve: some studies report loss-to-follow-up rates as high as 30% for the first year11.
The concept of gastric bypass is a combination of a restrictive procedure, due to the creation of a gastric pouch, and a moderate degree of malabsorption, resulting from the exclusion of the duodenum and the proximal jejunum from the gastrointestinal transit. Currently, limb length in bariatric surgery is still a matter of debate12,13. Available data show a high variability of procedures and no consensus has yet been reached on the optimal limb length for OAGB14,15. Nonetheless, many authors have reported a 200 cm BPL length as the standard for OAGB16,17,18. The mean length of the small bowel is about 700 cm19.
Several rodent models of RYGB have been developed worldwide20, with great variations in terms of pouch size, limb length, and the preservation of the vagal nerve. But very few authors reported a model of experimental OAGB; for this reason, theresearch team developed a model of OAGB in collaboration with bariatric surgeons. The rationale behind the development of the model was to mimic gastric bypass practiced in humans. The model incorporates the construction of a gastric pouch with the exclusion of the antrum and the body of the stomach. For it, the surgeon makes an ablation of the nonglandular stomach using a stapling device. Compared to a previous protocol20, the team decided to add a per-operative prophylactic antibiotic treatment in order to diminish the morbidity linked to gastrointestinal anastomosis, as is routine in human surgery21.
The rat limb length used in this model was chosen to reproduce the ratio between the BPL and the CL in humans. Preliminary measurements have shown the total small bowel length in rats to be between 90 and 120 cm22. Consequently, the length of the BPL chosen for OAGB was 35 cm. Furthermore, this model is practicable without making any vascular ligation, avoiding gastric pouch ischemia.

<table border="0" cellpadding="0" cellspacing="0" style="width:591px;" width="589">
	<tbody>
		<tr height="62">
			<td height="62" style="height:62px;width:223px;">High-Fat Diet, 45 % fat&#160;</td>
			<td style="width:73px;">Genestil, Royaucourt, France</td>
			<td style="width:123px;">C 1090-45</td>
			<td style="width:172px;">http://www.genestil.com/</td>
		</tr>
		<tr height="125">
			<td height="125" style="height:125px;">Metzenbaum Scissors</td>
			<td style="width:73px;">World Precision instrument, Sarasota, US</td>
			<td align="right">501739</td>
			<td>https://www.wpi-europe.com</td>
		</tr>
		<tr height="125">
			<td height="125" style="height:125px;">Dumont Tweezers</td>
			<td style="width:73px;">World Precision instrument, Sarasota, US</td>
			<td>14098</td>
			<td>https://www.wpi-europe.com</td>
		</tr>
		<tr height="125">
			<td height="125" style="height:125px;width:223px;">Iris Forceps</td>
			<td style="width:73px;">World Precision instrument, Sarasota, US</td>
			<td>15915</td>
			<td>https://www.wpi-europe.com</td>
		</tr>
		<tr height="125">
			<td height="125" style="height:125px;width:223px;">Iris Scissors 10cm</td>
			<td style="width:73px;">World Precision instrument, Sarasota, US</td>
			<td>14218</td>
			<td>https://www.wpi-europe.com</td>
		</tr>
		<tr height="125">
			<td height="125" style="height:125px;">Needle Holder</td>
			<td style="width:73px;">World Precision instrument, Sarasota, US</td>
			<td>14110</td>
			<td>https://www.wpi-europe.com</td>
		</tr>
		<tr height="125">
			<td height="125" style="height:125px;">Alm Self Retaining Retractor</td>
			<td style="width:73px;">World Precision instrument, Sarasota, US</td>
			<td>14240</td>
			<td>https://www.wpi-europe.com</td>
		</tr>
		<tr height="125">
			<td height="125" style="height:125px;">Baby Mixter Hemostatic Forceps,&#160; Right Angle</td>
			<td style="width:73px;">World Precision instrument, Sarasota, US</td>
			<td style="width:123px;">501240</td>
			<td>https://www.wpi-europe.com</td>
		</tr>
		<tr height="104">
			<td height="104" style="height:104px;">Non woven sterile swabs</td>
			<td style="width:73px;">LCH Medical Products, Paris, France</td>
			<td>SN40-0755</td>
			<td>www.lch-medical.com</td>
		</tr>
		<tr height="125">
			<td height="125" style="height:125px;width:223px;">Galilean Binocular Loupe 2.5x</td>
			<td style="width:73px;">World Precision instrument, Sarasota, US</td>
			<td style="width:123px;">504056</td>
			<td>https://www.wpi-europe.com</td>
		</tr>
		<tr height="104">
			<td height="104" style="height:104px;">Digestive thread: Isotactic polypropylene, monofil Prolene 7-0&#160;</td>
			<td style="width:73px;">Ethicon, Issy les&#160; Moulineaux, France</td>
			<td style="width:123px;">EH7813E</td>
			<td>www.ethicon.com</td>
		</tr>
		<tr height="83">
			<td height="83" style="height:83px;">Parietal thread : Coated Braided Polyester Ti-Cron 2-0</td>
			<td style="width:73px;">Covidien, Mannsfield, MA, USA</td>
			<td>3003-52</td>
			<td>www.covidien.com</td>
		</tr>
		<tr height="104">
			<td height="104" style="height:104px;">Cutaneous thread : Polyglactin, VICRYL RAPIDE 4-0&#160;</td>
			<td style="width:73px;">Ethicon, Issy les&#160; Moulineaux, France</td>
			<td>VR3100</td>
			<td>www.ethicon.com</td>
		</tr>
		<tr height="104">
			<td height="104" style="height:104px;">ETS-Flex 35- mm staple gun</td>
			<td style="width:73px;">Ethicon, Issy les&#160; Moulineaux, France</td>
			<td style="width:123px;">ATS45</td>
			<td>www.ethicon.com</td>
		</tr>
		<tr height="104">
			<td height="104" style="height:104px;">Proximate Reloadable Staplers</td>
			<td style="width:73px;">Ethicon, Issy les&#160; Moulineaux, France</td>
			<td>XR30V</td>
			<td>www.ethicon.com</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;">TA-DST 30mm-3.5mm</td>
			<td>Ethicon, Issy les&#160; Moulineaux, France</td>
			<td>TX30B</td>
			<td>www.ethicon.com</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Alcoholic 5% Betadine</td>
			<td>MEDA Pharma, Merignac, France</td>
			<td>41085</td>
			<td>www.medapharma.fr</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">LIDOCAINE AGUETTANT 20 mg/ml</td>
			<td>LABORATOIRE AGUETTANT, Lyon, France</td>
			<td>3400940000000.0</td>
			<td>https://www.aguettant.fr</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Penicillin G 5MUI</td>
			<td>Panpharma, Luitre, France</td>
			<td>3.40E+12</td>
			<td>https://www.panpharma.eu/fr</td>
		</tr>
		<tr height="62">
			<td height="62" style="height:62px;">Bionolyte G5 ; Sodium chloride 0.4%, glucose 5%, potassium chloride 0.2%)</td>
			<td style="width:73px;">Baxter, Maurepas, France</td>
			<td style="width:123px;"></td>
			<td></td>
		</tr>
		<tr height="62">
			<td height="62" style="height:62px;width:223px;">Liquid diet</td>
			<td style="width:73px;">Genestil, Royaucourt, France</td>
			<td style="width:123px;">C-0200T</td>
			<td>http://www.genestil.com/</td>
		</tr>
		<tr height="83">
			<td height="83" style="height:83px;width:223px;">Isoflurane 100%</td>
			<td style="width:73px;">Centravet, Plancoet, France</td>
			<td style="width:123px;">ISO007</td>
			<td>http://cooperative.centravet.net</td>
		</tr>
	</tbody>
</table>

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.

This protocol is reproducible and mimics OAGB as practiced on humans. The safety of this protocol is supported with published data23,24 with a low mortality rate between 12% and 25%. Different surgeons in the research team with a similar mortality rate have practiced this protocol.
Nonetheless, learning rodent surgery is complex, and the use of magnifying glasses is mand...

Watch this Scientific Journal Video about One-anastomosis Gastric Bypass OAGB in Rats at JoVE.com

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.

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 ...

Morbid obesity is a major health issue in the Western world with an increasing prevalence. Bariatric surgery remains the only long-term effective therapy for it and among all kind of surgeries, one Anastomosis Gastric Bypass, which is more recent procedure appears to be effective and safe. But, several questions remain unsolved.Especially, about metabolical and long term consequences on the antral gastric mucosa after the surgery. To our knowledge no animal model of one anastomosis gastric bypass has yet been developed. And this could be useful to study, for example, glucose metabolism, neuron de queen modifications are long time consequences on other gastric mucosa.The model, which is presented in this video has been developed in order to mimic the human procedure. First, the surgeon realizes a long and tubular gastric approach and then bypass 35 cm of small bowel. This length has been decided in order to reproduce the ratio between the biliopancreatic limb and the common limb.As it is done for human surgery. Use Wistar rats in this protocol. And use a diet and just obesity with at least 12 pro body weeks of high fat diet.Ensure that the rats are obese at the time of the surgery. With a weight between 600 and 800 grams. Here are presented surgical instruments which are needed for this procedure.Autoclave all surgical instruments before surgery. Anesthetize the rat with inhalation of 3%isoflurane in air for the indication in the redden box. Then transfer the rat to the warming plate and maintain the anesthesia with the face mask at the same flow rate of 3%Surgical approach is a megion la pareta.Peritoneum is cut along the linear alba in order to open the peritoneal cavity. Great gastric curve is dissected from the junction between the glandular and non-glandular stomach to the left side of the abdominal fagus. Gastrosplenic are progressively coagulated in order to liberate the great gastric curve to the his angle.Then the heretal area is exposed by a section of 10 ligaments. Abdominal fagus is dissected while preserving the left gastric artery and vagal nerve. Surgical stapler is applied horizontally at the junction between the glandular and non-glandular stomach to the left side of the gastro oesophageal junction.After cutting the non-glandular stomach this one is removed. Then a second stapler with a TA-device is applied to the first one. The result is a small and tubular gastric approach with an excluded antrum and body of the stomach.Duodenojejunal angle is located then the surgeon measures 35 cm to the future antmeradu. Antermere is performed on the antimesic side of the duodenojejunal. Then the operator performs a punctiform gastrectomy And then and intoside gasrodiginal anastomosis with 2 running sutures of isopropolene 7 zero.The key to success is to realize this anastomosis under magnifying glass and to perform about 7-8 closed extra sutures on each side of the one-anastomosis. The result is an amagalope with a bilo-pancreatic and acommon limb connected to the gastric pouch by this one-astomosis. At the end of the procedure the surgeon replaces the abdominal organs into their physiological positions then close the abdominal wall with running suture of taychron 2-0.Then there forms a perital infiltration of 1 possn zilochine ado this 1 militers of kilogram then close the skin with running suture of vicryl rapide 4-0 Performs and intrum schoolar injection of 20, 000 units kg of cheap isolene and the epirital performs a sub injection of isotne. 1 month later a significant weight loss is observed in this case the rat lost about 20%of it's pro body weight. It has been demonstrated in previous experiences a significant and sustained weight loss compared to sham surgery.After sacrifice no repair between the pouch and the excluded stomach has yet been observed. The procedure produces a similar metabolic profile after gastric bypass to that in humans. After around an a round of test is observed as well as a quicker return to basisemia when compared to sham rats.Furthermore after each test an increase in insulin sensitivity is observed. The main advantage of this model is to mimic closely the human procedure. It is reproducible and has already been performed by several surgeons with a low meticula weight of about 15%The main difficulty of this protocol is the gastroduodenal anastomosis In our experience, the learning curve requires about 10 operations for the surgeon to perform it effectively.Thank you for your attention.

Research

JoVE Journal

Medicine

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