Marco Bueter e Florian Seyfried sono stati sostenuti dalla Deutsche Forschungsgemeinschaft (DFG). Thomas A Lutz è stato sostenuto dal Fondo nazionale svizzero per la ricerca (FNS). Marco Bueter e Thomas Lutz A ulteriore beneficiare di un finanziamento dal National Institute of Health (NIH) e dal Centro Zurigo Integrativa Fisiologia Umana (ZIHP). Carel Le Roux W è stata sostenuta da un Dipartimento di Salute premio scienziato medico. Imperial College di Londra riceve il sostegno del regime di finanziamento NIHR Biomedical Research Centre.

1. Cura preoperatoria <ol><li> Togliere gli alimenti dal ratto durante la notte prima dell&#39;intervento. </li><li> Indurre l&#39;anestesia in camera con il 4-5% del flusso isoflurano e O2 di 2 l / min. </li><li> Shave addome da sterno al bacino con rasoio elettrico. </li><li> Mettere ratto anestetizzato in posizione supina sul pad riscaldamento isotermico. </li><li> Applicare una pomata oculare (Vitagel) prima di mettere il muso dei ratti in dell&#39;ogiva. </li><li> Mantenere l&#39;anestesia con isoflurano concentrazione del 2-3% e il flusso O2 di 2 l / min. </li><li> Disinfettare la cute con Betadine-Solution. </li><li> Confermare la profondità dell&#39;anestesia, con un pizzico pinze tra le dita della zampa posteriore. </li><li> Somministrare 5,7 mg / kg per via intraperitoneale Enrofloxacin come profilassi antibiotica perioperatoria, e 1 mg / kg Flunixin per l&#39;analgesia. </li></ol> 2. La laparotomia mediana <ol><li> Eseguire un&#39;incisione mediana con bisturi a partire proprio sotto processo xifoideo (lama n ° 10). </li><li> Mobilitare la pelle circonferenzialmente da Sottolinying muscoli addominali con le forbici Metzenbaum. </li><li> Aprire cavità addominale. </li><li> Installare divaricatori per facilitare l&#39;esposizione ottimale del campo operatorio. </li></ol> 3. Biliopancreatica e arti Alimentare <ol><li> Identificare dove duodeno o del digiuno prossimale passa sotto il colon. </li><li> Transetto del piccolo intestino di circa 10 cm aborally da qui e legare entrambe le estremità del budello (PDS 5-0). </li><li> Posizionare moncone prossimale delle due estremità in quadrante superiore sinistro dell&#39;addome come sarà successivamente usate per formare la parte biliopancreatica di Roux-en-Y ricostruzione. </li><li> Posizionare moncone distale delle due estremità in quadrante superiore destro dell&#39;addome come sarà successivamente usate per formare la parte alimentare di Roux-en-Y ricostruzione. </li></ol> 4. Jejuno-digiunostomia <ol><li> Identificare con valvola ileocoecal cieco e l&#39;ileo. </li><li> Seguire ileo per via orale per circa 25 cm. Il Jejuno-digiunostomia verrà inserito qui come punto di partenzadel canale comune di Roux-en-Y ricostruzione. </li><li> Recuperare arto biliopancreatica dal quadrante superiore sinistro dell&#39;addome e posizionarla vicino al canale comune dove si prevede di eseguire Jejuno-digiunostomia. </li><li> Biliopancreatica arto sicura e canale comune con ritenzione punto (PDS 6-0). </li><li> Incidere entrambi i cicli più di circa 10 mm con micro con le forbici. </li><li> Creare Jejuno-digiunostomia eseguendo da lato a lato anastomosi con suture interrotte PDS (6-0). </li><li> Primo lato dorsale e completa poi il lato ventrale della anastomosi. </li></ol> 5. Tasca gastrica <ol><li> Identificare giunzione gastro-esofagea. </li><li> Mobilitare questa area dissezione gastro-epatiche e gastro-splenica legamenti con le forbici Metzenbaum. </li><li> Spostare a sinistra dell&#39;arteria gastrica e fibre vagali di sinistra para-esofagea fascio lateralmente per evitare sanguinamenti maggiori e danni del nervo vagale quando piccola tasca gastrica è stato creato. </li><li> Esporre gastro-esofageo junction mettendo un batuffolo di cotone retro-oesophageally. </li><li> Coagulare piccoli vasi dello stomaco frontale mediante dispositivo di cauterizzazione disponibile in commercio - anche per prevenire emorragie. </li><li> Transetto stomaco circa 5 mm al di sotto gastro-esofageo giunzione creando tasca gastrica di una dimensione non superiore al 2-3% della dimensione originale utilizzando stomaco delicati, forbici curve. </li><li> Chiudi gastrico residuo (PDS 5-0). </li></ol> 6. Gastro-digiunostomia <ol><li> Recuperare arto alimentare dal quadrante superiore destro dell&#39;addome e posizionarla vicino al tasca gastrica. </li><li> Creare Gastro-digiunostomia eseguendo end-to-side anastomosi (PDS 7-0). </li><li> Prima lato posteriore completa e poi il lato anteriore di anastomosi. </li></ol> 7. Chiusura addominale <ol><li> Ridurre l&#39;anestesia, riducendo la concentrazione isoflurano a 1,5%. </li><li> Primo strato muscolare della parete addominale con suture continue PDS (4-0). </li><li> Somministrare 100 pl di 0,3 mg / mlsoluzione di buprenorfina per via sottocutanea per analgesia. </li><li> Inoltre ridurre la concentrazione di isoflurano fino a 1%. </li><li> Chiudere la pelle con punti staccati Vicryl (4-0). </li></ol> 8. Cura postoperatoria <ol><li> Fermare isoflurano e continuare con O2. </li><li> Somministrare 5 ml di soluzione salina calda per la sostituzione del fluido in tre depositi sottocutanei. </li><li> Rat posizione sotto la luce rossa fino al recupero completo. </li><li> Ritorna il ratto alla gabbia a casa. </li></ol> 9. Risultati rappresentativi Animali e abitazioni Ratti maschi Wistar (Harlan Laboratories Inc., Prugnolo, UK;. Elevage Janvier, Le-Genest-St Isola, Francia) di peso compreso tra 350 e 500 g sono stati alloggiati individualmente sotto un h 12/12 h ciclo luce-buio a temperatura ambiente di 21 ± 2 ° C. Acqua e standard di chow erano disponibili ad libitum, salvo diversa indicazione. Tutti gli esperimenti sono stati eseguiti sotto una licenza rilasciata dalla Casa Office, UK (PL70-6669) o approvati dal veterinario del Cantone di Zurigo, Svizzera. Tutti i ratti hanno dato una settimana di ambientamento prima di essere randomizzati a bypass gastrico o sham-operation. Dopo l&#39;intervento chirurgico, i ratti hanno ricevuto una dieta liquida per 3 giorni prima l&#39;accesso alla normalità Chow è stato reinstallato. Peso corporeo I dati del nostro modello bypass gastrico ratto sono coerenti con i precedenti risultati che la chirurgia di bypass gastrico è efficace per ridurre il peso corporeo e in particolare per mantenere la perdita di peso corporeo (Figura 2). Media pre-operatoria di peso corporeo di ratti utilizzati per il bypass gastrico e sham-operazioni è stata simile (sham: 433,4 ± 8,3 g vs bypass: 420,7 ± 8,4 g, p = 0,28). Cinque giorni dopo l&#39;intervento sham comandi azionati pesato significativamente più rispetto ai ratti di bypass gastrico (sham: 422,2 ± 8,3 g vs bypass: 374,7 ± 7,6 g, p &lt;0,001). Il giorno postoperatorio 60, la differenza del peso corporeo era quasi 170 g (sham: 533,2 ± 8,1 g vs bypass: 366,2 ± 10,8 g, p &lt;0,001). Assunzione di cibo L&#39;assunzione di cibo andamento simile come peso corporeo e ridotta nei ratti bypass gastrico rispetto al sham azionati ad libitum ratti alimentati. Figura 3 mostra il consumo medio giornaliera cibo per entrambi i gruppi (postoperatoria giorni 1-60). L&#39;assunzione di cibo giornaliera è stata costantemente inferiore dopo bypass gastrico (sham: 29,9 ± 0,2 g vs bypass: 25,7 ± 0,3 g, p &lt;0,001). Gut ormoni Sangue da tutti i ratti sono stati raccolti il giorno del termine dello studio 8,16. Gli animali avevano ad libitum l&#39;accesso al cibo la sera prima e sono stati decapitati all&#39;inizio del ciclo di luce giorno post-operatorio 60. Il sangue è stato ottenuto, immediatamente centrifugati a 3000 rpm per 10 minuti a 4 ° C, e conservato a -20 ° C fino a quando i campioni sono stati analizzati in duplicato in un unico passaggio. PYY immunoreattività simile era meavati con un saggio radioimmunologico specifico e sensibile, che misura, sia la lunghezza (PYY1-36) e il frammento (PYY3-36). GLP-1 è stata misurata mediante stabilito in-house radioimmunologici 17,18. Le differenze di assunzione di cibo può essere in parte spiegato da un aumento dei livelli plasmatici postprandiali di peptide YY (PYY) e il peptide glucagone-simile 1 (GLP-1) come ratti di bypass gastrico hanno mostrato livelli significativamente più elevati per PYY (Sham: 26 ± 2 pmol / L vs . bypass: 141 ± 14 pmol / L, p &lt;0,001) e GLP-1 (sham: 40 ± 5 pmol / L vs bypass: 215 ± 23 pmol / L, p &lt;0,001; Figura 4). <img alt="Figura 1" src="/files/ftp_upload/3940/3940fig1.jpg" /> Figura 1. Anatomia di bypass gastrico. Schema di anatomia piccolo intestino prima (A) e dopo (B) un&#39;operazione di bypass gastrico. Le diverse sfumature di rosso rappresentano approssimativamente corrispondenti segmenti del piccolo intestino con il rosso che rappresenta il mezzo di foregut(Esofago, stomaco, duodeno e digiuno prossimale), la luce rossa che rappresenta il midgut (digiuno prossimale e media, ileo prossimale) ed il rosso scuro che rappresenta la hindgut (ileo, cieco). <img alt="Figura 2" src="/files/ftp_upload/3940/3940fig2.jpg" /> Figura 2. . Perdita di peso corporeo dopo chirurgia di bypass gastrico nei ratti cambio del peso del corpo per un gruppo rappresentativo di ratti dopo bypass gastrico (-) (n = 52) e sham-operati ratti (-) (n = 52) durante un periodo di osservazione 60 giorni. I dati sono stati raccolti da pubblicazioni precedenti 6,8-10 e sono mostrati come valori medi ± SEM (*** = p &lt;0,001). <img alt="Figura 3" src="/files/ftp_upload/3940/3940fig3.jpg" /> Figura 3. Assunzione di cibo media dopo l&#39;intervento chirurgico di bypass gastrico nei ratti. Media giornaliera di alimenti di un gruppo rappresentativo di ratti dopo bypass gastrico (nero, n = 52) e sham-operati ratti (bianco, n = 52) per tutta laperiodo post-operatorio di 60 giorni. I dati sono stati raccolti da pubblicazioni precedenti 6,8-10 e sono mostrati come valori medi ± SEM. <img alt="Figura 3" src="/files/ftp_upload/3940/3940fig3.jpg" /> Figura 4. Postprandiale PYY e GLP-1 i livelli sierici dopo l&#39;intervento chirurgico di bypass gastrico post-prandiale nei ratti. PYY e il livello di GLP-1 nel siero per i ratti di bypass gastrico (nero, n = 18) e sham-operati ratti (bianco, n = 22). I dati sono stati raccolti da pubblicazioni precedenti 8,16 e sono mostrati come valori medi ± SEM.

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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>

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La Roux-en-Y bypass gastrico procedura per l&#39;uomo è stato descritto da Mason nel 1967 e modificato nella sua forma attuale Torres nel 1983 19. Attualmente, la procedura consiste in una piccola tasca gastrica e il bypass dell&#39;intestino prossimale di piccole dimensioni. Una illustrazione schematica dell&#39;anatomia pre-e post-operatoria è riportato in figura 1. Il bypass gastrico nell&#39;uomo induce e mantiene la perdita di peso corporeo di circa il 15-3...

<table border="1"><tbody><tr><td> Nome generico </td><td> Marca </td><td> Azienda </td><td> Numero di catalogo </td></tr><tr><td> Enrofloxacina </td><td> Baytril 2,5% </td><td> Provet AG </td><td> 1036 </td></tr><tr><td> Flunixin </td><td> Finadyne </td><td> Graeub </td><td> 908040 </td></tr><tr><td> Buprenorfina </td><td> Temgesic </td><td> Reckitt Benckiser </td><td> 138976 </td></tr><tr><td> Isoflurano </td><td> IsoFlo </td><td> Graeub </td><td> 902035 </td></tr><tr><td> Vitamina A </td><td> Vitagel </td><td> Bausch &amp; Lomb </td><td> 690 </td></tr><tr><td> Soluzione di iodio </td><td> Betadine </td><td> Mundipharma </td><td> 111141 </td></tr><tr><td> NaCl 0,9% </td><td> NaCl 0,9% </td><td> B. Braun </td><td> 534534 </td></tr></tbody></table> Tabella 1. Droga. <table border="1"><tbody><tr><td> Nome </td><td> Dimensione </td><td> Azienda </td><td> Numero di catalogo </td></tr><tr><td> PDS II </td><td> 4-0 </td><td> Ethicon </td><td> Z924H </td></tr><tr><td> PDS II </td><td> 5-0 </td><td> Ethicon </td><td> Z925H </td></tr><tr><td> PDS II </td><td> 6-0 </td><td> Ethicon </td><td> PUU2971E </td></tr><tr><td> PDS II </td><td> 7-0 </td><td> Ethicon </td><td> Z1370E </td></tr><tr><td> Vicryl </td><td> 4-0 </td><td> Ethicon </td><td> V451H </td></tr></tbody></table> Tabella 2. Punti di sutura. <table border="1"><tbody><tr><td> Nome </td><td> Azienda </td><td> Numero di catalogo </td></tr><tr><td> Scalpel maniglia No. 3 </td><td> Aesculap </td><td> BB073R </td></tr><tr><td> Lame di bisturi No. 10 </td><td> Swann-Morton </td><td> 0301 </td></tr><tr><td> Porta aghi </td><td> Aesculap </td><td> BM124R </td></tr><tr><td> Tessuto pinza </td><td> Aesculap </td><td> BD555R </td></tr><tr><td> Forbici Metzenbaum, diritto </td><td> Aesculap </td><td> BC022R </td></tr><tr><td> Metzenbaum forbici, curvo </td><td> Aesculap </td><td> BC023R </td></tr><tr><td> Forbici curve delicate, </td><td> Aesculap </td><td> BC061R </td></tr><tr><td> Pinza arteria, curvo </td><td> Aesculap </td><td> BH109R </td></tr><tr><td> Pinze arterie, curve, denti 1x2 </td><td> Aesculap </td><td> BH121R </td></tr><tr><td> Probe, doppio attacco </td><td> Aesculap </td><td> BN113R </td></tr><tr><td> Porta aghi Micro </td><td> Aesculap </td><td> FM 541R </td></tr><tr><td> Micro pinza </td><td> Aesculap </td><td> FM571R </td></tr><tr><td> Micro forbici </td><td> AESCulap </td><td> FM470R </td></tr><tr><td> Occhio cautery monouso </td><td> John Weiss internazionale </td><td> 0111122 </td></tr><tr><td> Cotton fioc </td><td> Hartmann AG </td><td> 9679369 </td></tr></tbody></table> Tabella 3. Attrezzature chirurgiche.

roux-en-y gastric bypass operation in rats

Attualmente, la terapia più efficace per il trattamento dell&#39;obesità patologica per indurre significativi e mantenuto la perdita di peso corporeo con un beneficio sulla mortalità provata è di 1,2 chirurgia bariatrica. Di conseguenza, si è registrato un costante aumento del numero di operazioni effettuate obesi in tutto il mondo negli ultimi anni, con la Roux-en-Y bypass gastrico (bypass gastrico) è la più comunemente eseguita funzionamento 3. In questo contesto, è importante comprendere i meccanismi fisiologici con cui bypass gastrico induce e mantiene la perdita di peso corporeo. Questi meccanismi non sono ancora pienamente compreso, ma possono includere la fame ridotti e una maggiore sazietà 4,5, l&#39;aumento della spesa di energia 6,7, la preferenza per il cibo modificato ad alto contenuto di grassi e zuccheri 8,9, il sale e il trattamento dell&#39;acqua alterata del rene 10 come così come alterazioni della flora intestinale 11. Tali cambiamenti osservati dopo bypass gastrico può almeno in parte derivano dal modo in cuila chirurgia altera l&#39;ambiente ormonale bypass gastrico perché aumenta il rilascio postprandiale di peptide-YY (PYY) e glucagone-simile-peptide-1 (GLP-1), ormoni che vengono rilasciati dall&#39;intestino in presenza di sostanze nutritive e che riducono mangiare 12. Negli ultimi due decenni numerosi studi utilizzando ratti sono stati eseguiti per investigare ulteriormente cambiamenti fisiologici dopo bypass gastrico. Il bypass gastrico modello di ratto ha dimostrato di essere uno strumento prezioso, non sperimentale, almeno per quanto imita da vicino il profilo temporale e l&#39;entità della perdita di peso umano, ma anche permette ai ricercatori di controllare e manipolare critici fattori anatomici e fisiologici, compreso l&#39;uso di controlli adeguati. Di conseguenza, esiste una vasta gamma di modelli di ratto di bypass gastrici disponibili in letteratura recensione altrove in dettaglio 13-15. La descrizione della tecnica chirurgica esatta di questi modelli varia ampiamente e differisce per esempio in termini di dimensioni sacchetto, artolunghezze, e la conservazione del nervo vagale. Se riferito, i tassi di mortalità sembrano variare da 0 a 35% 15. Inoltre, la chirurgia è stata effettuata quasi esclusivamente in ratti maschi di ceppi differenti ed età. Diete pre-e post-operatorio varia anche in modo significativo. Variazioni tecniche e sperimentali in modelli di bypass gastrico di ratto pubblicato complicare il confronto e l&#39;identificazione dei potenziali meccanismi fisiologici coinvolti nel bypass gastrico. Non vi è alcuna chiara evidenza che uno di questi modelli è superiore, ma c&#39;è un bisogno emergente per la standardizzazione delle procedure per ottenere dati omogenei e comparabili. Questo articolo si propone quindi di riassumere e discutere i dettagli tecnici e sperimentale del nostro modello validato e pubblicato rat bypass gastrico.

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

Numerosi studi che utilizzano modelli di ratto di bypass gastrico sono stati recentemente condotti per scoprire i meccanismi fisiologici alla base di Roux-en-Y operazioni di bypass gastrico. Questo articolo mira a dimostrare e discutere i dettagli tecnici e sperimentale del nostro modello di ratto pubblicato bypass gastrico per capire vantaggi e limiti di questo strumento sperimentale.

Roux-en-Y operazione di bypass gastrico in Rats

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

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23.4K Views.  University Hospital Zürich. Numerosi studi che utilizzano modelli di ratto di bypass gastrico sono stati recentemente condotti per scoprire i meccanismi fisiologici alla base di Roux-en-Y operazioni di bypass gastrico. Questo articolo mira a dimostrare e discutere i dettagli tecnici e sperimentale del nostro modello di ratto pubblicato bypass gastrico per capire vantaggi e limiti di questo strumento sperimentale.

Video: 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.

Tecniche di sleeve gastrectomy e modificata Roux-en-Y bypass gastrico nei topi

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 ...

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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.

Esclusione cardiopolmonare in un modello murino: un nuovo approccio

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.

Esclusione gastrica di un-anastomosi (OAGB) in ratti

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.

Un protocollo per il bypass gastrico Roux-en-Y nei ratti che utilizza cucitrici lineari

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.

Pancreatectomia centrale robotica con 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 ...

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.

Bypass duodeno-ileale a singola anastomosi con modello di gastrectomia a manica nei topi

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

Tecnica ecografica gastrica per mitigare il rischio di aspirazione peri-procedurale

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.

Autore in primo piano: Ecografia point-of-care per la valutazione del contenuto gastrico e la stratificazione del rischio nell'assistenza perioperatoria 

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.

Ecografia gastrica point of care negli adulti: acquisizione e interpretazione delle immagini

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