Marco Bueter e Florian Seyfried foram apoiados pelo Deutsche Forschungsgemeinschaft (DFG). A Thomas Lutz foi apoiado pela Fundação de Pesquisa Nacional Suíço (SNF). Marco Bueter e Thomas A. Lutz ainda receber financiamento do National Institute of Health (NIH) e do Centro de Zurique de Fisiologia Humana Integrativa (ZIHP) Carel le Roux W foi apoiada por um Department of Health prêmio cientista médico. Imperial College de Londres recebe o apoio da Investigação Biomédica NIHR regime de financiamento Centro.

1. Cuidados Pré-Operatórios <ol><li> Remover comida de rato durante a noite antes da cirurgia. </li><li> Indução da anestesia em câmara com fluxo de 4-5% isoflurano e O2 de 2 l / min. </li><li> Shave abdome do esterno às pélvis usando barbeador elétrico. </li><li> Coloque rato anestesiado em decúbito dorsal sobre a almofada de aquecimento isotérmico. </li><li> Aplicar pomada (Vitagel) antes de colocar focinho dos ratos em nosecone. </li><li> Manter a anestesia com isoflurano concentração de 2-3% e fluxo de O2 de 2 l / min. </li><li> Desinfectar a pele com Betadine Solução. </li><li> Confirme profundidade da anestesia com uma pinça pitada entre os dedos da pata traseira. </li><li> Administrar 5,7 mg / kg por via intraperitoneal Enrofloxacina como profilaxia antibiótico perioperatória e 1 flunixin mg / kg para analgesia. </li></ol> 2. Laparotomia mediana <ol><li> Realizar incisão mediana usando bisturi começando logo abaixo processo xifóide (Blade No. 10). </li><li> Mobilizar pele circunferencialmente de Sublinharying músculos abdominais utilizando tesoura Metzenbaum. </li><li> Abra cavidade abdominal. </li><li> Instale retratores para facilitar a exposição da melhor forma possível o campo de operação. </li></ol> 3. Biliopancreática e Limb Alimentar <ol><li> Identificar onde o jejuno proximal duodeno ou passa sob o cólon. </li><li> Transecão intestino delgado cerca de 10 cm aborally a partir daqui e ligar ambas as extremidades do intestino (PDS 5-0). </li><li> Coloque coto proximal das duas extremidades do quadrante superior esquerdo do abdómen, como será mais tarde utilizados para formar o membro biliopancreática de reconstrução de Roux-Y. </li><li> Coloque coto distai das duas extremidades do quadrante superior direito do abdómen, como será mais tarde utilizados para formar o membro alimentar de reconstrução de Roux-Y. </li></ol> 4. Jejuno-jejunostomia <ol><li> Identificar ceco com válvula ileocoecal e íleo. </li><li> Seguir íleo por via oral durante cerca de 25 centímetros. O jejuno-jejunostomia será colocado aqui como ponto de partidado canal comum de reconstrução Roux-en-Y. </li><li> Recuperar membro biliopancreática de quadrante superior esquerdo do abdome, e posicioná-lo próximo ao canal comum, onde você pretende executar jejuno-jejunostomia. </li><li> Membro biliopancreatic segura e canal comum com a retenção de ponto (PDS 6-0). </li><li> Incisar ambos os loops mais de 10 mm aproximada usando uma tesoura micro. </li><li> Criar jejuno-jejunostomia através da realização de um lado para outro-anastomose com sutura interrompida (PDS 6-0). </li><li> Lateral completa primeira dorsal e ventral, em seguida, do lado de anastomose. </li></ol> 5. Bolsa gástrica <ol><li> Identificar junção gastro-esofágico. </li><li> Mobilizar nesta área dissecando ligamentos gastro-hepáticas e gastro-esplênico usando uma tesoura Metzenbaum. </li><li> Mova artéria gástrica esquerda e fibras vagais de pacote para-esofágica esquerdo lateralmente para evitar sangramentos maiores e danos nos nervos vagal quando pequena bolsa gástrica é criado. </li><li> Exponha gastro-esofágico junction colocando cotonete retro-oesophageally. </li><li> Coagular pequenos vasos do estômago frontal usando cautério comercialmente disponível - também para evitar hemorragias. </li><li> Transecão estômago cerca de 5 mm abaixo da junção gastro-esofágico criando bolsa gástrica de um tamanho de não mais do que 2-3% do tamanho do estômago original usando delicadas, tesouras curvas. </li><li> Fechar gástrica remanescente (PDS 5-0). </li></ol> 6. Gastro-jejunostomia <ol><li> Recuperar tubo alimentar de quadrante superior direito do abdômen e posicioná-lo próximo a bolsa gástrica. </li><li> Criar gastro-jejunostomia através da realização de término-lateral-anastomose (PDS 7-0). </li><li> Primeira parte de trás completa e, em seguida, parte da frente da anastomose. </li></ol> 7. Encerramento abdominal <ol><li> Reduzir a anestesia por reduzir a concentração de isoflurano a 1,5%. </li><li> Feche camada muscular da parede abdominal com sutura contínua (PDS 4-0). </li><li> Administrar 100 uL de 0,3 mg / mlsolução de buprenorfina por via subcutânea para analgesia. </li><li> Reduzir ainda mais a concentração de isoflurano para baixo para 1%. </li><li> Feche a pele usando suturas interrompidas (Vicryl 4-0). </li></ol> 8. Cuidados Pós-Operatórios <ol><li> Pare de isoflurano e continuar com a O2. </li><li> Administrar 5 ml de solução salina quente para a substituição do fluido em três depósitos subcutâneos. </li><li> Rato posição sob luz vermelha até a recuperação completa. </li><li> Devolva o rato para gaiola. </li></ol> 9. Os resultados representativos Animais e habitação Ratos Wistar machos (Harlan Laboratories Inc., Blackthorn, Reino Unido,. Elevage Janvier, Le-Genest-St Isle, França) com peso entre 350 e 500 g foram alojados individualmente em / 12 a 12 h h ciclo claro-escuro a uma temperatura ambiente de 21 ± 2 ° C. Água e ração padrão foram disponíveis ad libitum, salvo indicação em contrário. Todos os experimentos foram realizados sob uma licença emitida pelo Offi Inícioce, Reino Unido (PL70-6669) ou aprovado pelo Serviço Veterinário do cantão de Zurique, na Suíça. Todos os ratos receberam uma semana de aclimatação antes de ser randomizados para bypass gástrico ou operação simulada. Após a cirurgia, os ratos receberam a dieta líquida durante 3 dias antes de o acesso a comida normal foi reinstalado. O peso corporal Dados do nosso modelo de derivação rato gástrico são consistentes com os resultados anteriores de que a cirurgia de bypass gástrico é eficaz para reduzir o peso corporal e, especialmente, para manter a perda de peso corporal (Figura 2). Peso corporal médio pré-cirúrgica de ratos para realização de bypass gástrico e simulada operações foi semelhante (farsa: 433,4 ± 8,3 g vs bypass: 420,7 ± 8,4 g, p = 0,28). Cinco dias após a cirurgia sham-operados controles pesaram significativamente mais em comparação com ratos bypass gástrico (sham: 422,2 ± 8,3 g vs bypass: 374,7 ± 7,6 g, p &lt;0,001). Após 60 dias, a diferença de peso corporal era quase 170 g (sham: 533,2 ± 8,1 g vs bypass: 366,2 ± 10,8 g, p &lt;0,001). A ingestão de alimentos A ingestão de alimentos seguido padrões semelhantes como peso do corpo e foi reduzido em ratos bypass gástrico quando comparado com o sham operados ad libitum ratos. Figura 3 mostra a ingestão de alimentos diária média para ambos os grupos (dias pós-operatória 1-60). Ingestão diária de alimentos foi consistentemente menor após o bypass gástrico (sham: 29,9 ± 0,2 g vs bypass: 25,7 ± 0,3 g, p &lt;0,001). Gut hormônios Sangue de todos os ratos foram coletadas no dia da final do estudo 8,16. Os animais tinham acesso ad libitum alimentos a noite antes e foram decapitados no início do ciclo de luz no dia pós-operatório 60. O sangue foi obtido, imediatamente centrifugado a 3000 rpm durante 10 minutos a 4 ° C, e armazenadas a -20 ° C até que as amostras foram ensaiadas em duplicado num único ensaio. PYY-like imunorreatividade foi medidomedido com um radioimunoensaio específico e sensível, que mede, tanto o comprimento total (PYY1-36) e do fragmento (PYY3-36). O GLP-1 foi medida por estabelecida in-house radioimunoensaios 17,18. Diferenças na ingestão de alimentos pode ser parcialmente explicada pelo aumento dos níveis plasmáticos pós-prandiais de peptídeo YY (PYY) e glucagon-like peptide 1 (GLP-1) como ratos bypass gástrico apresentaram níveis significativamente mais elevados para 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="A Figura 1" src="/files/ftp_upload/3940/3940fig1.jpg" /> Figura 1. Anatomia de bypass gástrico. Ilustração esquemática da anatomia do intestino delgado antes (A) e após (B) operação de bypass gástrico. Os diferentes tons de vermelho representam cerca de segmentos correspondentes do intestino delgado com o vermelho que representa o meio foregut(Esôfago e duodeno, estômago e jejuno proximal), a luz vermelha que representa o intestino (jejuno proximal e médio, íleo proximal) eo vermelho escuro representando o intestino posterior (íleo, ceco). <img alt="A Figura 2" src="/files/ftp_upload/3940/3940fig2.jpg" /> Figura 2. . Perda de peso corporal após a cirurgia de bypass gástrico em ratos mudança de peso corporal para um grupo representativo de ratos após derivação gástrica (-) (n = 52) e sham-operado ratos (-) (n = 52) ao longo de um período de observação de 60 dias. Os dados foram reunidos a partir de publicações anteriores 6,8-10 e são mostrados como valores médios ± SEM (*** = p &lt;0,001). <img alt="A Figura 3" src="/files/ftp_upload/3940/3940fig3.jpg" /> Figura 3. Consumo alimentar médio após a cirurgia de bypass gástrico em ratos. Ingestão alimentar média diária de um grupo representativo de ratos após o bypass gástrico (preto, n = 52) e sham-operado ratos (branco, n = 52) ao longo de umpós-operatório de 60 dias. Os dados foram reunidos a partir de publicações anteriores 6,8-10 e são mostrados como valores da média ± SEM. <img alt="A Figura 3" src="/files/ftp_upload/3940/3940fig3.jpg" /> Figura 4. PYY pós-prandial e GLP-1 níveis séricos após a cirurgia de bypass gástrico em ratos. PYY pós-prandial e nível de GLP-1 no soro para os ratos de bypass gástrico (preto, n = 18) e sham operados ratos (branco, n = 22). Os dados foram reunidos a partir de publicações anteriores 8,16 e são mostrados como valores da média ± 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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O procedimento de Roux-en-Y bypass gástrico em humanos foi primeiramente descrita por Mason em 1967 e modificada em sua forma atual por Torres em 1983 19. Actualmente, o processo consiste em uma pequena bolsa gástrica e da derivação do intestino delgado proximal. Uma ilustração esquemática da anatomia pré e pós-operatório é dado na Figura 1. Bypass gástrico em humanos induz e mantém a perda de peso de cerca de 15-30% 2. A maioria do peso co...

<table border="1"><tbody><tr><td> Nome genérico </td><td> Marca </td><td> Companhia </td><td> Número de catálogo </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> Buprenorphin </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> A vitamina A </td><td> Vitagel </td><td> Bausch &amp; Lomb </td><td> 690 </td></tr><tr><td> Solução de iodo </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> Tabela 1. Drogas. <table border="1"><tbody><tr><td> Nome </td><td> Tamanho </td><td> Companhia </td><td> Número de catálogo </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> Tabela 2. Suturas. <table border="1"><tbody><tr><td> Nome </td><td> Companhia </td><td> Número de catálogo </td></tr><tr><td> Bisturi alça No. 3 </td><td> Aesculap </td><td> BB073R </td></tr><tr><td> Lâminas de bisturi Sem. 10 </td><td> Swann-Morton </td><td> 0301 </td></tr><tr><td> Suporte de agulha </td><td> Aesculap </td><td> BM124R </td></tr><tr><td> Pinça </td><td> Aesculap </td><td> BD555R </td></tr><tr><td> Metzenbaum tesoura, em linha reta </td><td> Aesculap </td><td> BC022R </td></tr><tr><td> Metzenbaum tesoura, curvada </td><td> Aesculap </td><td> BC023R </td></tr><tr><td> Tesouras curvas delicadas, </td><td> Aesculap </td><td> BC061R </td></tr><tr><td> Fórceps da artéria, curvada </td><td> Aesculap </td><td> BH109R </td></tr><tr><td> Fórceps da artéria, curvado, dentes 1x2 </td><td> Aesculap </td><td> BH121R </td></tr><tr><td> Sonda, de duas pontas </td><td> Aesculap </td><td> BN113R </td></tr><tr><td> Suporte de agulha Micro </td><td> Aesculap </td><td> FM 541R </td></tr><tr><td> Micro pinça </td><td> Aesculap </td><td> FM571R </td></tr><tr><td> Micro tesoura </td><td> AESCulap </td><td> FM470R </td></tr><tr><td> Cautério olho descartável </td><td> John Weiss Internacional </td><td> 0111122 </td></tr><tr><td> Cotonetes </td><td> Hartmann AG </td><td> 9679369 </td></tr></tbody></table> Tabela 3. Equipamento cirúrgico.

roux-en-y gastric bypass operation in rats

Atualmente, a terapia mais eficaz para o tratamento da obesidade mórbida para induzir perda de peso significativa e mantida corpo com um benefício comprovado de mortalidade é de 1,2 a cirurgia bariátrica. Consequentemente, tem havido um aumento constante no número de operações bariátricas realizadas em todo o mundo nos últimos anos com o Roux-en-bypass gástrico em Y (bypass gástrico) é a operação mais realizada 3. Neste contexto, é importante entender os mecanismos fisiológicos por que o bypass gástrico induz e mantém perda de peso corporal. Estes mecanismos não são ainda totalmente conhecidos, mas podem incluir fome reduzidos e aumento da saciedade 4,5, maior gasto de energia 6,7, de preferência alterado para alimentos ricos em gordura e açúcar 8,9, sal alterada e tratamento de água do rim 10 como bem como alterações na microbiota intestinal 11. Tais mudanças observadas após bypass gástrico pode pelo menos em parte derivam comoa cirurgia altera o meio hormonal gástrica porque aumenta a libertação pós-prandial de péptido-YY (PYY) e glucagon-like peptide--1 (GLP-1), hormonas que são libertados pelo intestino, na presença de nutrientes e que reduzem a comer 12. Durante as últimas duas décadas, inúmeros estudos com ratos têm sido realizados para investigar alterações fisiológicas após o bypass gástrico. O modelo do rato de bypass gástrico tem provado ser uma ferramenta valiosa não menos experimental, pois imita o perfil de tempo e magnitude da perda de peso humano, mas também permite aos pesquisadores controlar e manipular críticos fatores anatômicos e fisiológicos, incluindo o uso de controles apropriados. Consequentemente, existe uma grande variedade de modelos de ratos bypass gástrico disponíveis na literatura em qualquer outra parte mais detalhe 13-15. A descrição da técnica cirúrgica exacta desses modelos varia amplamente e difere por exemplo, em termos de tamanho da bolsa, o membrocomprimentos, ea preservação do nervo vago. Se relatado, as taxas de mortalidade parecem variar de 0 a 35% 15. Além disso, a cirurgia foi realizada quase exclusivamente em ratos machos de diferentes estirpes e idades. Dietas pré e pós-operatório também variou significativamente. Variações técnicas e experimentais em modelos de ratos publicados gástrica de desvio complicar a comparação e identificação de potenciais mecanismos fisiológicos envolvidos na bypass gástrico. Não há nenhuma evidência clara de que qualquer um destes modelos é superior, mas não há uma necessidade emergente para a normalização do procedimento para a obtenção de dados consistentes e comparáveis. Este artigo visa, portanto, resumir e discutir detalhes técnicos e experimental do nosso modelo de rato previamente validado e publicado bypass gástrico.

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

Numerosos estudos utilizando modelos de ratos bypass gástrico foram recentemente realizados para desvendar os mecanismos fisiológicos subjacentes de Roux-en-Y operações de bypass gástrico. Este artigo visa demonstrar e discutir os detalhes técnicos e experimental da nossa publicado modelo do rato de bypass gástrico para compreender as vantagens e limitações desta ferramenta experimental.

Roux-en-Y operação de bypass gástrico em ratos

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

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JoVE Journal

Medicine

23.4K visualizações.  University Hospital Zürich. Numerosos estudos utilizando modelos de ratos bypass gástrico foram recentemente realizados para desvendar os mecanismos fisiológicos subjacentes de Roux-en-Y operações de bypass gástrico. Este artigo visa demonstrar e discutir os detalhes técnicos e experimental da nossa publicado modelo do rato de bypass gástrico para compreender as vantagens e limitações desta ferramenta experimental.

Vídeo: 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.

Técnicas de gastrectomia vertical e modificado Roux-en-Y bypass gástrico em ratos

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 ...

Medicina

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.

Bypass cardiopulmonar em um modelo do rato: uma nova abordagem

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.

1-anastomose Bypass gástrico (OAGB) em ratos

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.

Um protocolo para bypass gástrico Roux-en-Y em ratos usando grampos lineares

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 Central Robótica com Pancreaticojejunostomia Roux-en-Y

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.

Modelo de Bypass Duodeno-Ileal de Anastomose Única com Gastrectomia Vertical em Camundongos

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

Técnica de ultrassom gástrico para mitigar o risco de aspiração periprocedimento

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.

Autor em destaque: Ultrassom no local de atendimento para avaliação do conteúdo gástrico e estratificação de risco nos cuidados perioperatórios 

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.

Ultrassonografia gástrica em adultos: aquisição e interpretação de imagens

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