We thank Gilles Mithieux and Aude Barataud (INSERM U1213, Lyon, France) and Marie Liabeuf and Stephanie Lemarchand-Minde (Animal facility, l'Institut du Thorax, Nantes, France) for their help with the animal care protocol. This work was supported by grants from La r&#233;gion des Pays de la Loire, the Fondation d'Avenir, and the Casden Bank. We would like to thank Catherine Postic, Fadila Benhamed and Michelle Ca&#252;zac from l'institut Cochin for their hospitality and their help during the filming process.

Animal e habitação: Obter ratos 8 semanas de idade C57BL / 6 do sexo masculino. Às 10 semanas de idade, dê o acesso gratuito camundongos C57BL / 6 para a água e uma dieta rica em gordura (DIO dieta: 35% kcal de gordura, 25,8% caseína, 1,30% AIN mineral, 1,30% de vitaminas, fosfato bicálcico 1,70%, 0,7 carbonato% de cálcio, 2,10% citrato de potássio, 0,026% de bitartrato de colina, 8,9% de sacarose, 0,384% de cistina, 6,5% de celulose, 31,7% de banha, óleo de soja 3,3%, e 16,29% de maltodextrina) para oito (SG) ou 14 (BGYR) semanas antes das cirurgias bariátricas. Para promover o ganho de peso, dar a ratinhos dedicada à cirurgia BGYR (Sham &amp; BGYR) de água contendo 20% de frutose (w / v) em adição à dieta rica em gordura. Declaração de Ética: Todos os passos protocolo descrito a seguir seguir as orientações do Comitê de Ética em Experimentação Animal da Pays de la Loire sob o número de aprovação 01.953,01. 1. Geral pré-operatória Preparação <ol><li> Jejuar ratos durante 6 h antes da cirurgia. gel diet alimentos foi dada 3 dias antes da cirurgia e exclusivamente um dia antes da cirurgia. Induzir a anestesia em uma câmara com 5% de isoflurano (0,4 L / min) e O 2 (dioxigénio; 0,4 L / min). Realizar um teste toe-pitada para confirmar que a anestesia é eficaz. Administrar analgésicos (0,1 mg / kg de buprenorfina), antibióticos (10 mg / kg marbofloxacine), e pró-cinética (de 1 mg / kg de cloridrato de metoclopramida) por meio de injecções subcutâneas. </li><li> Alocar uma área de trabalho específica para procedimentos cirúrgicos (distantes dos fãs de tráfego laboratório e ventilação). Limpar a área cirúrgica com desinfetantes de superfície dura dedicados. Coloque uma almofada de aquecimento na área de espaço de trabalho para manter homeothermy mouse durante a cirurgia. Aplique uma underpad limpo, absorvente sobre a almofada de aquecimento. </li><li> Raspar o abdômen do esterno às pelve usando um barbeador elétrico. Enrole o abdômen do mouse no esterilizados de plástico envoltório (Figuras 1A e 2A) e coloque o mouse na posição supina sobre o aquecimento pde Anúncios. </li><li> Aplicar vet pomada sobre os olhos para evitar a secura e sob anestesia. Colocar o rato dentro do cone de nariz e manter a anestesia com isoflurano a 2% (0,4 L / min) e O 2 (0,4 L / min). </li><li> Antes de iniciar a cirurgia, colocar um avental estéril exame, uma tampa esfrega descartável, uma máscara e luvas estéreis. Abrir um pacote de autoclavada contendo uma esterilizados set instrumento cirúrgico, que é exigido para todas as etapas da cirurgia. Cortar uma janela no filme plástico esterilizado e desinfectar a pele com 2 soluções Iodopovidona sucessivas. </li></ol> 2. gastrectomia vertical: Procedimento Cirúrgico <ol><li> Laparotomia mediana (Figura 1B) <ol><li> Sob um microscópio binocular e com um bisturi, executar uma incisão na linha média a partir do esterno até ao meio do abdómen para abrir a cavidade abdominal (não danificar os músculos abdominais). Proteger a pele com uma compressa esterilizada embebida em solução salina C 37 °. </li></ol></li><li> Exposição do estômago (Figura 1C) <ol><li> Gentilmente mobilizar o estômago usando cotonetes de algodão umedecido. Livre o estômago de suas laterais estreitas anexos de tecido conjuntivo usando cotonetes humedecidos ou micro tesoura. </li><li> Gentilmente, externalizar o estômago totalmente e coloque um colágeno hemostática comprimir atrás do estômago. Sutura do piloro e vasos esófago ao longo da grande curvatura do estômago com 8,0 suturas não absorvíveis para evitar futuro hemorragia (Figura 1D e E). Nota: o uso Hemostat pode induzir dano tecidual, certifique-se apenas para usá-lo em tecido que pretendem ser ressecado. </li></ol></li><li> Ressecção da região cardíaca do estômago (fundo) <ol><li> Executar uma gastrotomia na linha anatômica presente entre a região pilórica (corpus) e na região cardíaca do estômago (fundo) (Figura 1F). </li><li> Retire os alimentos residual com 2 zaragatoas de algodão humedecido em relação uns aoslado do estômago. Utilizando micro-tesoura, cortar o estômago ao longo da fronteira entre o fundo do útero e o corpo do estômago (Figura 1G). </li><li> Pressione uma colágeno hemostática comprimir por 2 min em caso de hemorragia grave. Fechar a abertura do estômago com 8,0 suturas não absorvíveis a partir da junção gastro-esofágico para o fim da incisão (Figura 1H). </li></ol></li><li> Ressecção da região pilórica do estômago (corpus) <ol><li> Conclua a ressecção do estômago ao longo da curvatura maior, de modo a remover aproximadamente 80% do estômago (Figura 1I). Padronizar a largura do SG a 3 mm. Pressione uma colágeno hemostática comprimir por 2 min em caso de hemorragia grave. </li><li> Fechar a abertura da região pilórica do estômago com 8,0 sutura não absorvível (Figura 1J). Agite-2 cotonetes de algodão humedecido no sentido de cada lado do estômago para assegurar que a sutura é à prova de fugas. </li><li>Completo com 8,0 suturas não absorvíveis em caso de vazamento. Retirar as compressas de colagénio hemostáticos e devolver o estômago para a cavidade abdominal. Deixar um colágeno hemostática comprimir contra a sutura. </li></ol></li><li> fechamento abdominal <ol><li> Feche a camada muscular da parede abdominal com 5,0 suturas não-absorvíveis (Figura 1K). Reduzir a anestesia através da redução da concentração de isoflurano a 1%. Feche a pele usando 5,0 suturas não-absorvíveis (Figura 1D). </li></ol></li></ol> 3. Roux-en-Y bypass gástrico: Procedimento Cirúrgico <ol><li> laparotomia mediana <ol><li> Sob um microscópio binocular e com um bisturi, executar uma incisão na linha média a partir do esterno até ao meio do abdómen para abrir a cavidade abdominal (não danificar os músculos abdominais). Proteger a pele com uma compressa estéril embebida com uma solução salina a 37 ° C (Figura 2B). </li></ol> &lt;/ Li&gt; <li> Membro biliopancreática e tubo alimentar <ol><li> Externalizar o intestino (Figura 2C). Medida 8 cm a partir do piloro e executar duas ligaduras do intestino com 5,0 suturas não absorvíveis (Figura 2D). </li><li> Cortar o intestino entre as duas ligaduras (Figura 2E). Coloque o membro proximal das duas extremidades no quadrante superior esquerdo do abdome. Nota: Isto será utilizado como o tubo alimentar (Figura 2F). </li><li> Coloque a parte distal do membro de as duas extremidades de frente para o tubo alimentar 6 cm abaixo do membro proximal (Figura 2F). NOTA: Este valor será usado como o membro biliar. </li></ol></li><li> Jejuno-jejunostomia <ol><li> Cortar tanto o membro proximal e o loop intestino utilizando micro tesouras e fazer duas incisões antimesentéricas do mesmo comprimento (Figura 2G e 2H). </li><li> Executar lado a lado anastomose com dois 8,0suturas não absorvíveis. Realização da anastomose lado dorsal primeiro (Figura 2I), seguido pela anastomose lado ventral (Figura 2J). </li><li> Delicadamente rolar 2 compressas de algodão umedecidos para com cada lado da anastomose para garantir que a sutura é à prova de fugas. Completo com 8,0 suturas não absorvíveis em caso de vazamento. </li></ol></li><li> Gastro-jejunostomia <ol><li> Gentilmente mobilizar o estômago usando cotonetes humedecidos. Livre o estômago de suas laterais estreitas anexos de tecido conjuntivo usando cotonetes humedecidos ou micro tesoura. </li><li> Gentilmente, externalizar o estômago totalmente, colocando um colágeno hemostática re-absorvível comprimir atrás do estômago. Realizar uma ligadura do piloro usando uma sutura 5.0 não absorvível passado através do omento usando micro pinça curva (Figura 2K e 2L). </li><li> Cortar o lado ventral do estômago, a 1,5 cm do piloro, e parte distal do membroutilizando micro-tesoura, criando duas incisões do mesmo comprimento (Figura 2M). </li><li> Execute anastomose lado-a-lado com dois 8,0 suturas não absorvíveis. Comece com a anastomose lado dorsal (Figura 2 N) e, em seguida, executar a anastomose lado ventral (Figura 2O). Delicadamente rolar 2 compressas de algodão embebido em direção cada lado da anastomose para garantir que a sutura é à prova de fugas. Completo com 8,0 suturas não absorvíveis em caso de vazamento. </li></ol></li><li> fechamento abdominal <ol><li> Feche a camada muscular da parede abdominal utilizando 5,0 suturas não-absorvíveis (Figura 2P). Reduzir a anestesia através da redução da concentração de isoflurano a 1%. Fechar a pele usando 5,0 suturas não absorvíveis (Figura 2q) .Administer 25 ml / kg de solução salina quente através de injecção subcutânea. </li></ol></li></ol> 4. Geral Cuidados no pós-operatório <ol><li> pare de isofluranoe continuar com um fluxo de O2 de 0,8 L / min até que o mouse é totalmente acordado. Não deixe o mouse sem vigilância até que ele recupera o controle motor, indicado pela partida animal para mover ao redor da gaiola e ser capaz de ficar de pé e caminhar sem cair. </li><li> Colocar o rato (apenas um rato por gaiola) em uma incubadora sob condições de temperatura de 30 ° C durante 5 dias. </li><li> Manter o ferro (0,5 mg / kg / dia; injecção subcutânea) e vitamina (800 mg / 180 mL em água) a suplementação em ratinhos BGYR até ao final do protocolo. </li><li> Retornar o livre acesso à dieta gel alimentar (dieta com gel alto teor de gordura: 10% de banha, açúcar líquido de 10%, 57% de água) durante 5 dias após a cirurgia. Reintroduzir uma dieta sólida 3 dias após a cirurgia. </li><li> Subcutaneamente injectar buprenorfina (0,1 mg / kg, duas vezes por dia, desde o dia 0 até ao dia 3 após a cirurgia), meloxicam (1 mg / kg, a partir de dia 0 até ao dia 3 após a cirurgia), metoclopramida (1 mg / kg, do dia 0 ao 5 dias após a cirurgia), e marbofloxacine (10 mg / kg, a partir de dia 0 até ao dia 3 afte<html> cirurgia R). </li></ol> Avaliação pós-operatória 5. Metabolic Parâmetros <ol><li> Medição da ingestão de alimentos <ol><li> Permitir que os ratos a recuperar durante uma semana após a cirurgia. Casa a ratinhos um por gaiola. Medir a quantidade de dieta sólida colocado na gaiola. Peso os restantes 24 alimentos h mais tarde. Repita este passo enquanto for necessário. </li></ol></li><li> Teste de tolerância oral à glicose <ol><li> Jejuar ratos durante 6 h antes do bolus oral. Colher uma gota de sangue da ponta da cauda e aplicá-lo sobre uma tira de glucose inserido num glucometer para determinar o tempo de valor de glicose no sangue 0. </li><li> Administrar um bolus por via oral de uma solução de D-glicose a 20% (2 g / kg). Medir os níveis de glicose no sangue aos 15, 30, 60 e 120 min após gavagem. </li></ol></li><li> Análise de nível de hemoglobina <ol><li> Usando um sistema de hematologia, medir 20 mL de sangue fresco para provar o nível de hemoglobina. </li></ol></li></ol>&quot;&gt; 6. Eutanásia <ol><li> Anestesiar os ratos por via intraperitoneal uma solução de injecção de xilazina / cetamina (10/80 mg / kg). Realizar uma luxação cervical. Verifique a eutanásia completa, garantindo que o coração não está batendo eo reflexo de piscar globo ocular está perdido. </li></ol>

<ol>
	<li>Ng, M., Fleming, T., 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=Global,+regional,+and+national+prevalence+of+overweight+and+obesity+in+children+and+adults+during+1980-2013:+a+systematic+analysis+for+the+Global+Burden+of+Disease+Study+2013.">Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013.</a> The Lancet. 384 (9945), 766-781 (2014).</li><li>Calle, E. E., Thun, M. J., Petrelli, J. M., Rodriguez, C., Heath, 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=Body-mass+index+and+mortality+in+a+prospective+cohort+of+U.S.+adults.">Body-mass index and mortality in a prospective cohort of U.S. adults.</a> The New England Journal of Medicine. 341 (15), 1097-1105 (1999).</li><li>Sj&#246;str&#246;m, L., Lindroos, A. K., 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=Lifestyle,+diabetes,+and+cardiovascular+risk+factors+10+years+after+bariatric+surgery.">Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery.</a> The New England Journal of Medicine. 351 (26), 2683-2693 (2004).</li><li>Buchwald, H., Avidor, Y., 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+surgery:+a+systematic+review+and+meta-analysis.">Bariatric surgery: a systematic review and meta-analysis.</a> JAMA. 292 (14), 1724-1737 (2004).</li><li>Yin, D. P., Gao, Q., 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=Assessment+of+different+bariatric+surgeries+in+the+treatment+of+obesity+and+insulin+resistance+in+mice.">Assessment of different bariatric surgeries in the treatment of obesity and insulin resistance in mice.</a> Annals of surgery. 254 (1), 73-82 (2011).</li><li>Buchwald, H., Oien, D. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Metabolic/Bariatric+Surgery+Worldwide+2008.">Metabolic/Bariatric Surgery Worldwide 2008.</a> Obesity Surgery. 19 (12), 1605-1611 (2009).</li><li>Liu, W., Zassoko, R., 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=Establishment+of+duodenojejunal+bypass+surgery+in+mice:+A+model+designed+for+diabetic+research.">Establishment of duodenojejunal bypass surgery in mice: A model designed for diabetic research.</a> Microsurgery. 28 (3), 197-202 (2008).</li><li>Lan, Z., Zassoko, R., 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=Development+of+techniques+for+gastrojejunal+bypass+surgery+in+obese+mice.">Development of techniques for gastrojejunal bypass surgery in obese mice.</a> Microsurgery. , (2010).</li><li>Schlager, A., Khalaileh, A., 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=A+mouse+model+for+sleeve+gastrectomy:+Applications+for+diabetes+research.">A mouse model for sleeve gastrectomy: Applications for diabetes research.</a> Microsurgery. 31 (1), 66-71 (2011).</li><li>Troy, S., Soty, 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=Intestinal+Gluconeogenesis+Is+a+Key+Factor+for+Early+Metabolic+Changes+after+Gastric+Bypass+but+Not+after+Gastric+Lap-Band+in+Mice.">Intestinal Gluconeogenesis Is a Key Factor for Early Metabolic Changes after Gastric Bypass but Not after Gastric Lap-Band in Mice.</a> Cell Metabolism. 8 (3), 201-211 (2008).</li><li>Seyfried, F., Lannoo, 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=Roux-en-Y+gastric+bypass+in+mice--surgical+technique+and+characterisation.">Roux-en-Y gastric bypass in mice--surgical technique and characterisation.</a> Obesity surgery. 22 (7), 1117-1125 (2012).</li></ol>

The authors declare no conflicts of interest.

Para superar a crescente epidemia de obesidade, os primeiros procedimentos de cirurgia bariátrica surgiu na década de 1960 nos Estados Unidos. Desde então, o número de procedimentos realizados anualmente no mundo ainda aumentar, e hoje, estas técnicas representam a melhor opção terapêutica para o tratamento da obesidade mórbida 6. Entre os procedimentos desenvolvidos, SG e RYGB são os dois métodos mais populares usados na prática clínica 4. modelos animais, no...

A pandemia mundial de obesidade e diabetes é devastador em termos de gravidade. Mais de dois mil milhões de adultos em todo o mundo (30% da população) estão com sobrepeso (IMC&gt; 25 kg / m 2) ou obesidade (IMC&gt; 30 kg / m 2) 1. Isto pode vir junto com complicações metabólicas, tais como diabetes tipo 2, hipertensão, dislipidemia e, levando a um aumento da morbidade e mortalidade. A obesidade aumenta o mortalidade geral e a prevalência de câncer 2. Devido à falta de quaisquer tratamentos eficazes não invasivos, cirurgia bariátrica representa a única opção que pode conduzir a longo prazo, a perda de peso sustentada 3, 4. Um número de diferentes métodos cirúrgicos foram desenvolvidos, mas a gastrectomia vertical (SG) e de bypass gástrico Roux-en-Y (RYGB) são os dois procedimentos mais comumente utilizados na prática clínica. Durante o procedimento de SG, 80% do volume inicial do estômago estáremovido; Assim, esta técnica é uma das cirurgias restritivas que melhora a saciedade. O BGYR é uma das técnicas de acordos e de má absorção. Durante BGYR, uma pequena bolsa gástrica (1-2% do volume gástrico total) é criado e o intestino é rearranjado em uma forma de Y, o que retarda a digestão e a absorção de nutrientes. Estas duas técnicas levar a reduções significativas de peso corporal e melhorias gerais na comorbidades frequentemente associados (por exemplo, hipertensão, diabetes tipo 2 e dislipidemia) 3, com uma maior eficiência visto em RYGB. No entanto, os mecanismos moleculares por trás dos efeitos benéficos pleiotrópicos das cirurgias bariátricas muitas vezes não são completamente elucidados. Devido às inúmeras linhagens geneticamente modificados disponíveis, um modelo do rato é o modelo animal mais conveniente para explorar esses mecanismos moleculares. No entanto, os procedimentos bariátricos são difíceis de se adaptar diretamente para modelos animais de pequeno porte e requirE High destreza cirúrgica. Enquanto SG pode ser facilmente realizado em roedores com uma muito boa taxa de sobrevivência, RYGB é letal em camundongos devido a obstruções intestinais graves 5. Diferentes técnicas RYGB modificados têm sido propostos para combater este problema, nomeadamente a oesojejunostomy 5. Aqui, apresentamos uma outra alternativa: o gastrojejunostomy sem excisão estômago. Este BGYR modificado reproduz a maioria dos efeitos benéficos observados em seres humanos (isto é, uma redução de peso de corpo significativa e uma melhoria na glucose e lípidos homeostase). Este manuscrito visa resumir e discutir os detalhes técnicos e experimentais de SG e RYGB em camundongos e facilitar estes procedimentos com a ajuda de vídeos. Um destaque específico será feita em relação a otimização dos protocolos de cuidados de saúde pré-operatórias e pós-operatórias que permitem a redução das deficiências de vitaminas e ferro.

<table><tbody><tr><td>&lt;strong&gt;Drugs&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>High Fat diet</td><td>DIO diet</td><td>Safe</td><td></td></tr><tr><td>Isoflurane</td><td>Forane</td><td>Baxter</td><td></td></tr><tr><td>Buprenorphin</td><td>Buprecare</td><td>Animalcare</td><td></td></tr><tr><td>Marbofloxacine</td><td>Marbocyl</td><td>Vetoquinol</td><td></td></tr><tr><td>Ammonium iron citrate, vitamins PP-B12</td><td>Fercobsang</td><td>Vetoquinol</td><td></td></tr><tr><td>Vitamins A-D3-E-K-B</td><td>Vita Rongeur</td><td>Virbac</td><td></td></tr><tr><td>NaCl 0.9%</td><td>NaCl 0,9%</td><td></td><td></td></tr><tr><td>Povidone solution</td><td>Betadine Scrub</td><td>Betadine</td><td></td></tr><tr><td>Povidone solution</td><td>Betadine Solution</td><td>Betadine</td><td></td></tr><tr><td>Carboptol 980 NF</td><td>Ocrygel</td><td>TVM</td><td></td></tr><tr><td>&lt;strong&gt;Name&lt;/strong&gt;</td><td>&lt;strong&gt;References&lt;/strong&gt;</td><td>&lt;strong&gt;Company&lt;/strong&gt;</td><td>&lt;strong&gt;Comments&lt;/strong&gt;</td></tr><tr><td>&lt;strong&gt;Sutures&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Prolene&amp;reg;</td><td>8.0, 6,5 mm</td><td>Ethicon</td><td></td></tr><tr><td>Prolene&amp;reg;</td><td>5.0, 13 mm</td><td>Ethicon</td><td></td></tr><tr><td>&lt;strong&gt;Name&lt;/strong&gt;</td><td>&lt;strong&gt;References&lt;/strong&gt;</td><td>&lt;strong&gt;Company&lt;/strong&gt;</td><td>&lt;strong&gt;Comments&lt;/strong&gt;</td></tr><tr><td>&lt;strong&gt;Surgical equipments&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Scissors</td><td></td><td>FST</td><td></td></tr><tr><td>Needle holder</td><td>Olsen-Hegar</td><td>FST</td><td></td></tr><tr><td>Micro scissors</td><td>Vannas</td><td>FST</td><td></td></tr><tr><td>Micro forceps&amp;nbsp;</td><td>Graefe</td><td>FST</td><td></td></tr><tr><td>Micro forceps curved</td><td>Graefe</td><td>FST</td><td></td></tr><tr><td>Curved micro needle holder</td><td>Castroviejo</td><td>FST</td><td></td></tr><tr><td>Hemostatic collagen compress</td><td>Pangen</td><td>Urgo</td><td></td></tr><tr><td>Absorbent underpads</td><td></td><td>VWR</td><td></td></tr><tr><td>&lt;strong&gt;Name&lt;/strong&gt;</td><td>&lt;strong&gt;References&lt;/strong&gt;</td><td>&lt;strong&gt;Company&lt;/strong&gt;</td><td>&lt;strong&gt;Comments&lt;/strong&gt;</td></tr><tr><td>&lt;strong&gt;Specific equipments&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Hematology system&amp;nbsp;</td><td>Hemavet 950FS</td><td>Hemavet</td><td></td></tr><tr><td>Glucose strips and glucometer</td><td>One touch Verio</td><td>Life scan</td><td></td></tr><tr><td>Stereo microscope</td><td>MZ6</td><td>Leica&amp;nbsp;</td><td></td></tr></tbody></table>

techniques of sleeve gastrectomy and modified roux-en-y gastric bypass in mice

A obesidade é um problema de saúde pública, com uma prevalência de 4-28% para os homens e 6,2-36,5% para as mulheres na Europa (2003-2008). A obesidade mórbida é frequentemente associada a complicações metabólicas, como diabetes tipo 2, hipertensão e dislipidemia, reduzindo a expectativa de vida e qualidade. Na ausência de quaisquer tratamentos não invasivos eficazes, a cirurgia bariátrica é uma opção terapêutica valiosa para pacientes com obesidade mórbida (índice de massa corporal (IMC)&gt; 40 kg / m 2), levando a longo prazo, sustentado perda de peso e melhorias em complicações metabólicas . No entanto, os mecanismos celulares e moleculares subjacentes à sustentação dos efeitos benéficos da cirurgia bariátrica não são ainda totalmente compreendidas. Devido às inúmeras linhagens geneticamente modificados disponíveis, o modelo de rato é o modelo animal mais conveniente para explorar os mecanismos moleculares por trás dos efeitos benéficos pleiotrópicos das cirurgias bariátricas. Aqui, detalhou o healthc otimizadasão métodos e protocolos cirúrgicos em ratos para as duas cirurgias bariátricas mais utilizados: a gastrectomia vertical e do bypass gástrico Roux-en-Y modificada. Decifrar os mecanismos moleculares subjacentes aos efeitos terapêuticos de cirurgias bariátricas oferece a promessa de identificação de novos alvos terapêuticos.

Condições Gerais O tempo cirúrgico médio para o procedimento de SG foi de 49,3 ± 1,5 min. Removemos 62,8 ± 5,0 mg do estômago, o que representa cerca de 80% por cento do estômago. Sem ratos morreram durante a cirurgia ou durante os sete dias seguintes. Um rato (7,1%) morreram no dia pós-operatório de 11 devido a uma obstrução gástrica causada por um bezoar. <p class="jove_content" f...

Watch this Scientific Journal Video about Techniques of Sleeve Gastrectomy and Modified Roux-en-Y Gastric Bypass in Mice at JoVE.com

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

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 ...

techniques-sleeve-gastrectomy-modified-roux-en-y-gastric-bypass

Research

JoVE Journal

Medicine

11.9K visualizações.  INSERM, CNRS, UNIV Nantes. 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.

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

Modified Technique for Coronary Artery Ligation in Mice

Myocardial infarction (MI) is one of the most important causes of mortality in humans1-3. In order to improve morbidity and mortality in patients with MI we need better knowledge about pathophysiology of myocardial ischemia. This knowledge may be valuable to define new therapeutic targets for innovative cardiovascular therapies4. Experimental MI model in mice is an increasingly popular small-animal model in preclinical research in which MI is induced by means of permanent or temporary ligation of left coronary artery (LCA)5. In this video, we describe the step-by-step method of how to induce experimental MI in mice.
The animal is first anesthetized with 2% isoflurane. The unconscious mouse is then intubated and connected to a ventilator for artificial ventilation. The left chest is shaved and 1.5 cm incision along mid-axillary line is made in the skin. The left pectoralis major muscle is bluntly dissociated until the ribs are exposed. The muscle layers are pulled aside and fixed with an eyelid-retractor. After these preparations, left thoracotomy is performed between the third and fourth ribs in order to visualize the anterior surface of the heart and left lung. The proximal segment of LCA artery is then ligated with a 7-0 ethilon suture which typically induces an infarct size ~40% of left ventricle. At the end, the chest is closed and the animals receive postoperative analgesia (Temgesic, 0.3 mg/50 ml, ip). The animals are kept in a warm cage until spontaneous recovery.

The surgical procedure used to induce experimental myocardial infarction in mice begins with left thoracotomy between the third and the fourth ribs in order to visualize the anterior surface of the heart and left lung. The left coronary artery is ligated, the chest is closed and the mouse is allowed to recover spontaneously.

Técnica modificada para ligação da artéria coronária em ratos

Myocardial infarction (MI) is one of the most important causes of mortality in humans1-3. In order to improve morbidity and mortality in patients with MI ...

Medicina

Roux-en-Y Gastric Bypass Operation 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 benefit is bariatric surgery1,2. Consequently, there has been a steady rise in the number of bariatric operations done worldwide in recent years with the Roux-en-Y gastric bypass (gastric bypass) being the most commonly performed operation3. Against this background, it is important to understand the physiological mechanisms by which gastric bypass induces and maintains body weight loss. These mechanisms are yet not fully understood, but may include reduced hunger and increased satiation4,5, increased energy expenditure6,7, altered preference for food high in fat and sugar8,9, altered salt and water handling of the kidney10 as well as alterations in gut microbiota11. Such changes seen after gastric bypass may at least partly stem from how the surgery alters the hormonal milieu because gastric bypass increases the postprandial release of peptide-YY (PYY) and glucagon-like-peptide-1 (GLP-1), hormones that are released by the gut in the presence of nutrients and that reduce eating12.
During the last two decades numerous studies using rats have been carried out to further investigate physiological changes after gastric bypass. The gastric bypass rat model has proven to be a valuable experimental tool not least as it closely mimics the time profile and magnitude of human weight loss, but also allows researchers to control and manipulate critical anatomic and physiologic factors including the use of appropriate controls. Consequently, there is a wide array of rat gastric bypass models available in the literature reviewed elsewhere in more detail 13-15. The description of the exact surgical technique of these models varies widely and differs e.g. in terms of pouch size, limb lengths, and the preservation of the vagal nerve. If reported, mortality rates seem to range from 0 to 35%15. Furthermore, surgery has been carried out almost exclusively in male rats of different strains and ages. Pre- and postoperative diets also varied significantly.
Technical and experimental variations in published gastric bypass rat models complicate the comparison and identification of potential physiological mechanisms involved in gastric bypass. There is no clear evidence that any of these models is superior, but there is an emerging need for standardization of the procedure to achieve consistent and comparable data. This article therefore aims to summarize and discuss technical and experimental details of our previously validated and published gastric bypass rat model.

Numerous studies using gastric bypass rat models have been recently conducted to uncover the underlying physiological mechanisms of Roux-en-Y gastric bypass operations. This article aims to demonstrate and discuss the technical and experimental details of our published gastric bypass rat model to understand advantages and limitations of this experimental tool.

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 ...

Assessment of Gastric Emptying in Non-obese Diabetic Mice Using a [13C]-octanoic Acid Breath Test

Gastric emptying studies in mice have been limited by the inability to follow gastric emptying changes in the same animal since the most commonly used techniques require killing of the animals and postmortem recovery of the meal1,2. This approach prevents longitudinal studies to determine changes in gastric emptying with age and progression of disease. The commonly used [13C]-octanoic acid breath test for humans3 has been modified for use in mice4-6 and rats7 and we previously showed that this test is reliable and responsive to changes in gastric emptying in response to drugs and during diabetic disease progression8. In this video presentation the principle and practical implementation of this modified test is explained. As in the previous study, NOD LtJ mice are used, a model of type 1 diabetes9. A proportion of these mice develop the symptoms of gastroparesis, a complication of diabetes characterized by delayed gastric emptying without mechanical obstruction of the stomach10.
This paper demonstrates how to train the mice for testing, how to prepare the test meal and obtain 4 hr gastric emptying data and how to analyze the obtained data. The carbon isotope analyzer used in the present study is suitable for the automatic sampling of the air samples from up to 12 mice at the same time. This technique allows the longitudinal follow-up of gastric emptying from larger groups of mice with diabetes or other long-standing diseases.

Assessment of Gastric Emptying in Non-obese Diabetic Mice Using a [13C]-octanoic Acid Breath Test

Determination of gastric emptying with a non-invasive [13C]-octanoic acid breath test for tracking gastroparesis in female NOD LtJ mice.

Estudo do esvaziamento gástrico em ratos diabéticos não obesos utilizando a [<sup&gt; 13</sup&gt; C]-octanóico teste de respiração Ácido

Gastric emptying studies in mice have been limited by the inability to follow gastric emptying changes in the same animal since the most commonly used ...

Using the Sleeve Technique in a Mouse Model of Aortic Transplantation - An Instructional Video

Orthotopic aortic transplantation using the sleeve technique reduces injury to the aorta with failure rate of only 10-20%. The time to anastomose the aorta in mice using the sleeve method was short and easy averaging 20 min, permitting studies of iso/allo grafts. The following article describes the aortic transplantation procedure used in our laboratory. The mice were anesthetized with a mixture of 1.5% volume isoflurane and 100% oxygen through a face mask. At this point, the segment of the aorta between the renal arteries and its bifurcation was separated from the vena cava, freely prepared and clampedat the proximal and distal segments with a single silk suture. Prior to the removal of the aorta, a saline solution containing heparin was injected into the inferior vena cava. Then the aorta was cut between the clamps and a saline heparin solution was used to flush the lumen. The sleeve technique with monofilament sutures was used in order to transplant the abdominal aorta in the orthotopic position.

We present an orthotopic aortic transplantation model using the sleeve technique in mice. It is a very rapid anastomosis method, which can be employed in studies of vascular disease.

Usando a técnica de manga em um modelo do rato da transplantação da aorta - um vídeo instrutivo

Orthotopic aortic transplantation using the sleeve technique reduces injury to the aorta with failure rate of only 10-20%. The time to anastomose the ...

Sleeve Gastrectomy in Mice using Surgical Clips

The number of people who are overweight and obese is continually increasing both in the adult and adolescent populations. This coincides with the increased universal phenomenon of type 2 diabetes (T2D) and other metabolic problems. Bariatric surgery, such as SG, is currently one of the most effective and commonly used long-term treatment for obesity and T2D, but the association between them is not completely explored yet. The mechanisms underlying the outcomes seen after bariatric surgery in humans can be investigated based on preclinical animal studies. The SG reduces body weight, glucose levels and many metabolic parameters, and is easy to perform with a low incidence of complications. The goal of this work is to provide a simple method and an uncomplicated preclinical model of bariatric surgery in animals for researchers.

The prevalence of diabetes and obesity is continuously increasing worldwide. The mechanisms between diabetes, obesity and their associated mortality and co-morbidities need to be further investigated. Here, we present a protocol for sleeve gastrectomy (SG) in animals as an uncomplicated preclinical model of bariatric surgery.

Gastrectomia de manga em camundongos usando clipes cirúrgicos

The number of people who are overweight and obese is continually increasing both in the adult and adolescent populations. This coincides with the ...

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 ...

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 ...

A Murine Model of Vertical Sleeve Gastrectomy

Bariatric surgery, such as vertical sleeve gastrectomy (VSG), is a surgery of the gastrointestinal tract that is performed for the purpose of weight loss. Bariatric surgery is currently the most effective long-term treatment for obesity. In addition to weight loss, bariatric surgery produces additional health benefits such as remission of type 2 diabetes, remission of hypertension, and decreased risk of developing certain types of cancer. The mechanisms beyond weight loss for these benefits remain incompletely defined. Therefore, animal models of bariatric surgery are being developed and validated to identify the mechanisms leading to these benefits, with the goal of improving understanding of gastrointestinal physiology and identifying new therapeutic targets. VSG has become the most commonly performed bariatric procedure in the clinic in the United States because it is highly effective at producing weight loss and metabolic improvement, and is simpler to perform than other bariatric procedures. Therefore, we have developed and validated a murine model of VSG. This murine VSG model recapitulates many of the effects of VSG seen in humans, including improved glucose and blood pressure regulation. The method is based on isolation of the stomach, ligation of gastric vessels, and removal of 70% of the stomach by transecting along the greater curvature of the stomach. We have successfully applied this surgical protocol to various genetically modified mouse lines to define the mechanistic contributors to the benefits of VSG. Furthermore, this murine VSG model has been combined with other surgical techniques, to achieve deeper mechanistic insight. Therefore, this is a simple and versatile model for studying gastrointestinal physiology and the health benefits of bariatric surgery.

The following describes the performance of vertical sleeve gastrectomy in mice. This is a type of weight-loss surgery that involves removal of approximately 70% of the stomach.

Um modelo murino de gastrectomia de manga Vertical

Bariatric surgery, such as vertical sleeve gastrectomy (VSG), is a surgery of the gastrointestinal tract that is performed for the purpose of weight loss. ...

Biologia

Roux-en-Y Gastric Bypass Procedure: A Bariatric Surgical Procedure for Gastric Resectioning in Murine Model

Source: Ayer, A., et al., <a href="https://www.jove.com/v/54905">Techniques of Sleeve Gastrectomy and Modified Roux-en-Y Gastric Bypass in Mice.</a> J. Vis. Exp. (2017).
This video describes a bariatric surgery-Roux-en-Y procedure. This involves the cutting of the jejunum- the middle portion of the intestine- to generate two intestinal limbs. The biliary limb is attached to the existing intestinal loop and the alimentary limb is attached to the stomach, creating a gastric bypass. The gastric bypass created here helps to decrease the nutrient uptake and efficiently reduces body weight.

Procedimento de bypass gástrico em Y-de-Roux: um procedimento cirúrgico bariátrico para ressecção gástrica em modelo murino

Source: Ayer, A., et al., Techniques of Sleeve Gastrectomy and Modified Roux-en-Y Gastric Bypass in Mice. J. Vis. Exp. (2017).
This video describes a ...

JoVE Encyclopedia of Experiments

Modelo de Roedores

Adulto

Murine Vertical Sleeve Gastrectomy: A Surgical Procedure to Downsize Stomach in Experimental Mouse Models

Before beginning the procedure, apply veterinary ointment to the eyes of an anesthetized mouse and place the mouse on a heating pad. Remove the hair from the umbilicus to the axilla, gently holding the skin taut to avoid skin lesions, and use cotton tip applicators to sequentially disinfect the exposed skin with povidone-iodine and ethanol.
Wearing sterile gloves and using sterile technique, place sterile surgical drapes on either side of the animal. Cut a small hole in the foil to allow access to the mouse&#39;s abdomen and use a piece of autoclaved aluminum foil as a surgical drape. Make a skin incision from the mid-abdomen to the xiphoid cartilage.
Under a dissecting microscope, use iris scissors to cut through the body wall along the linea alba and use new cotton tip applicators to gently elevate the stomach out of the abdomen. Bluntly dissect the greater omentum from the greater curvature of the stomach.
Then, use 7.0 monofilament absorbable sutures to place two ligatures around the short gastric artery that runs between the fundus of the stomach and the spleen. When both ligatures have been placed, use spring scissors to cut between the two sutures and fully exteriorize the stomach from the abdominal cavity.
Place gauze under the stomach and hydrate the organ with saline. For a vertical sleeve gastrectomy procedure, use a 7.0 monofilament absorbable suture with a taper needle to ligate the prominent branches of the gastric artery and vein, just below the intended line of transection. Place a simple continuous line of 6.0 monofilament absorbable suture through both gastric walls, just below the intended line of transection, to prevent spillage of the gastric contents.
Place thin-tipped hemostats above the suture line and use spring scissors to cut between the suture line and the hemostats. Remove the transected gastric tissue from the sterile surgical field and use fresh cotton tip applicators to clean the blood and digesta from the stomach.
Use a 6.0 monofilament absorbable suture with a taper needle to reinforce the apposition of the gastric walls in a simple discontinuous pattern. Using a 20G gavage needle attached to a 20-milliliter syringe, perform gastric lavage with fresh saline and securely close the stomach with a minimum of 20 knots.
Then, gently press the stomach with a cotton applicator to test for leaks. If no leaks are detected, lavage the stomach with at least 60 more milliliters of fresh saline to remove any infectious particulates.
After the procedure, use a cotton tip applicator to return the stomach under the liver within the abdominal cavity and place an applicator along the dorsal aspect of the abdominal cavity to absorb any excess fluid.
Use a blunt 18G needle to inject lactated Ringer&#39;s solution with or without antibiotics directly into the abdominal cavity, and use 6.0 monofilament absorbable sutures to close the abdominal muscle layer in a simple discontinuous pattern and the skin layer in a simple continuous pattern. Then, place tissue adhesive on the skin and fold the skin over the suture line to protect the suture from disruption by the animal.

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

Resumo

Explore mais vídeos

Capítulos neste vídeo