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

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

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

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

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

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

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

one-anastomosis gastric bypass (oagb) in rats

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

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

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

One-anastomosis Gastric Bypass OAGB in Rats

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

One-anastomosis Gastric Bypass (OAGB) in Rats

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

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

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Research

JoVE Journal

Medicine

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.

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

Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma

Determining resection margins for gastric cancer, which are not exposed to the serosal surface of the stomach, is the most important procedure during totally laparoscopic gastrectomy (TLG). The aim of this protocol is to introduce a procedure for intraoperative gastroscopy, in order to directly mark tumors during TLG for gastric cancer in the middle third of the stomach. Patients who were diagnosed with adenocarcinoma in the middle third of the stomach were enrolled in this case series. Before surgery, additional gastroscopy for tumor localization is not performed. Under general anesthesia, laparoscopic mobilization of the stomach is performed first. After the first portion of the duodenum is mobilized from the pancreas and clamped, the surgeon moves to the other side for the gastroscopic procedure. On the insertion of a gastroscope through the oral cavity into the stomach, 2 - 3 cc of indigo carmine is administered via an endoscopic injector into the gastric muscle layer at the proximal margin of the stomach. The location of stained serosa in the laparoscopic view is used to guide distal subtotal gastrectomy, however, total gastrectomy is performed if the tumor is too close to the esophagogastric junction. A specimen is sampled after distal gastrectomy to confirm sufficient length from resection margin to tumor before reconstruction. In our case series, all patients had tumor-free margins and required no additional resection. There was no morbidity related to the gastroscopic procedure, and the time required for the procedure has gradually decreased to about five minutes. Intraoperative gastroscopy for tumor localization is an accurate and tolerated method for gastric cancer patients undergoing totally laparoscopic distal gastrectomy.

In early gastric cancer, the aim of surgery is to precisely remove the distal stomach including the primary tumor. To do this, accurate localization of the tumor is crucial, especially in totally laparoscopic surgery. This protocol describes a procedure for intraoperative gastroscopy in totally laparoscopic subtotal gastrectomy.

Determining resection margins for gastric cancer, which are not exposed to the serosal surface of the stomach, is the most important procedure during ...

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.

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 ...

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.

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

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.

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.

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

Gastric Ultrasound Technique for Mitigating Peri-Procedural Aspiration Risk

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.

Author Spotlight: Point-of-Care Ultrasound for Gastric Content Assessment and Risk Stratification in Perioperative Care 

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.

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

Exploring Left Upper Quadrant Gastric Body Views for Advanced Gastric Ultrasound Evaluations

Begin by positioning the patient in the supine position. After selecting a low frequency probe, set the preset to abdominal mode. Place the probe on the left mid-axillary line in the longitudinal plane of the patient's body to obtain a left upper quadrant, or LUQ, coronal gastric body view.Start with image optimization by identifying the spleen and the left hemi diaphragm. Then fan posteriorly from the spleen to identify the kidney. Once these landmarks are identified, angle the transducer in an anterior direction to obtain a view of the gastric body.Then click acquire to save a video clip of this sonographic view. For LUQ anterior transverse gastric body view, place the probe on the anterior surface of the patient's abdomen. Then optimize the image by fanning the probe cranial to caudal until the gastric body is seen deep into the spleen.Then click on acquire to save a video clip of the current sonographic view. In LUQ coronal view, the gastric body appears anterior to the spleen, and the absence of haustra distinguishes it from the large bowel. The LUQ anterior transverse view shows a distended gastric body containing both solid and liquid contents.

&lt;i&gt;Desmodium caudatum &lt;/i&gt; Decoction&#039;s Impact on Intestinal Microbiota of Rats

Effects of Desmodium caudatum on Gastrointestinal Hormones and Intestinal Flora in Rats with Gastritis

In order to preliminarily explore the effects of Desmodium caudatum on gastritis and intestinal flora in rats, a chronic gastritis rat model was established using the classic sodium salicylate method. Eighteen SPF rats were divided into three groups: the control group (Group C), the model group (Group M), and the treatment group (Group T). Pathological sections of the gastric wall were taken from rats in each group. Furthermore, the concentrations of gastrin and malondialdehyde in the serum of rats in each group were determined by ELISA. Additionally, the effects of D. caudatum on the intestinal flora of rats with gastritis were explored through a detailed comparison of gut bacterial communities in the three groups, employing Illumina-based 16S rRNA gene sequencing. The results indicated that D. caudatum decoction could reduce the malondialdehyde content and increase the gastrin content. Moreover, D. caudatum decoction was found to enhance the diversity and abundance of intestinal flora, exerting a positive impact on the treatment of gastritis by regulating and restoring the intestinal flora.

Author Spotlight: Exploring the Mysteries of Sichuan&#039;s Herbal Medicine in Chinese Medicine Research

The present protocol describes the method for analyzing intestinal flora using Illumina-based 16S rRNA gene sequencing and provides a framework for evaluating the effectiveness of herbal decoctions.