2型糖尿病を合併する高度肥満症に対してlaparoscopic sleeve gastrectomy with transit bipartitionを施行した1例

A case of laparoscopic sleeve gastrectomy with transit bipartition for morbid obesity complicated by type 2 diabetes mellitus

◆要旨：従来の腹腔鏡下スリーブ状胃切除術にバイパスを付加して効果を高める“スリーブプラス”が近年世界的に注目されている．これまで日本では一部施設においてスリーブプラスとして十二指腸を離断して十二指腸-空腸を吻合する腹腔鏡下スリーブバイパス術が行われてきた．この術式は特に2型糖尿病への治療効果が高い反面，高難度かつ術後に通常内視鏡による十二指腸観察が困難という欠点がある．今回われわれは2型糖尿病を合併する高度肥満症症例に対して，十二指腸を離断せず胃-空腸バイパスを加えるlaparoscopic sleeve gastrectomy with transit bipartitionを実施したので，日本で初めて報告する．

　The “sleeve plus” procedure, which consists of a sleeve gastrectomy and intestinal bypass, has been attracting attention worldwide. To date, only a few hospitals in Japan have performed the laparoscopic sleeve gastrectomy with duodenojejunal bypass（LSG-DJB） as a form of sleeve-plus. This procedure, which involves disconnecting the duodenum and anastomosing the duodenum and jejunum, is highly difficult. It also has the disadvantage of making postoperative endoscopic observation of the duodenum difficult. Herein, we report the first case in Japan of laparoscopic sleeve gastrectomy with transit bipartition, a procedure that adds gastric-jejunal bypass without disconnecting the duodenum. This procedure was performed for a patient with severe obesity complicated by type 2 diabetes.