# Proximal Jejunal Bypass with Sleeve Gastrectomy for Severe Obesity and Type 2 Diabetes: First Case Report in Japan

## TL;DR

This paper reports the first case in Japan of a modified bariatric surgery that combines sleeve gastrectomy with jejunal bypass, showing promising weight loss and diabetes improvement.

## Contribution

The first documented case of proximal jejunal bypass with sleeve gastrectomy in Japan for severe obesity and T2DM.

## Key findings

- The patient achieved 18.0% weight loss and improved hemoglobin A1c levels after 252 days.
- No adverse events like diarrhea or liver dysfunction were observed post-surgery.
- The procedure may offer better long-term outcomes than standard sleeve gastrectomy.

## Abstract

Laparoscopic sleeve gastrectomy is the most common metabolic bariatric surgery performed in Japan. Nevertheless, concerns persist regarding its long-term efficacy, which is considered inferior to that of procedures involving gastrointestinal bypass. In response to these concerns, a modified approach known as the “sleeve plus procedure” has been introduced and is now covered by insurance for patients with severe obesity and type 2 diabetes mellitus (T2DM). We successfully performed proximal jejunal bypass with sleeve gastrectomy (PJB-SG), a variant of this approach, marking the first documented case of its kind in Japan. This report presents the clinical outcomes of this procedure along with a review of the relevant literature.

A 50-year-old female patient with a body mass index of 46.9 kg/m2 presented with obstructive sleep apnea and T2DM. The patient exhibited resistance to pharmacological treatment, including glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 (SGLT2) inhibitors. Fifteen months after the initial consultation, she opted for PJB-SG. The operation lasted 207 min, with 18 mL of blood loss. At 252 days postoperatively, the patient had achieved a total weight loss of 18.0% and a hemoglobin A1c level of 6.0% while continuing a minimal dose of SGLT2 inhibitors. No adverse events related to the bypass procedure, such as diarrhea or liver dysfunction, were observed.

To our knowledge, this is the first reported case of PJB-SG conducted in Japan. This procedure may represent a promising alternative for patients with severe obesity and T2DM in Japan.