Editors’ Commentary

Excerpt

The Santoro III operation is performed by laparoscopy (five ports) plus an additional 6-cm open incision. The procedure consists of a subtotal, 75–80%, sleeve gastrectomy, an omentectomy, and a jejunectomy, retaining 120 cm of duodenum and jejunum in their normal configuration anastomosed 80 cm from the ileocecal valve to a 180-cm long Roux limb. The resected stomach is gone, as is a large segment of intestine now unavailable for functional restoration of bowel continuity in case of malnutrition or a future emergency involving bowel loss. In the experience of one of the editors (NS), who has measured more than 3,000 small bowels, the mean total intestinal length is about 800 cm; the Santoro III operation entails the excision of more than 60% of the small intestine. Of the standard metabolic/bariatric operations, only biliopancreatic diversion with or without duodenal switch and sleeve gastrectomy involve organ resections, and these resections are limited to a two-thirds distal gastrectomy or a subtotal greater curvature gastric resection. Though there is some evidence that an omentectomy might mitigate the metabolic syndrome [1], there are no definitive data to indicate that removal of the greater omentum, the “infection watch dog of the abdominal cavity,” promotes weight loss. …