The Effect Of Duodenojejunal Bypass On Glucose Metabolism In Mice And Comparison Of Different Operative Methods

ObjectiveWe try to find the best way to build stable duodenojejunal bypass model of mice, and identify the impact of the operation on glucose metabolism and the intestinal morphological changes induced by the operation.MethodsThe mice are divided into three groups, the preoperative fasting time of the three groups is6hours,24hours,36hours respectively. We use two methods in intestinal anastomosis:side to side anastomosis withcontinuoussuture and end to side anastomosis withdiscontinuoussuture. Postoperative complications and survival rate are compared among the groups with different preoperative fasting time or different suture methods. The mice receive intraperitoneal glucose tolerance test and insulin tolerance test1 month after operation. Comparing with sham group, we try to identify the impact of operation on glucose tolerance and insulin sensitivity of mice. Hematoxylin and eosin(HE) staining of duodenal segment, proximal jejunal segment, gastrojejunal segment, ileal segment is performed1month after operation to observe the morphological changes.ResultsWe find that incidence of intestinal anastomotic block is higher in side to side anastomosis with continuous suture group than in end to side anastomosis withdiscontinuous suture group. It’s also higher in group with preoperative fasting of6hours than groups with24-hour fast or36-hour fast. However, no differenceis found between the latter two groups. In group with preoperative fasting of24hours, the postoperative survival rate of the subgroup underwent end to side anastomosis with discontinuous suture is46.67%, higher than35%of the subgroup which underwent side to side anastomosis with continuous suture. Similar result is observed in the group with preoperative fasting of36hours(64.29%vs38.46%).In side to side anastomosis group, the postoperative survival rate of subgroup with preoperative6-hour fast is8.33%, the worst of the three. Intraperitoneal glucose tolerance test and insulin tolerance test demonstrate that comparing with the sham group, mice underwent duodenojejunal bypass operation have significant improvement in glucose tolerance and insulin sensitivity.We alsofind atrophy and regression of villus in the duodenal and proximal jejunal segments of the mice after operation, while the villus of the other two segments develop well. ConclusionEnd to side anastomosis with discontinuous suture is better than side to side anastomosis with continuous suture in small bowel anastomosis of mouse. Preoperative fasting plays an important role in reducing postoperative complications and increasing survival rate after operation. Duodenojejunal bypass operation performed in our experiment successfully improves glucose intoleranceand insulin sensitivity of mice.