A Protocol for Roux-en-Y Gastric Bypass in Rats using Linear Staplers

Summary

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.

Abstract

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.

Introduction

Obesity and type 2 diabetes have become worldwide epidemics¹. Although medical weight loss can improve diabetes in patients, those with severe diabetes benefit most from bariatric surgery. Bariatric surgery has proven to be safe and effective at weight loss and improving or curing type 2 diabetes^2,3, even in those with long-standing disease⁴. Metabolic bariatric procedures, such as the current gold-standard Roux-en-Y gastric bypass (RYGB) surgery, induce rapid and sustained improvements in glucose homeostasis while also reducing the need for diabetic medications<....

Protocol

Animal use protocols were approved by the Health Science Animal Care and Use Committee at the University of Alberta (AUP00003000). See Figure 1 for a diagram demonstrating the RYGB anatomy.

1. Roux-en-Y gastric bypass

1. Preparation of animals and operative setup
   1. One week prior to the surgery, provide the rats with oral rehydration therapy and liquid diet in addition to their solid diet and water to acclimatize them to this new diet.
   2. Fast rats with only access to water for 12-18 h prior to the surgery.
      1. Ensure rats are fasted on a raised wire platform so that they ca....

Results

Animals and housing
36 male Wistar rats were housed in pairs and were fed 60% sterile rodent high-fat diet starting from six weeks of age (Figure 2). At 16 weeks of age, they underwent RYGB or sham surgery. After the first postoperative week, rats were resumed on a high fat diet. Half of the rats were euthanized at 2 weeks post-operative and the other half were euthanized at 14 weeks postoperative.

Mortality
Overall, 33 (9.......

Discussion

RYGB involves the creation of a small gastric pouch (less than 30 mL), and the creation of a biliopancreatic limb and a Roux limb (Figure 1). In humans, the biliopancreatic limb is typically 30 to 50 cm and transports secretions from the gastric remnant, liver, and pancreas. The Roux limb is typically 75 to 150 cm in length and is the primary channel for ingested food. The common channel is the remaining small bowel distal to where the two limbs join and is where the majority of digestion an.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
2-0 Silk Sutures	Ethicon	K533
3-0 Vicryl Sutures	Ethicon	J219H
4% Isoflurane	N/A	N/A
5% Dextrose and 0.9% Sodium Chloride Solution - 1000 mL	Baxter	2B1064
50 mL Conical Centrifuge Tubes	Fisher Scientific	14-432-22
6-0 Prolene Sutures	Ethicon	8805H
Anesthetic Machine	N/A	N/A
Animal Hair Shaver	N/A	N/A
Betadine Solution	N/A	N/A
Castrojievo Needle Holder with lock 14 cm (smooth curved)	World Precision Instruments	503258
ECHELON FLEX Articulating Endoscopic Linear Cutter	Ethicon	EC45A
Economy Tweezers #4	World Precision Instruments	501978
ENDOPATH ETS Articulating Linear Cutter 45mm Reloads	Ethicon	6R45B
Far Infrared Warming Pad Controller with warming pad (15.2 cm W x 20.3 cm L), pad temperature probe, and 10 disposable, non-sterile sleeve protectors	Kent Scientific	RT-0515
Large Rat Elizabethan Collar	Kent Scientific	EC404VL-10
Liquid Diet Feeding Tube (150 mL)	Bio-Serv	9007
Liquid Diet Feeding Tube Holder (short adjustable)	Bio-Serv	9015
Micro Mosquito Forceps	World Precision Instruments	500452
Micro Scissors	World Precision Instruments	503365
Mouse Diet, High Fat Fat Calories (60%), Soft Pellets	Bio-Serv	S3282
No. 11 Blade and Scalpel Handle	N/A	N/A
OPMI Vario Surgical Microscope	ZEISS	S88
Raised Floor Grid	Tecniplast	GM500150 Raised Floor Grid
Rodent Liquid Diet, Lieber-DeCarli '82, Control, 4 Liters/Bag	Bio-Serv	F1259
Sodium Chloride Irrigation 0.9% Solution - 500 mL	Baxter	JF7633
Sterile Cotton Swabs	N/A	N/A
Sterile Drape	N/A	N/A
Sterile Towel	N/A	N/A
Thermal Cautery Unit	World Precision Instruments	501293