Long-Term Outcome of Isolated Duodenal Transit Bipartition as Initial Metabolic Surgery: A 19-Year Follow-Up Case Report

Paulo Reis Rizzo Esselin de Melo; Victor Ramos Mussa Dib; Carlos Augusto Scussel Madalosso; Luiz Alfredo Vieira d'Almeida; Eudes Paiva de Godoy; Elinton Adami Chaim; Caio Gustavo Gaspar de Aquino; Rui José Silva Ribeiro; Carlos Antonio Madalosso; Hiroji Okano Júnior; Giorgio Alfredo Pedroso Baretta; Nicholas Tavares Kruel; Joe Joaquim Waltrick Junior; Diogo Swain Kfouri; Félix Antônio Insaurriaga dos Santos; Nilton Tokio Kawahara; Rafael Antoniazzi Abaid; Fernando de Barros; Carlos Frota Dillenburg; José Geraldo Moraes Sampaio Neto; Ricardo Augusto Martins Bueno da Costa; Guilherme Spósito Ribeiro Goyano; Fernando Reis Esselin Melo; Thonya Cruz Braga; Daniel Oscar Caiña; Patrick Noel; Tahir Ebrahim Yunus; Chetan Parmar; Ricardo Zorron; André Teixeira; Manoel Galvao Neto; Almino Cardoso Ramos; Antônio Torres

doi:10.12659/AJCR.950650

12 January 2026 : Case report Brazil

Long-Term Outcome of Isolated Duodenal Transit Bipartition as Initial Metabolic Surgery: A 19-Year Follow-Up Case Report

Unusual clinical course, Educational Purpose (only if useful for a systematic review or synthesis)

Paulo Reis Rizzo Esselin de Melo

^{ABDEF 1,2,3*}, Victor Ramos Mussa Dib

^{EF 4}, Carlos Augusto Scussel Madalosso

^{EF 5}, Luiz Alfredo Vieira d'Almeida

^{EF 6}, Eudes Paiva de Godoy

^{EF 7}, Elinton Adami Chaim

^{EF 8}, Caio Gustavo Gaspar de Aquino

^{EF 9}, Rui José Silva Ribeiro

^{EF 10}, Carlos Antonio Madalosso

^{EF 5,11}, Hiroji Okano Júnior

^{EF 12}, Giorgio Alfredo Pedroso Baretta

^{EF 13}, Nicholas Tavares Kruel

^{EF 14}, Joe Joaquim Waltrick Junior

^{EF 15}, Diogo Swain Kfouri

^{EF 16}, Félix Antônio Insaurriaga dos Santos

^{EF 17}, Nilton Tokio Kawahara

^{EF 18}, Rafael Antoniazzi Abaid

^{EF 19}, Fernando de Barros

^{EF 20}, Carlos Frota Dillenburg

^{EF 21}, José Geraldo Moraes Sampaio Neto

^{EF 1}, Ricardo Augusto Martins Bueno da Costa

^{EF 1}, Guilherme Spósito Ribeiro Goyano

^{EF 1}, Fernando Reis Esselin Melo

^{EF 1,22}, Thonya Cruz Braga

^{EF 1,23}, Daniel Oscar Caiña

^{EF 24,25}, Patrick Noel

^{EF 26,27}, Tahir Ebrahim Yunus

^{EF 28}, Chetan Parmar

^{EF 29}, Ricardo Zorron

^{EF 30}, André Teixeira

^{EF 31}, Manoel Galvao Neto

^{EF 31}, Almino Cardoso Ramos

^{EF 32}, Antônio Torres

^{EF 33}

DOI: 10.12659/AJCR.950650

Am J Case Rep 2026; 27:e950650

Authors information Article notes Copyright and License information

¹ Alfredo Nasser University Center (UNIFAN), Goiânia, GO, Brazil
²Metabolic Surgery Service, Dr. Alberto Rassi State Hospital, Goiânia, GO, Brazil
³ Paulo Reis Institute, Goiânia, GO, Brazil
⁴ Victor Dib Institute, Manaus, AM, Brazil
⁵ Gastrobese Clinic, Passo Fundo, RS, Brazil
⁶Department of Bariatric and Metabolic Surgery, Pro-Cardiac Hospital, Rio de Janeiro, RJ, Brazil
⁷Obesity and Related Diseases Surgery Service - Surgery Unit, Onofre Lopes University Hospital of the Federal University of Rio Grande do Norte, Natal, RN, Brazil
⁸Department of Surgery, Faculty of Medical Sciences (FCM) – Unicamp, Campinas, SP, Brazil
⁹Einstein Surgery Program, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
¹⁰Department of Surgery, Lusíadas Amadora Hospital, Lisboa, Portugal
¹¹Department of Gastroenterology and Digestive Surgery, University of Passo Fundo, Passo Fundo, RS, Brazil
¹²Centro Clínico Advance, Gastrocare Clinic, Brasília, DF, Brazil
¹³ Giorgio Baretta Institute, Curitiba, PR, Brazil
¹⁴ Dr. Nicholas Kruel Institute (Nkbariatrics), Florianópolis, SC, Brazil
¹⁵ Video Clinic of the Digestive System, Jaraguá do Sul, SC, Brazil
¹⁶Digestive System Surgery and Bariatric Surgery, Paraná Obesity Treatment Center (OBEPAR), Curitiba, PR, Brazil
¹⁷Department of Surgery, Faculty of Medicine, Federal University of Pelotas (UFPEL), Pelotas, RS, Brazil
¹⁸Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, Brazil
¹⁹Department of Surgery, Abaid Institute, Santa Cruz do Sul, RS, Brazil
²⁰Department of General and Specialized Surgery, Faculty of Medicine, Fluminense Federal University, Niterói, RJ, Brazil
²¹Bariatric and Metabolic Surgery, Obese and Metabolic Patient Care Service (SAO), Novo Hamburgo, RS, Brazil
²² IOM-Intraoperative Medical Services, Brasília, DF, Brazil
²³Clínica de Anestesia (CLIANEST Group), Renaissance Hospital, Goiânia, GO, Brazil
²⁴Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
²⁵Department of Bariatric and Metabolic Surgery of Malvinas Argentinas, Dr. Alberto Cormillot Municipal Center for Obesity and Metabolic Diseases, Buenos Aires, Argentina
²⁶Bariatric Department, PHI Medcare Hospital, Lusail, Doha, Qatar
²⁷Bariatric Department, Private Hospital Bouchard, Marseille, France
²⁸Department of Surgery, Evercare Hospital Lahore, Lahore, Pakistan
²⁹Department of Surgery, Whittington Hospital, London, United Kingdom
³⁰Department of Bariatric and Metabolic Surgery, CUF Descobertas Hospital, Lisbon, Portugal
³¹Bariatric Research, Orlando Health Weight Loss and Bariatric Surgery Institute, Orlando, USA
³² Gastro Obeso Center, São Paulo, SP, Brazil
³³Department of Surgery, Hospital Clinico San Carlos, Universidad Complutense de Madrid, Madrid, Spain

^*Corresponding Author: Paulo de Melo, e-mail: moc.duolci@aigruricrp

^AStudy design/planning
^BData collection/entry
^DData interpretation
^EPreparation of manuscript
^FLiterature analysis/search

Introduction Case Report Discussion Conclusions References

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Table 2 Laboratory results after 19 years of isolated duodenal transit bipartition.

Laboratory parameter	Values (unit)	Reference
Vitamin D – 25 hydroxy	13.6 ng/mL	>20.0 ng/mL
A/G ratio	2.74	1.00–3.00
Total proteins	6.4 g/dL	6.4–8.3 g/dL
Albumin	4.6 g/dL	3.7–5.2 g/dL
Globulins	1.8 g/dL	2.5–4.5 g/dL
A/G ratio	2.74	1.00–3.00
Fasting glucose	90 mg/dL	60–99 mg/dL
HbA1c	4.4%	≤5.7%
Estimated average glucose	79.6 mg/dL	≤150.0 mg/dL
Urea	28 mg/dL	21.0–43.0 mg/dL
Creatinine	0.56 mg/dL	0.40–1.30 mg/dL
Glomerular filtration	>60.0 ml/min/1.73 m	≥60.0 ml/min/1.73 m
Body surface area	1.71 m2
Sodium	143 mmol/L	135–145 mmol/L
Potassium	5.2 mmol/L	3.5–5.1 mmol/L
Cholesterol	89 mg/dL	≤190 mg/dL
HDL cholesterol	40 mg/dL	≥40 mg/dL
LDL cholesterol	40 mg/dL	≤130 mg/dL
VLDL cholesterol	11 mg/dL
Triglycerides	43 mg/dL	≤150 mg/dL
Magnesium	2.20 mg/dL	1.6–2.6 mg/dL
TSH	1.34 μU/mL	0.35–4.94 μU/mL
Free T3	2.86 pg/mL	1.58–3.91 pg/mL
Free T4	0.88 ng/dL	0.70–1.48 ng/dL
ALT	56 U/L	0–50 U/L
AST	38 U/L	8–41 U/L
Intact PTH	91.9 pg/mL	15.0–68.3 pg/mL
Serum Iron	50 μg/dL	50–170 μg/dL
Ferritin	99.1 ng/mL	11.0–306.8 ng/mL
Postprandial glucose	92 mg/dL
Calcium	8.4 mg/dL	8.4–10.2 mg/dL
Total bilirubin	0.60 mg/dL	0.2–1.2 mg/dL
Direct bilirubin	0.31 mg/dL	0.0–0.5 mg/dL
Indirect bilirubin	0.29 mg/dL
Erythrocytes	4.2 tera/L	4.0–5.0 tera/L
Hemoglobin	13.0 g/dL	12.0–16.0 g/dL
Hematocrit	39.9%	36.0–45.0%
MCV	94.1 fL	80.0–100.0 fL
MCH	30.7 pg	26.5–33.5 pg
MCHC	32.6%	31.5–35.0%
RDW	13.2%	11.6–14.8%
Total leukocytes	100%; 5.870/μL	3.500–11.000/μL
Promyelocytes	0%; 0/μL	0–0/μL
Myelocytes	0%; 0/μL	0–0/μL
Metamyelocytes	0%; 0/μL	0–0/μL
Bands (stab neutrophils)	2%; 117/μL	0–500/μL
Segmented neutrophils	76%; 4.461/μL	1.500–7.000/μL
Lymphocytes	19%; 1.115/μL	800–4.000/μL
Monocytes	3%; 176/μL	100–1.000/μL
Eosinophils	0%; 0/μL	35–500/μL
Basophils	0%; 0/μL	0–100/μL
Blasts	0%; 0/μL	0–0/μL
Platelets	303 000/μL	150 000–500 000/μL
A/G – albumin/globulin; HbA1c – glycated hemoglobin; HDL – high-density lipoprotein; LDL – low-density lipoprotein; VLDL – very-low-density lipoprotein; TSH – thyroid-stimulating hormone; T3 – triiodothyronine; T4 – thyroxine; ALT – alanine aminotransferase; AST – aspartate aminotransferase; PTH – parathyroid hormone; MCV – mean corpuscular volume; MCH – mean corpuscular hemoglobin; MCHC – mean corpuscular hemoglobin concentration; RDW – red cell distribution width.

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Long-Term Outcome of Isolated Duodenal Transit Bipartition as Initial Metabolic Surgery: A 19-Year Follow-Up Case Report

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