Comparison of 2-Year Results of Roux-en-Y Gastric Bypass and Transit Bipartition with Sleeve Gastrectomy for Superobesity

Weight Loss, Type 2 Diabetes, and Nutrition in 355 Patients with Obesity Undergoing Sleeve Gastrectomy with Transit Bipartition: Two-Year Outcomes

“…In the few SG-TB reports to date [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 15 , 21 ], this procedure appears to effect marked weight loss and reduction of comorbid disease, particularly T2D, with minimal complications and without causing malnutrition. Recently, we reported initial outcomes of our complete SG-TB series performed in patients with class 1 and 2 obesity ( n = 883, mean preoperative BMI 34.1 ± 5.0 kg/m 2 ) and diagnosed T2D ( n = 883) [ 18 ].…”

“…The still-novel sleeve gastrectomy with transit bipartition (SG-TB) procedure, introduced in 2006 by Santoro et al [ 3 ] for patients with severe obesity, was designed to have the metabolic efficacy of the biliopancreatic diversion (BPD) with duodenal switch without its technical complexity or long-term nutritional instability. Several short-term investigations of SG-TB [ 4 , 5 , 6 , 7 , 8 , 9 ] have shown it to be safe and effective in facilitating weight loss and resolution of diseases comorbid with all stages of obesity.…”

Can we abandon foregut exclusion for an ideal and safe metabolic surgery?

“…This hypothesis proposes that the exclusion of the proximal small intestine (duodenum and proximal jejunum) from the transit of nutrients may prevent the secretion of a "factor" that promotes insulin resistance and type 2 diabetes mellitus (3,14,15). However, the foregut hypothesis fails to explain how several other bariatric procedures that did not comprise duodenal exclusion, such as SG-JJB, SG-II, SG-TB, and standalone SG, still achieved excellent diabetes remission results (6,7,(10)(11)(12). Furthermore, we are yet to identify the foregut "factor" that affects the glucose homeostasis.…”

“…While the hindgut theory (rapid transit of nutrients to the distal intestine) has been widely accepted, the foregut theory is not (4,5). Several procedures that do not comprise duodenal exclusions, such as sleeve with jejunojejunal bypass/SG-JJB, sleeve with ileal interposition/SG-II, sleeve with transit bipartition/SG-TB, and standalone sleeve gastrectomy/SG (Figure 1), have similar diabetes remission outcomes when compared with procedures comprising duodenal exclusions, such as gastric bypass/GB, biliopancreatic diversion with duodenal switch/DS, and diverted sleeve with ileal interposition/DSG-II (Figure 2) (6)(7)(8)(9)(10)(11)(12)(13). Furthermore, the complete exclusion of the proximal intestine may result in significant micronutrient malabsorption.…”

Testosterone Changes in Men With Obesity and Type 2 Diabetes 6 Months After Sleeve Gastrectomy With Transit Bipartition

“…1 SG with transit bipartition (SG-TB) is a relatively new MBS procedure initiated by Santoro and colleagues and reported in their cohort of 1020 patients in 2012. 2,3 A number of studies have described a safe and effective experience with SG-TB over the early and medium terms, [3][4][5][6][7][8][9][10][11][12][13] including our own report of results at 4 years. 14 Although SG-TB is still considered an investigational procedure by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), it was designed to facilitate metabolic improvements similar to those achieved by biliopancreatic diversion with duodenal switch without the technical complexity or long-term nutritional challenges.…”