ObjectiveTo analyze why sleeve gastrectomy (SG) with jejunojejunal bypass (SG-JJB), despite being the second most common bariatric procedure in China, has not been recommended in national and international guidelines nor endorsed by expert consensus; to investigate the primary obstacles to its standardization and widespread adoption; and to propose strategies leveraging China’s extensive clinical experience to refine the technique, establish standardized protocols, and address existing challenges, thereby defining its future role in metabolic surgery. MethodsBy systematically reviewing the evolution, current evidence profile, and distinctive features of SG-JJB compared to other SG-Plus procedures, this study aimed to identify constraints hindering its adoption. Concurrently, considering the characteristics of domestic healthcare resources, we explored the feasibility of procedural refinements, key steps for standardization, and solutions to potential challenges, thereby facilitating the optimization and standardization of SG-JJB. ResultsThe three key constraints hindering SG-JJB development were: risks of blind loop syndrome, uncertainty regarding optimal bypass limb length, and limited evidence on long-term efficacy. To address these issues, this study proposed leveraging China’s clinical and multi-center collaboration strengths to: conduct high-quality studies defining the impact of bypass length on outcomes, establish unified diagnostic and monitoring protocols for blind loop syndrome, and systematically collect longitudinal data to evaluate long-term efficacy, thereby informing evidence-based surgical standardization. ConclusionsSG-JJB holds significant potential in Chinese bariatric-metabolic practice, yet its standardization faces persistent challenges. Addressing concerns about blind loop syndrome, defining optimal bypass limb length, and accumulating robust long-term efficacy data are pivotal for advancing SG-JJB standardization and adoption. Leveraging domestic clinical resources through multi-center collaborations, high-quality research, and evidence-based protocol development is the essential pathway to overcoming these barriers, achieving standardized implementation, and securing recognition in authoritative guidelines.
ObjectiveTo systematically review the research progress in the selection of metabolic bariatric procedures, efficacy, safety, complication prevention, and long-term management for elderly patients, so as to provide references for surgical decision-making and perioperative management in future metabolic and bariatric surgery for elderly obese patients. MethodA review of recent domestic and international literature on metabolic and bariatric surgery in elderly patients was conducted. ResultsWith the intensification of societal aging, the incidence of obesity and related metabolic diseases among the elderly population has significantly increased. Metabolic and bariatric surgery has been proven to effectively reduce weight and improve obesity-related metabolic diseases in elderly patients. Current guidelines no longer consider age an absolute contraindication for surgery. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most commonly used procedures internationally. SG is superior to RYGB in terms of surgical safety, while RYGB has greater advantages in improving metabolic diseases. Although the postoperative mortality and complications risks in elderly obese patients are higher than those in younger obese patients, strict preoperative assessment and individualized procedure selection can significantly reduce these risks. ConclusionsMetabolic and bariatric surgery can serve as an effective treatment for elderly obese patients, offering comprehensive benefits in weight loss and metabolic improvement. Procedure selection requires individualized assessment, balancing the patient’s baseline condition and metabolic needs. Postoperative success hinges on systematic long-term follow-up and management to ensure sustained benefits and safety. Future efforts should focus on clarifying the definitions or standards of “elderly” and “obesity,” followed by more large-sample, long-term follow-up randomized controlled studies to validate the safety and efficacy of metabolic and bariatric surgery.
Objective To explore the influencing factors for early complications after laparoscopic sleeve gastrectomy (LSG). Methods A retrospective analysis was conducted for the clinical data of 306 obese patients undergoing LSG at the Weight Reduction and Metabolism Center of Xuzhou Medical University Affiliated Hospital of Lianyungang from January 2020 to September 2022. Early postoperative complications (≤30 d) of LSG were classified according to the Clavien-Dindo classification, and the influencing factors of early postoperative complications were explored. Results There were 27 cases (8.8%) suffered from early complications, including 8 cases of grade Ⅰ (2.6%), 15 cases of grade Ⅱ (4.9%), 4 cases of grade Ⅲ (1.3%), there were no grade Ⅳ and grade Ⅴ complications. The multivariate results showed that BMI≥45 kg/m2 [OR=3.63, 95%CI (1.10, 11.92)], high cholesterol [OR=7.12, 95%CI (2.42, 20.95)], and preoperative GERD [OR=3.69, 95%CI (1.11, 12.23)] were influencing factors for early complications. Conclusions LSG is a safe diagnostic and therapeutic method for treating obesity. Attention should be paid to the impact of BMI, high cholesterol, and preoperative GERD on the occurrence of complications after LSG.
Objective To compare the effectiveness of three kinds of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy combined with transit bipartition (SG+TB ) as three weight-loss surgical differences in weight loss and glucose control as well as alleviation of nephropathy in obese rats with diabetic nephropathy (DN). MethodsTwelve of 60 SD male rats were randomly selected according to their average body mass and fed with a standard diet (12% fat fever) as normal control (NC) group, and the remaining 48 were fed with high-fat diet (40% fat calories) for 1 month and combined with low-dose 1% streptozotocin method to induce the establishment of obese combined diabetic nephropathy rat model, and subsequently randomized equally into SG group, RYGB group, SG+TB group and sham-operated group. Body mass and food intake were weighed and the fasting blood glucose (FBG) level after fasting for 6 hours was detected before and every month at 1–6 months after operation. At the same time, oral glucose tolerance test (OGTT), insulin tolerance test (ITT), urinary albumin creatinine ratio (UACR), serum creatinine (Scr) and blood urea nitrogen (BUN) were tested before operation and at the 1st and 6th month after operation. Finally, rat kidney tissues were taken to observe the pathological changes. Results Body mass and food intake of the SG group, the RYGB group and the SG+TB group were lower than that of the sham-operated group at 1–6 months after operation (P<0.05). The body mass of the RYGB group and the ST+TB group were lower than that of the SG group at 1–6 months after operation (P<0.05). There was no significant difference in food intake among the SG group, the RYGB group and the SG+TB group (P>0.05). The FBG levels in the SG group, the RYGB group and the SG+TB group were lower than those in the sham-operation group at 1–6 months after operation (P<0.05). The FBG levels in the RYGB group and the SG+TB group were lower than those in the SG group at 4–6 months after operation(P<0.05). The blood glucose levels detected by OGTT and ITT in the SG group, the RYGB group and the SG+TB group after operation were all lower than those in the sham-operation group (P<0.05), and all were lower than before operation (P<0.05), and the blood glucose level detected by OGTT in the RYGB group at the 1st postoperative month was lower than those in the SG group and the SG+TB group (P<0.05). Whereas there was no significant difference in the blood glucose levels detected by OGTT at the 6-month postoperative period between the the RYGB group and the SG+TB group (P>0.05), but were lower than the SG group (P<0.05). The levels of UACR, Scr and BUN in the SG group, the RYGB group and the SG+TB group after operation were lower than those in the sham-operation group (P<0.05) and lower than those before operation (P<0.05). The UACR and Scr levels in the RYGB group and the SG+TB group were lower than those in the SG group at the 1st and 6th month after operation (P<0.05). There was no significant difference in BUN level among the SG group, the RYGB group and the SG+TB group after operation (P>0.05). Typical pathological changes of diabetic nephropathy occurred in the kidney of rats in sham operation group, such as glomerular edema, capillary cavity congestion and congestion, and mesangial matrix increase. The mesangial matrix of rats in the SG group, the RYGB group and the SG+TB group were significantly improved compared with that in the sham-operation group. Conclusion SG, RYGB and SG+TB can effectively reduce weight, reduce blood sugar and relieve diabetic nephropathy, and SG+TB and RYGB are better than SG.
Laparoscopic sleeve gastrectomy (LSG) is an effective and lasting method for treating obesity, type 2 diabetes and other obesity related metabolic diseases. The symmetrical three-port LSG has been proven to be a simple, safe, and effective surgical procedure. However, China still lacks standardized surgical operation guidelines for this method. This guideline provides a detailed description of the various steps and key details of the symmetrical three-port LSG, aiming to standardize and normalize the symmetrical three-port LSG in the bariatric and metabolic field in China, and to provide standardized surgical procedures for clinical surgeons in this field.
ObjectiveTo investigate effects of sleeve gastrectomy (SG)-transit bipartition (SG-TB) and simple SG on bariatric and anti-diabetic and protective effect on esophagus reflux. MethodsA total of 36 male Sprague-Dawley rats were used to successfully induce the obesity with type 2 diabetes mellitus (T2DM) model by dietary feeding and receiving intraperitoneal injection of streptozotocin (35 mg/kg), then were randomly averagely divided into SG, SG-TB, and sham operation (SO) groups according to the surgical methods, and 8 rats from each procedure were randomly selected and included to use for experimental observation. The observation period was 12 weeks. The changes of terminal esophageal mucosa were observed at the 12th week after operation. The body weight and food intake were measured every 2 weeks after operation. The fasting blood glucose (FBG), oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) blood glucose levels were measured before operation and at the 4th and 12th week after operation. And the changes of glucagon like peptide-1 (GLP-1) and insulin levels were measured before operation and at the 12th week after operation. ResultsThere were no significant differences in all indexes among the 3 groups before operation (P>0.05). ① No esophageal papillomatosis was observed in the SG-TB group at the 12th week after operation, but more severe esophageal papillomatosis was observed in the SG group, and the mucosal height in the SG-TB group was lower than that in the SG group (P<0.05). ② From the 4th week after operation, the body weight and food intake of the SG-TB group and SG group were lower than the SO group (P<0.05), and their changes of these two groups over time were generally stable. While no significant difference was found in the reduction of body weight between the SG-TB group and the SG group (P>0.05), however the food intakes of the SG-TB group were higher than the SG group at the 10th and 12th week after operation (P<0.05). ③ The levels of FBG, OGTT and ITT blood glucoses in the SG-TB group and SG group were lower than in the SO group at the 4th and 12th week after operation (P<0.05) and remained stable after operation. However, no significant difference was found in the FBG and ITT blood glucose level between the SG-TB group and the SG group (P>0.05), while the level of OGTT blood glucose in the SG-TB group was lower than that in the SG group at the 12th week after operation (P<0.05). ④ The levels of GLP-1 in the SG-TB group and SG group were higher than in the SO group and still higher than before operation (P<0.05), while the insulin levels were lower than in the SO group and lower than before operation (P<0.05). ConclusionsFrom preliminary results of this study, change of terminal esophageal mucosa after SG-TB is weaker than that of SG operation, and it is found that SG-TB surgery shows a better trend in blood glucose control as compared with SG operation. However, due to the limitations of sample size, further research and anti-reflux effect of SG-TB operation still need to be verified.
ObjectiveTo compared weight loss and metabolic improvement effects of laparoscopic sleeve gastrectomy (LSG) in treatment of obese males and females. MethodsAccording to the inclusion and exclusion criteria, the obese patients were retrospectively collected, who underwent LSG from January 2020 to June 2021 in the Affiliated Hospital of Xuzhou Medical University, and there were complete preoperative data and postoperative follow-up data at month 1, 3, 6, and 12. The weight loss and metabolic improvement effects of obese males and females were compared, as well as the remissions of diabetes and hyperlipidemia at the 12th month after surgery were observed. ResultsA total of 129 eligible obese patients were included, including 44 obese males and 85 obese females. The preoperative body mass index (BMI), fasting blood glucose (FBG) level, and insulin level of the obese males were higher than those of the obese females (P<0.05). ① Weight loss effect after LSG: For both obese males and females, the change value (Δ) of BMI (all change values of the indexes were the difference between preoperative and postoperative value in this study), the percentage of excess body weight loss (EWL%), and percentage of total body weight loss showed continuous upward trends within the observation time range (P<0.05). And it was found that the obese males’ ΔBMI was higher than that of the obese females at the 1st and 3rd month after surgery (P<0.05), and the EWL% of the obese males was lower than that of the obese females at the 3rd, 6th, and 12th month after operation (P<0.05). ② Metabolic improvement effect after LSG: Blood glucose and lipid metabolism indicators in both male and female patients（ΔFBG, ΔINS, ΔHbA1c, ΔTC and ΔTG) changed the fastest at 1 month after operation, and the change became flat after 3 months, except for males ΔTC index (P>0.05), the overall difference between male and female patients at each time point after operation was statistically significant (P<0.05). After operation, the ΔFBG (at the 1st, 3rd, 6th, and 12th month) and Δinsulin (at the 3rd, 6th, and 12th month) in the obese males were higher than those in the obese females (P<0.05). The remission rates of diabetes and hyperlipidemia in the obese males and females at the 12th month after surgery were both higher, but there was no significant difference between the two groups [64.7% (11/17) versus 81.0% (17/21), χ2=0.578, P=0.447; 73.9% (17/23) versus 84.4% (27/32), χ2=0.378, P=0.539]. ConclusionsFrom the results of this study, LSG is an effective method in treatment of obesity and its complications for both males and females. Bariatric surgery should be suggested to perform as soon as possible for obese males with poor metabolic status.
Single-incision laparoscopic sleeve gastrectomy (SILSG) was first described in 2008, which could effectively control excess body weight and treat metabolic diseases relevant to obesity in a long term. Over more than a decade of refinement and technical advancement, precise and standardized surgical techniques have become critical for ensuring treatment efficacy and reducing the rate of postoperative complications. Thus, this review summarizes the evolution of SILSG, further understanding and emphasizing the importance of standardized and precise surgical procedures.
ObjectiveTo evaluate the efficacy of laparoscopic sleeve gastrectomy (LSG) in the treatment of obesity with different degrees of obesity.MethodsThe clinicopathologic data of patients received LSG in this hospital from October 2016 to October 2018 were analyzed retrospectively. The effect of LSG on postoperative weight loss in patients with different degrees of obesity were analyzed too.Results① A total of 161 patients with simple obesity were included in this study, including 40 cases of degree Ⅰ obesity, 41 cases of degree Ⅱ obesity, 61 cases of degree Ⅲ obesity, and 19 cases of super obesity. All operations were successfully completed, there was no conversion to laparotomy or mortality. The postoperative bleeding occurred in 4 (2.5%) cases, nausea and vomiting occurred in 97 (60.2%) cases during hospitalization, and 143, 130, and 122 cases were followed up in 1-, 2-, and 3-year after operation. The body mass indexes (BMIs) were decreased significantly in postoperative 1-, 2-, and 3-year (P<0.05) as compared with their preoperative values, respectively. The excess BMI loss percentage(EBMIL%) in postoperative 1-, 2-, and 3-year were (87.4±25.7)%, (84.6±30.5)%, and (88.8±20.4)%, respectively. The rates of weight regaining were 3.8% (5/130) and 4.9% (6/122) in 2- and 3-year following-up, respectively. ② There were no remarkable changes in the trend of BMI in patients with degree Ⅰ and Ⅱ obesity [the EBMIL% changes from postoperative year-1 to year-3 were (–2.3±1.1)% and (3.3±1.5)%, respectively]. Conversely, there were remarkable changes in the trend of BMI in patients with degree Ⅲ obesity and super obesity [the EBMIL% changes from postoperative year-1 to year-3 were (–7.1±1.9)% and (–11.6±5.3)%, respectively].ConclusionsFrom the results of this study, LSG has a good effect on weight loss in the treatment of patients withdegree Ⅰ and Ⅱ obesity. The long-term efficacy of LSG in patients with degree Ⅲ and super obesity, whether to take other bariatric procedures, whether to perform the second operation, and the timing of the second operation need to be further explored.
Metabolic and bariatric surgery has continued to evolve under the dual imperatives of efficacy and safety. Sleeve gastrectomy (SG) with transit bipartition (SG-TB), derived from SG, reconstructs a “dual-channel” pathway that preserves the pylorus and proximal small-bowel function, while aiming to achieve metabolic effects comparable to biliopancreatic diversion with fewer severe nutritional complications. In 2025, the first Chinese expert consensus on SG-TB was released, and the inaugural international SG-TB consensus meeting was convened in Europe, reaching preliminary alignment on procedure classification, key technical parameters, and indications/contraindications. Emerging clinical evidence indicates that SG-TB confers advantages in weight reduction, remission of type 2 diabetes, and prevention of gastroesophageal reflux disease, and also demonstrates feasibility in revisional surgeries and complex cases. Nevertheless, current studies are predominantly observational, with limited evidence quality and considerable heterogeneity. Stratification of surgical parameters and establishment of reproducible training systems remain unmet needs. Building upon a synthesis of national and international consensus statements and recent clinical advances, this commentary further analyzes the challenges that SG-TB faces in procedural heterogeneity, evidence accumulation, individualized practice, and mechanistic research. This commentary seeks to offer practical reference and research directions for the bariatric community, ultimately supporting the advancement of SG-TB from a promising technique toward standardized and mainstream adoption.