Sleeve Gastrectomy with Loop Gastro Ileal Bypass (SG LGIB) is a novel bariatric/ metabolic surgery. It is known as Single Anastomosis Sleeve Ileal (SASI) Bypass or Sleeve Gastrectomy with Loop Bipartition (SG LB). It is a loop modification of Sleeve Gastrectomy with Transit Bipartition (SG TB), which in turn is a modification of Bilio-pancreatic Diversion with Duodenal Switch (BPD DS).
Procedure – Sleeve gastrectomy is done starting 6 cm proximal to pylorus. Terminal ileum at 300 cm point is anastomosed to antero-inferior aspect of pyloric antrum, horizontally in a loop fashion using hand sewn or stapled method Anastomosis is ante-colic.
Physiology – In this surgery sleeve has two outlets. Undigested food entering terminal ileum across the anastomosis results in distal gut hormonal changes (Increased GLP 1, Peptide YY etc). So weight loss is more, weight regain risk is less and chances of resolution of type 2 diabetes are more. Since duodeno-jejunal pathway is also intact, part of the food goes through proximal intestine leading to reduced risk of malabsorption.
Main advantage is that endoscopic access to biliary tract is maintained and there is no at risk gastric remnant. Since food also enters duodenum, anti incretin effect is intact, and as a result, risk of hypoglycaemia and dumping syndrome is less. This surgery is very easy to perform. Learning curve is short. Surprisingly there is no risk of diarrhoea. Its effect on weight loss and diabetes resolution is comparable to that of BPD DS.
SLEEVE GASTRECTOMY WITH LOOP GASTRO ILEAL BYPASS (SG LGIB)
SINGLE ANASTOMOSIS SLEEVE ILEAL (SASI) BYPASS
SLEEVE GASTRECTOMY WITH LOOP BIPARTITION (SG LB)
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