From consensus to evidence: current status and challenges of sleeve gastrectomy with transit bipartition_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YAO Libin ^1,2 , WANG Jian ^1,2 , HONG Jian ^1,2 ,  ZHU Xiaocheng ^1,2

1. Department of Bariatric Metabolic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221006, P. R. China;
2. International Center for Obesity and Metabolic Disease, Xuzhou Medical University, Xuzhou, Jiangsu 221004, P. R. China;

Corresponding author：

ZHU Xiaocheng, Email: zhuxccf@163.com

Keywords：

sleeve gastrectomy; transit bipartition; metabolic and bariatric surgery; expert consensus

DOI：

10.7507/1007-9424.202509043

Video：

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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.

1.	Santoro S, Malzoni CE, Velhote MC, et al. Digestive adaptation with intestinal reserve: a neuroendocrine-based operation for morbid obesity. Obes Surg, 2006, 16(10): 1371-1379.
2.	中华医学会外科学分会甲状腺及代谢外科学组, 中国医师协会外科医师分会肥胖和代谢病外科专家工作组. 胃袖状切除联合双通道手术中国专家共识 (2025版). 中国实用外科杂志, 2025, 45(6): 611-617.
3.	Mahdy T, Al Wahedi A, Schou C. Efficacy of single anastomosis sleeve ileal (SASI) bypass for type-2 diabetic morbid obese patients: gastric bipartition, a novel metabolic surgery procedure: a retrospective cohort study. Int J Surg, 2016, 34: 28-34.
4.	Mui WL, Lee DW, Lam KK. Laparoscopic sleeve gastrectomy with loop bipartition: a novel metabolic operation in treating obese type Ⅱ diabetes mellitus. Int J Surg Case Rep, 2014, 5(2): 56-58.
5.	Ribeiro R, Viveiros O, Taranu V, et al. One anastomosis transit bipartition (OATB): rational and mid-term outcomes. Obes Surg, 2024, 34(2): 371-381.
6.	Widjaja J, Sun X, Chu Y, et al. Sleeve gastrectomy with braun anastomosis transit bipartition (B-TB): a potential midway between single anastomosis and Roux-en-Y transit bipartition. Obes Surg, 2021, 31(12): 5500-5503.
7.	中华医学会外科学分会甲状腺及代谢外科学组, 中国医师协会外科医师分会肥胖和代谢病外科专家工作组, 刘金钢, 等. 中国肥胖及代谢疾病外科治疗指南 (2024版). 中国实用外科杂志, 2024, 44(8): 841-849.
8.	中国医师协会外科医师分会肥胖和代谢病外科专家工作组, 中国医师协会外科医师分会肥胖代谢病综合管理与护理专家工作组, 中国肥胖代谢外科研究协作组. 中国肥胖代谢外科数据库: 2024年度报告. 中华肥胖与代谢病电子杂志, 2025, 11(2): 85-91.
9.	Lin YH, Ser KH, Lee MH, et al. Single anastomosis sleeve jejunal bypass (SASJ) has become the leading metabolic bariatric surgery in Taiwan. Obes Surg, 2025. doi: 10.1007/s11695-025-07995-2.
10.	Ataya K, Patel N, Aljaafreh A, et al. Outcomes of single anastomosis sleeve ileal (SASI) bypass as an alternative procedure in treating obesity: an updated systematic review and meta-analysis. Obes Surg, 2024, 34(9): 3285-3297.
11.	Aghajani E, Schou C, Gislason H, et al. Mid-term outcomes after single anastomosis sleeve ileal (SASI) bypass in treatment of morbid obesity. Surg Endosc, 2023, 37(8): 6220-6227.
12.	Mahdy T, Gado W, Emile S. Single anastomosis sleeve ileal (SASI) bipartition//Agrawal S. Obesity, bariatric and metabolic surgery: a comprehensive guide. Cham: Springer International Publishing, 2023: 867-881.
13.	Zhao S, Li R, Zhou J, et al. Sleeve gastrectomy with transit bipartition: a review of the literature. Expert Rev Gastroenterol Hepatol, 2023, 17(5): 451-459.
14.	Oliveira CR, Santos-Sousa H, Costa MP, et al. Efficiency and safety of single anastomosis sleeve ileal (SASI) bypass in the treatment of obesity and associated comorbidities: a systematic review and meta-analysis. Langenbecks Arch Surg, 2024, 409(1): 221. doi: 10.1007/s00423-024-03413-w.
15.	姚立彬, 于英华, 李胜利, 等. 胃袖状切除术与胃袖状切除联合双通路术术后胃食管反流病对比研究. 中国实用外科杂志, 2024, 44(8): 911-915.
16.	朱孝成, 王键, 洪健, 等. 胃袖状切除联合双通路术对预防胃袖状切除术后胃食管反流病的价值. 中国实用外科杂志, 2024, 44(8): 880-884.
17.	Wael M, Kandel MM, Altabbaa H, et al. Laparoscopic single anastomosis sleeve ileal bypass versus laparoscopic Roux-en-Y gastric bypass as single stage procedure for management of patients with class Ⅴ obesity (BMI ≥ 60 kg/m²): short-term follow-up. Obes Surg, 2025, 35(7): 2446-2460.
18.	Erol MF, Kayaoglu HA. Comparison of the effectiveness of single anastomosis sleeve ileal bypass and Roux-en-Y gastric bypass in obese patients with type 2 diabetes. Obes Surg, 2024, 34(10): 3748-3754.
19.	Carandina S, Ferro S, DE Palma M, et al. Reviving weight loss and metabolic obesity-related comorbidities: mid-term results of single anastomosis sleeve ileal (SASI) bypass for failed sleeve gastrectomy. a retrospective cohort study. Int J Surg, 2025. doi: 10.1097/JS9.0000000000002874.
20.	Christogianni V, Rao A, Halter CJ, et al. Conversion of sleeve gastrectomy to different types of bipartitions: OATB, B-TB, and RYTB-a retrospective single-center study. Updates Surg, 2025. doi: 10.1007/s13304-025-02267-1.

1. Santoro S, Malzoni CE, Velhote MC, et al. Digestive adaptation with intestinal reserve: a neuroendocrine-based operation for morbid obesity. Obes Surg, 2006, 16(10): 1371-1379.
2. 中华医学会外科学分会甲状腺及代谢外科学组, 中国医师协会外科医师分会肥胖和代谢病外科专家工作组. 胃袖状切除联合双通道手术中国专家共识 (2025版). 中国实用外科杂志, 2025, 45(6): 611-617.
3. Mahdy T, Al Wahedi A, Schou C. Efficacy of single anastomosis sleeve ileal (SASI) bypass for type-2 diabetic morbid obese patients: gastric bipartition, a novel metabolic surgery procedure: a retrospective cohort study. Int J Surg, 2016, 34: 28-34.
4. Mui WL, Lee DW, Lam KK. Laparoscopic sleeve gastrectomy with loop bipartition: a novel metabolic operation in treating obese type Ⅱ diabetes mellitus. Int J Surg Case Rep, 2014, 5(2): 56-58.
5. Ribeiro R, Viveiros O, Taranu V, et al. One anastomosis transit bipartition (OATB): rational and mid-term outcomes. Obes Surg, 2024, 34(2): 371-381.
6. Widjaja J, Sun X, Chu Y, et al. Sleeve gastrectomy with braun anastomosis transit bipartition (B-TB): a potential midway between single anastomosis and Roux-en-Y transit bipartition. Obes Surg, 2021, 31(12): 5500-5503.
7. 中华医学会外科学分会甲状腺及代谢外科学组, 中国医师协会外科医师分会肥胖和代谢病外科专家工作组, 刘金钢, 等. 中国肥胖及代谢疾病外科治疗指南 (2024版). 中国实用外科杂志, 2024, 44(8): 841-849.
8. 中国医师协会外科医师分会肥胖和代谢病外科专家工作组, 中国医师协会外科医师分会肥胖代谢病综合管理与护理专家工作组, 中国肥胖代谢外科研究协作组. 中国肥胖代谢外科数据库: 2024年度报告. 中华肥胖与代谢病电子杂志, 2025, 11(2): 85-91.
9. Lin YH, Ser KH, Lee MH, et al. Single anastomosis sleeve jejunal bypass (SASJ) has become the leading metabolic bariatric surgery in Taiwan. Obes Surg, 2025. doi: 10.1007/s11695-025-07995-2.
10. Ataya K, Patel N, Aljaafreh A, et al. Outcomes of single anastomosis sleeve ileal (SASI) bypass as an alternative procedure in treating obesity: an updated systematic review and meta-analysis. Obes Surg, 2024, 34(9): 3285-3297.
11. Aghajani E, Schou C, Gislason H, et al. Mid-term outcomes after single anastomosis sleeve ileal (SASI) bypass in treatment of morbid obesity. Surg Endosc, 2023, 37(8): 6220-6227.
12. Mahdy T, Gado W, Emile S. Single anastomosis sleeve ileal (SASI) bipartition//Agrawal S. Obesity, bariatric and metabolic surgery: a comprehensive guide. Cham: Springer International Publishing, 2023: 867-881.
13. Zhao S, Li R, Zhou J, et al. Sleeve gastrectomy with transit bipartition: a review of the literature. Expert Rev Gastroenterol Hepatol, 2023, 17(5): 451-459.
14. Oliveira CR, Santos-Sousa H, Costa MP, et al. Efficiency and safety of single anastomosis sleeve ileal (SASI) bypass in the treatment of obesity and associated comorbidities: a systematic review and meta-analysis. Langenbecks Arch Surg, 2024, 409(1): 221. doi: 10.1007/s00423-024-03413-w.
15. 姚立彬, 于英华, 李胜利, 等. 胃袖状切除术与胃袖状切除联合双通路术术后胃食管反流病对比研究. 中国实用外科杂志, 2024, 44(8): 911-915.
16. 朱孝成, 王键, 洪健, 等. 胃袖状切除联合双通路术对预防胃袖状切除术后胃食管反流病的价值. 中国实用外科杂志, 2024, 44(8): 880-884.
17. Wael M, Kandel MM, Altabbaa H, et al. Laparoscopic single anastomosis sleeve ileal bypass versus laparoscopic Roux-en-Y gastric bypass as single stage procedure for management of patients with class Ⅴ obesity (BMI ≥ 60 kg/m²): short-term follow-up. Obes Surg, 2025, 35(7): 2446-2460.
18. Erol MF, Kayaoglu HA. Comparison of the effectiveness of single anastomosis sleeve ileal bypass and Roux-en-Y gastric bypass in obese patients with type 2 diabetes. Obes Surg, 2024, 34(10): 3748-3754.
19. Carandina S, Ferro S, DE Palma M, et al. Reviving weight loss and metabolic obesity-related comorbidities: mid-term results of single anastomosis sleeve ileal (SASI) bypass for failed sleeve gastrectomy. a retrospective cohort study. Int J Surg, 2025. doi: 10.1097/JS9.0000000000002874.
20. Christogianni V, Rao A, Halter CJ, et al. Conversion of sleeve gastrectomy to different types of bipartitions: OATB, B-TB, and RYTB-a retrospective single-center study. Updates Surg, 2025. doi: 10.1007/s13304-025-02267-1.

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