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What is a Sleeve Bipartition Bypass?

Sleeve bipartition is also called modified Roux-en-Y gastric bypass.
During the procedure, the stomach is sleeved and a hole in the stomach wall, close to the pylorus, is made. This hole in the stomach wall called the second stomach exit is connected to a shortened section of the small intestine that allows the food to go more quickly into the large intestine. The rest of the intestine is then reconnected to the “bypassed” section, so that a portion of the food will still go through the pylorus and the entirety of the intestine.

From its first iteration in 1950, bypass surgery has been improved year after year. Even today, we keep finding better methods and tools to satisfy and improve on all requirements of the surgery: weight loss results, speed of recovery, comfort, long-term sustainability, etc. This version of the gastric bypass was invented in 2004 in Brazil by Dr. Sergio Santoro.

The surgery

After sleeving the stomach by removing a portion of it, we cut the small intestine close to the transition to the large intestine (cecum). The distance from the cecum (and thus the length of the bypassed portion) will depend on several patient characteristics.
We then connect the portion that has been cut (and is attached to the cecum) to the stomach, creating another exit for the food to pass through. The longer portion of the small intestine is then attached to the bypassed bowel, so that the food exiting the pylorus will go through the entire small intestine as well as the bypassed intestine. The food passing through the bypassed intestine will have a shorter journey in the digestive system, and its nutrients will be absorbed less.

The surgery effect

Weight loss surgeries have two main effects: restriction and malabsorption. Restriction refers to the reduction in quantity of food that can be ingested, while malabsorption refers to the lower absorption of nutrients that is enabled by surgeries that shorten the length of the intestine, thus giving less time to the body to take nutrients out of the food.

With a sleeve bipartition, we achieve restriction by sleeving the stomach, and we ensure a good level of malabsorption by choosing the right length for the bypassed intestine and letting a part of the food still go through the complete digestion process. Other bypass surgeries do not allow this, and their malabsorptive effect might be too intense.

Moreover, contrary to other bypass procedures, the sleeve bipartition allows the food to go through every portion of the intestine, avoiding “blind loops” and blind loop syndrome.

Surgery benefits
  • With modern, highly-refined-carbs food, the full process of digestion will be complete in less than one third of the bowel, preventing the final portion of the small intestine (the distal portion) to release enteric hormones, that are important for the feeling of satiety and the regulation of the glucose metabolism. This procedure will move food to the end of the small intestine more quickly, thus stimulating the release of both GLP1 and PYY hormones, that are important in regulating glucose and the feeling of satiety
  • Other bypass surgeries could create a blind loop, which is not a problem with sleeve bipartition. With sleeve bipartition no parts of the food pathway are stagnant. Thereby, we avoid blind loops, and therefor the risk of blind loop syndrome.
  • With a sleeve bipartition, the food is able to access first part of the small bowel (duodenum) where the bile and pancreatic openings are. This is important in the management of gall stones outside the gall bladder
  • A sleeve bipartition provides an excellent configuration for bile and acid reflux management
  • We will be able to choose the length of bypassed limbs without the worry of malabsorption, diarrhea and other consequences of aggressive small bowel bypasses
  • The procedure is also one of the best bypass surgeries for you, if you have had sleeve gastrectomy previously
  • Sleeve bipartition avoids excessive bacterial growth in the lumen of the small bowel, which might be a complication of other bypass procedures. An excessive bacterial growth will lead to the breakdown of bile with eventual unwanted malabsorption. The byproduct of bacteria could also affect liver function and cause cirrhosis in a small percentage of patient

One of most important changes you have to make is always have a small mouthful of food at a time. Chew it at least ten times before swallowing and avoid over filling your small stomach. Stretching the esophagus and the newly shaped stomach will decrease restriction, which is one of most important effects of bariatric surgeries. Apart from weight regain, stretching your stomach will lead to long-term unfavorable changes, that will make losing weight more challenging, even with revision surgeries.

Please do your research. Although we endeavor to provide you with the best quality information with our website, our guides, our videos and during consultations you should not only depend on our information. One of the important ways to get a better perspective is to talk with previous patients.
The surgery follow-ups are the most important parts of your journey. You might feel that there is no need to attend your follow-up appointments, and you might be doing very well for a few years. But simple recurrent mistakes will eventually catch up and will lead to a rapid weight regain within a short period of time.
It is not difficult to drift back into old habits. Picking up these drifts early is important to avoid major drifts later, as they might need more drastic measures, including revision surgery.
You should always remember that surgery can’t fix everything. The best thing to do if you would like to lose weight is to avoid stretching the stomach. Changing habits is not easy, and it needs significant commitment from your side. You have to make sure that you are ready and willing to make these changes. We highly recommend you practice these changes well before surgery.

Surgery risks

The following complications could be encountered by all type of bariatric surgery.

  • General anesthetic complications (allergies to anesthetics / anaphylaxis, oral or airway complications, aspiration pneumonia, etc.) Our anesthetist will take you through all these possible complications prior to surgery
  • General laparoscopic surgical complications, such as wound infections, bleeding into muscle layers or intra-abdominally, severe bruising of abdominal wall, hernias through the port sites
  • Numbness of upper thigh, from pressure of edema of abdominal apron
  • Reflux and recurrent abdominal pain. Reflux might be caused by a narrowing of the joint site (anastomosis), twisting, bowel blockage, internal hernia and other small complications. These are natural occurrences when “re-plumbing” the bowel
  • Nutritional deficiencies, in line with any bariatric surgeries. Please come to your follow-up appointments regularly to ensure you are taking the appropriate supplements to avoid all long-term consequences of poor nutrition
  • Skin redundancy, which is the eventual consequence of losing a good percentage of excess body weight. The amount of loose skin will be different from other patients, as it depends on how much and from where you will lose the body fat. Going for plastic surgery might be the right choice
  • Weight regains and the need for further procedures. Obesity is both a disease of the body, and a complex physiological condition. We don’t have a cure for it, and you need to commit to a lifelong healthy lifestyle that practices diet and exercise. Without your appropriate participation, life is going to be hard. There is no alternative to your participation, nobody else can do it for you. You should avoid drifting into the misconception that surgery will do everything and if it happens, weight regain is because the surgery didn’t work.
  • Intra-abdominal organ injuries, which includes liver, spleen, small and large bowel and on rare occasions major blood vessels injury
  • Bleeding from the bowel and stomach joint site (the anastomosis)
  • Bleeding from stitching of the bowel / stomach and Omentum (intra-abdominal fat apron).
  • Leakage from joint sites (anastomosis). This is the most significant complication from the bowel joint site. Literature shows that this happens at an average rate of about 0.2%, one every 500 cases. Perfecting surgical procedures and good patient diet compliance, should bring the rate to 0%, and reduce the impact in case this adverse event happens
  • Marginal ulcers, usually developed at the small bowel and stomach joint site. They are a consequence of excessive exposure of the small bowel to stomach acid, as it is not designed to put up with high acidity. You will be taking acid medication for three months to minimize the possibility of the development of ulcers. The formation of these ulcers usually follows non-compliance with acid medication and, most importantly, smoking. It is very important to avoid any type of smoking forever after surgery
  • Changes of bowel habit, or exacerbations of previous problems, in particular defecation issues from pelvic floor weakness, especially for female patients. Increasing fiber and pelvic floor exercises is a must
  • Gall bladder stones. Any rapid weight loss could lead to the formation of gall stones. This is mainly due to the rapid mobilization of body fat, which increases cholesterol concentration in the bile, and the stagnation of bile in the gall bladder due to the dietary restrictions. Gradual dieting before surgery to avoid rapid loss at the immediate post-operative period helps to avoid extreme increases in cholesterol concentration of the bile.
    Have regular small amount of oil or butter in the diet will help to encourage circulation of bile in the gall bladder

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