Assessment of Dumping and Quality of Life 6 Months Following Sleeve Gastrectomy With and Without Transit Bipartition : Comparative Study

Background and Rationale

Obesity has become one of the most important public-health challenges worldwide. It is associated with a wide range of comorbid conditions such as type 2 diabetes mellitus, hypertension, dyslipidemia, non-alcoholic fatty liver disease, obstructive sleep apnea, degenerative joint disease, and increased cardiovascular morbidity and mortality. Conservative management strategies-including dietary modification, physical activity, and pharmacologic therapy-often result in only modest and temporary weight reduction. Consequently, bariatric and metabolic surgery has emerged as the most effective and durable intervention for achieving long-term weight loss and improvement or remission of obesity-related diseases.

Among the different bariatric procedures, laparoscopic sleeve gastrectomy (LSG) has gained worldwide popularity. It is technically simpler than gastric bypass procedures and does not involve intestinal anastomoses or foreign materials. During LSG, approximately 75-80% of the stomach is resected along the greater curvature, leaving a tubular gastric "sleeve." This results in restrictive limitation of food intake and favorable hormonal changes, such as decreased ghrelin secretion, leading to appetite suppression. LSG has proven effective in producing substantial and durable weight loss as well as improvement in metabolic parameters.

However, despite these benefits, some patients experience functional gastrointestinal symptoms after LSG, including gastroesophageal reflux disease, food intolerance, early satiety, and dumping syndrome. Dumping syndrome refers to a collection of symptoms that occur when food passes too rapidly from the stomach into the small intestine. It can be divided into early dumping (occurring 10-30 minutes after eating, with symptoms such as nausea, abdominal cramps, palpitations, and dizziness) and late dumping (1-3 hours after eating, characterized by hypoglycemia, fatigue, and sweating). These symptoms may significantly impair quality of life (QoL), limit dietary freedom, and affect social activities.

To enhance the metabolic efficacy of sleeve gastrectomy while minimizing complications, several hybrid or modified techniques have been introduced. One such modification is sleeve gastrectomy with transit bipartition (SG-TB). In this operation, a side-to-side anastomosis is created between the distal ileum and the antrum or the first portion of the duodenum, allowing ingested food to pass through both the natural duodenal route and an alternative shortcut to the distal small intestine. This design maintains continuity of the biliary and pancreatic secretions, preserves access to the duodenum for endoscopy, and reduces the risk of nutritional deficiencies commonly seen with complete bypass procedures. Physiologically, the presence of dual intestinal transit is believed to enhance incretin hormone release (GLP-1, PYY) and improve insulin sensitivity.