Sleeve gastrectomy with transit bipartition is a novel bariatric and metabolic procedure providing significant metabolic benefits while minimizing the risk of malnutrition. However, due to the technical complexity of the Roux-en-Y transit bipartition configuration, several derivative procedures have been developed in clinical practice, including single anastomosis sleeve ileal bypass (SASI), single anastomosis sleeve jejunal bypass (SAS-J), and sleeve gastrectomy with Braun anasto-mosis transit bipartition (B-TB). These procedures vary in complexity, weight loss and metabolic efficacy, nutritional impact, and anti-reflux properties. SASI offers technical simplicity but raises concerns about bile reflux. SAS-J emphasizes nutritional safety, whereas B-TB incorporates a Braun anastomosis to enhance anti-reflux protection. The authors review and compare the clinical charac-teristics and indications of these procedures, aiming to provide a reference for surgeons in selecting individualized metabolic and bariatric surgical strategies.

Sleeve gastrectomy with transit bipartition is a novel bariatric and metabolic procedure providing significant metabolic benefits while minimizing the risk of malnutrition. However, due to the technical complexity of the Roux-en-Y transit bipartition configuration, several derivative procedures have been developed in clinical practice, including single anastomosis sleeve ileal bypass (SASI), single anastomosis sleeve jejunal bypass (SAS-J), and sleeve gastrectomy with Braun anasto-mosis transit bipartition (B-TB). These procedures vary in complexity, weight loss and metabolic efficacy, nutritional impact, and anti-reflux properties. SASI offers technical simplicity but raises concerns about bile reflux. SAS-J emphasizes nutritional safety, whereas B-TB incorporates a Braun anastomosis to enhance anti-reflux protection. The authors review and compare the clinical charac-teristics and indications of these procedures, aiming to provide a reference for surgeons in selecting individualized metabolic and bariatric surgical strategies.

Background and aims:Liver cirrhosis is a complex disease that may result in increased morbidity and mortality following bariatric surgery(BS).This study aimed to explore the outcome of BS in patients with unexpected cirrhosis,focusing on postoperative complications and the progression of liver disease. Methods:A retrospective study of bariatric patients with cirrhosis from four centers in China between 2016 and 2023 was conducted,with follow-up for one year after BS.The primary outcome was the safety of BS in patients with unexpected cirrhosis,while the secondary outcome was the metabolic efficacy of BS in this group postoperatively. Results:A total of 47 patients met the study criteria,including 46 cases of Child-Pugh class A cirrhosis and 1 case of Child-Pugh B.Pathological examination confirmed nodular cirrhosis in 21 patients(44.68％),pseudolobule formation in 1 patient(2.13％),lipedema degeneration with inflammatory cell infiltration in 3 patients(6.38％),and chronic hepatitis in 1 patient(2.13％).The average percentage of total weight loss was 29.73±6.53％at one year postoperatively.During the 30-day postoperative period,the complication rate was 6.38％,which included portal vein thrombosis,gastrointestinal bleeding,and intra-abdominal infection.Moreover,no cases of liver decompensation or mortality were reported during the follow-up period.The remission rates of comorbidities among 41 patients one year after surgery were as fol-lows:dyslipidemia 100％,type 2 diabetes 82.61％,hypertension 84.62％,and obstructive sleep apnea syndrome 85.71％. Conclusions:BS can be safely performed in patients with unexpected cirrhosis in the compensated stage of liver disease,with low postoperative morbidity and no mortality observed during one-year follow-up.