Sleeve Gastrectomy with Loop Bipartition (SG LB) is a novel bariatric/ metabolic surgery. After Sleeve Gastrectomy, Terminal ileum at 250 to 300 cm point is anastomosed to antero-inferior aspect of pyloric antrum in a loop fashion using hand sewn or stapled anastomosis in an ante-colic fashion. Physiology - In this surgery sleeve has two outlets. Most of the undigested food reaches terminal ileum through anastomosis leading to increased hormonal changes (Increased GLP 1, Peptide YY etc). So weight loss is more, risk of weight regain is less and chances of resolution of type 2 diabetes are more. Since duodenal pathway is also intact, part of the food goes through proximal intestine leading to reduced malabsorption. Main advantage is that endoscopic access to biliary tract is maintained. Since food is passes through duodenum, anti incretin effect is intact, and as a result hypoglycemia risk is less.
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