Weight loss (bariatric) surgery involves a range of procedures designed to help patients achieve sustainable weight loss and improve metabolic conditions such as type 2 diabetes.

Sleeve Gastrectomy

The sleeve gastrectomy is the most common bariatric procedure, involving the removal of 80% of the stomach to create a narrow gastric tube that restricts food intake and reduces hunger hormones (ghrelin). This typically results in a 25–35% total body weight loss (approximately 50–70% excess weight loss), along with excellent resolution of comorbidities.

Advantages of sleeve gastrectomy over gastric bypass include its simplicity and safety, with fewer long-term complications such as dumping syndrome, ulcers, bowel obstructions, and vitamin deficiencies.

• Rare (~1%) risk of leakage requiring intervention
• 11–33% may develop reflux long-term
• May require medication or revisional surgery

Image of Sleeve Gastrectomy

Roux-en-Y Gastric Bypass (RYGB)

The Roux-en-Y Gastric Bypass (RYGB) is a well-established bariatric procedure that creates a small stomach pouch and reroutes the small intestine, significantly reducing food intake and calorie absorption. This typically results in a 25–35% total body weight loss (approximately 50–70% excess weight loss).

• Powerful anti-reflux effect
• Effective revision procedure
• More complex than sleeve gastrectomy

       Risks:

• dumping syndrome, ulcers, bowel obstruction, abdominal pain
• Requires lifelong vitamin supplementation

                                                     

One Anastomosis / Mini Gastric Bypass (OAGB/MGB)

The Single Anastomosis/Mini Gastric Bypass (MGB) is a simplified version of the RYGB, involving the creation of a long, narrow stomach pouch and a single connection to a loop of the small intestine.

This reduces food intake and calorie absorption, leading to similar weight loss (approximately 25–35% total body weight loss) and metabolic outcomes as RYGB.

• Less complex than RYGB
• Lower risk of internal hernias and bowel obstruction
• Similar dumping and ulcer risks
• Risk of bile reflux (may require revision)

SADI-S

SADI-S is probably the most powerful weight loss procedure suitable for both primary and revisionary cases following sleeve gastrectomy, typically achieving the highest excess weight loss (around 80–90% EWL).

It consists of a sleeve gastrectomy followed by a small bowel bypass, connecting the duodenum to the ileum to reduce absorption and alter metabolic hormones.

• Highest and most sustained weight loss
• Strong metabolic effect
• Higher surgical complexity

Risks:

• malabsorption, protein deficiency, chronic diarrhoea
• Requires strict long-term follow-up

Intestinal Bipartition ( Single Anastomosis Sleeve Ileal Bypass ‘SASI’)

Intestinal Bipartition (IB) is a relatively new type of bariatric surgery that involves dividing the small intestine into two separate pathways One pathway is much shorter than the other. Food is routed through both pathways, but the shorter pathway allows for less absorption of nutrients and calories. This procedure is still being studied, but it shows promise for people with type 2 diabetes who are obese or overweight.

How does IB work?

The exact mechanism of how IB helps with weight loss and diabetes is not fully understood, but it is thought to work in a few ways:

• Reduced calorie absorption: By dividing the small intestine, IB changes the way food is digested and absorbed. This can lead to a reduction in the number of calories your body absorbs, which can help with weight loss.
• Improved insulin sensitivity: Studies have shown that IB can improve insulin sensitivity, which means that your body uses insulin more effectively. This can help to lower blood sugar levels.
• Hormonal changes: IB may also affect the production of hormones that regulate appetite and metabolism. This could help to reduce hunger and increase feelings of fullness.

Dr. George is among a small number of surgeons globally performing this promising revisional bariatric procedure. If you are interested in exploring this option, please contact us for more information.