Sleeve and sleeve plus
Obesity is an epidemic issue that will cause type 2 diabetes, cardiometabolic diseases, stroke, osteoarthritis, sleep apnea and some kinds of cancer. These diseases may be lethal and usually cause high cost of medical expenditure. Many studies have reported that bariatric surgeries are much superior than intensive medical therapies in reaching therapeutic goal of weight loss and resolution of co-morbidities. The golden standard procedure, laparoscopic Roux-en-Y gastric bypass (LRYGB) has most satisfied resolution rates of metabolic diseases especially in type 2 diabetes mellitus (T2DM). However, needs for long-term supplement of vitamins and higher rates of complications makes bariatric surgeons to invent other modified surgical techniques. Due to short learning curve and satisfied surgical results, laparoscopic sleeve gastrectomy (LSG) now is worldwide accepted. However, comparing with LRYGB, LSG could not achieve the same remission rates of obesity-related comorbidities especially T2DM. Therefore, a new surgical procedure: loop duodenojejunal bypass with sleeve gastrectomy (LDJB-SG) has been invented. Today, we review the sleeve gastrectomy and LDJB-SG from basic surgical methods to possible mechanisms: weight-dependent and weight-independent mechanisms (intestinal inversion and change of gastrointestinal hormones) to discuss the roles of these two surgical procedures in bariatric surgery.