Sleeve plus procedures

Bariatric surgery is now well developed in western countries, even its starting was not too late in Asia, and its development has been slow. One of the reasons is the ratio of obesity is not that high in comparison with western countries. However, recent progress of bariatric and metabolic surgery in Asia is outstanding because the number and ratio of diabetes are quite high in Asia. For Asian population, diabetes is bigger burden than obesity.
Gastric bypass is known to be superior to sleeve gastrectomy in terms of remission of diabetes, in some Asian countries, gastric cancer is still one of the biggest issue to be concerned after gastric bypass.  Laparoscopic sleeve gastrectomy as a standalone procedure has gained a lot of popularity over laparoscopic Roux-en-Y gastric bypass in the last decades and is the most frequently performed bariatric procedure worldwide, however, the long-term results are not promising in terms of weight regain and re-emergence of comorbidities. Considering the proven concept of biliopancreatic diversion with duodenal switch, many novel procedures have been developed involving a sleeve gastrectomy along with some intestinal bypass or alteration in small intestine anatomy.So called “ Sleeve plus” procedures, including Sleeve DJB, Sleeve PJB and SAID are being performed in Asia in order to achieve better glycemic control and to avoid the risk of remnant gastric cancer.
Sleeve plus procedures will be the one of the option for bariatric and metabolic surgery in Asia