Selection and controversies of sleeve gastrectomy with transit bipartition procedures

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.