Sometimes the Best Solution Is Transit Bipartition: Video Case Report


The simplest definition of Santoro’s operation is a sleeve gastrectomy with transit bipartition. Santoro et al. reported long-term data regarding sleeve gastrectomy with transit bipartition, which is a similar operation to duodenal switch but without complete exclusion of the duodenum to minimize nutritional complications and to allow endoscopic management of obstructive jaundice. Afterward, several studies proved the efficacy and safety of transit bipartition; the real benefit of this operation is the reduction of side effects and protein malnutrition compared with the bilio-pancreatic diversion with duodenal switch or Roux-en-Y gastric bypass. One of the well-known complications of sleeve gastrectomy is reflux which usually responds well to medical treatment, but in few cases, the reflux is refractory to conservative management and warrants surgical intervention as a conversion of the sleeve gastrectomy to other bariatric procedures. There are many theories concerning the increased incidence of gastro-esophageal reflux disease after sleeve gastrectomy which included reduction of lower esophageal sphincter pressure due to the division of ligaments and blunting of the angle of His, reduction in gastric compliance, increased sleeve pressure with an intact pylorus due to the use of Bougie < 40 Fr, decreased sleeve volume and distensibility, and dilated upper part of the final shape with a relative narrowing of the mid-stomach without complete obstruction. Our video report aims to present a unique surgical case and to show the surgical technique in this patient despite the complex surgical history.

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  1. 1.

    Santoro S, Castro LC, Velhote MC, et al. Sleeve gastrectomy with transit bipartition: a potent intervention for metabolic syndrome and obesity. Ann Surg. 2012;256(1):104–10.

    Article  PubMed  Google Scholar 

  2. 2.

    Topart P, Becouarn G, Finel JB. Is transit bipartition a better alternative to biliopancreatic diversion with duodenal switch for superobesity? Comparison of the early results of both procedures. Surg Obes Relat Dis. 2020;16(4):497–502.

    Article  PubMed  Google Scholar 

  3. 3.

    Topart P, Becouarn G, Finel JB. Comparison of 2-year results of Roux-en-Y gastric bypass and transit bipartition with sleeve gastrectomy for superobesity. Obes Surg. 2020;30:3402–7.

    Article  PubMed  Google Scholar 

  4. 4.

    Shim JK, Tayim RJ, Lehmann RK. Esophageal reflux disease before and after bariatric surgery. In: Reavis K, Barrett A, Kroh M, editors. The SAGES Manual of Bariatric Surgery. Cham: Springer; 2018.

    Google Scholar 

  5. 5.

    Melissas J, Braghetto I, Molina JC, et al. Gastroesophageal reflux disease and sleeve gastrectomy. Obes Surg. 2015;25:2430–5.

    Article  PubMed  Google Scholar 

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Correspondence to Midhat Abu Sneineh.

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Sneineh, M.A., Strypstein, S. & Dillemans, B. Sometimes the Best Solution Is Transit Bipartition: Video Case Report. OBES SURG (2021).

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  • Bariatric surgery
  • Sleeve gastrectomy
  • Gastric bypass
  • Redo bariatric surgery
  • Transit bipartition
  • Santoro operation