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Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
➤ Procedure: SG followed by diversion of biliopancreatic secretions to
the distal ileum.
➤ Mechanism: Significant malabsorption plus restriction; high incretin
and bile acid changes.
➤ Effects: Maximal weight loss, T2DM remission, but greater
nutritional risk.
➤ Risks: Protein-calorie malnutrition, fat-soluble vitamin deficiencies,
frequent stools.
➤ Role: Patients with a high BMI or refractory T2DM under close
interdisciplinary follow-up.
Adjustable Gastric Band (AGB)
➤ Procedure: Silicone band placed around the proximal stomach with
adjustable inflation.
➤ Mechanism: Purely restrictive; minimal hormonal impact.
➤ Effects: Reduced meal size tolerance; variable efficacy.
➤ Risks: Band slippage, erosion, reoperation.
➤ Role: Largely obsolete due to poor outcomes and high reoperation
rates.
Single-Anastomosis Duodeno-Ileal Bypass with Sleeve
Gastrectomy (SADI-S)
➤ Procedure: SG followed by a single duodenoileostomy to the mid-
to-distal ileum.
➤ Mechanism: Restriction plus moderate malabsorption; hormonal
effects similar to DS.
➤ Effects: Durable weight loss, robust incretin response.
➤ Risks: Nutrient malabsorption, loose stools, long-term data evolving.
➤ Role: Alternative to DS in patients with an elevated BMI.
