Sleeve Plus Procedures: A Review of Technical Evolution Along a Schematic Diagram

Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most widely accepted bariatric and metabolic surgeries, but each has its respective drawbacks. Roux-en-Y gastric bypass has the important limitation of hindering surveillance of the gastric remnant in addition to common drawbacks of bypass procedures. SG is generally safe and effective, but its limitations include reduced efficacy compared to RYGB, long-term recurrent weight gain, and diabetes recurrence. This has led to the development of sleeve plus procedures that combine SG with bypass techniques. This review presents these procedures along a schematic diagram, illustrating the characteristics of each technique, and categorizing them by the type of bypass technique used, length of the food pathway, and the inclusion of duodenal diversion.