Expanding the Contemporary Paradigm of Sleeve Gastrectomy: Innovation, Prevention, and Physiological Preservation

Over the past two decades, sleeve gastrectomy has become the most widely performed bariatric operation, yet growing long-term evidence has highlighted limitations such as weight recurrence, gastroesophageal reflux, and declining metabolic durability, prompting a shift toward refining rather than abandoning sleeve-based strategies. The articles in this special issue collectively demonstrate how thoughtful innovations-ranging from metabolic enhancements and reflux-preserving solutions to reversible procedures and preventive diagnostic measures-can expand the therapeutic scope of sleeve gastrectomy while maintaining physiological continuity and minimizing long-term morbidity. Together, they articulate a unifying vision for the future of bariatric surgery: individualized, adaptable, and physiology-respecting interventions that prioritize durable outcomes and quality of life over increasingly radical anatomical alteration.