Recent studies have shown metabolic effect of sleeve gastrectomy beyond just restriction of food intake. Although an improvement of insulin tolerance is reported after sleeve gastrectomy, it might be insufficient to treatment of type 2 diabetes. However, this operation also has a fear of blind loop syndrome. Recently, we added sleeve gastrectomy with resectional jejunal bypass as a surgical treatment option for morbid obesity patient with type 2 diabetes. Operative Techniques: Overall procedures was similar with general sleeve gastrectomy. After completion of sleeve gastrectomy, small bowel was traced and measured a length from ligament of Treiz. Jejunum was divided at 40cm from ligament of Treiz. Entero-enterostomy for jejunal bypass was performed between biliopancreatic limb and small bowel below 150cm from the origin of alimentary limb, which is actually non-functional blind loop in this procedure. The final remaining blind loop, a 150 cm small bowel, can easily be removed via ligasure


Laparoscopic sleeve gastrectomy with jejunal bypass is technically feasible procedure even for a surgeon who is inexperienced for bariatric surgery but experienced for laparoscopic surgery. SG combined with intestinal loop induces better glycolipid metabolism than simple SG, with the lipid metabolism. It is not a difficult procedure to remove proximal jejunum that may cause blind loop syndrome. Long-term result should be verified for obesity control and nutritional problem.