Intestinal Bipartition, also known as Transit Bipartition (TB), is a cutting-edge bariatric and metabolic surgery designed to promote long-term weight loss and improve overall metabolic health, without the lifetime of severe vitamin deficiencies associated with gastric bypass. Developed as an advanced solution for patients struggling with obesity and type 2 diabetes, this procedure combines stomach reduction with a carefully planned intestinal reconnection.
By allowing part of the food to follow the normal digestive path while directing another portion more quickly to the lower intestines, transit bipartition reduces calorie absorption, improves insulin sensitivity, and helps manage metabolic disorders.
In this blog, we’ll explore how the Transit Bipartition procedure works, its key benefits, and who may be an ideal candidate.
Transit Bi-Partition Explained
The Sleeve Gastrectomy with Transit Bipartition (SG-TB) is a distinct bariatric and metabolic surgery pioneered by Brazilian surgeon Sergio Santoro. A sleeve gastrectomy is combined with rerouting of the small intestine at the ileum (the final section of the small intestine). Two connections (anastomoses) are created:
- Between the remaining stomach and the small intestine
- Between two different parts of the small intestine
The gastric sleeve creates restriction and reduces the secretion of hunger hormones. The new pathway in the small intestinal tract alters the way food interacts with the intestines, changing gut hormone responses, such as FGF-19, which improves insulin sensitivity. SG-TB can reduce hunger, yield substantial weight loss, and improve blood sugar control.
Transit Bipartitan is not yet FDA-approved. This procedure is being performed extensively in Latin America and Europe with strong results, which is why it’s gaining traction worldwide.
How the Transit Bipartition is Performed
- Stomach modification: In some variations, the stomach may first be reduced, often into a sleeve-like shape, which is called the gastric sleeve with intestinal bipartition.
- Intestinal division: The small intestine is divided at a specific point (ileum), creating two distinct pathways for food to travel.
- Stomach Anastomosis: The stomach’s antrum (lower part) is connected directly to the lower part of the small intestine.
- Duodenal bypass: The upper portion of the small intestine is reconnected to a lower part of the intestine, creating a shortcut that bypasses a large section of the small intestine.
Benefits of Transit Bipartition Surgery
- Reduced Acid Reflux – Unlike some traditional bariatric surgeries, intestinal bipartition helps minimize gastroesophageal reflux, making it an excellent alternative for patients who struggle with chronic reflux.
- Bile Reflux – Designed to prevent bile reflux after the operation.
- Better Vitamin Absorption – Because this technique preserves a larger portion of the natural digestive pathway, it allows for greater absorption of vitamins and nutrients, helping reduce long-term deficiencies.
- Weight Loss – Patients often achieve much better long-term weight management. On average, patients with transit bipartition can expect to lose 85% to 90% of excess weight.
- Diabetes Management – It is highly effective at improving and sometimes resolving type 2 diabetes by producing FGF-19 and reducing insulin resistance.
- Improved Metabolic Health – The surgery can reduce other metabolic issues, such as hypertension and high cholesterol.
- Reversibility – In some cases, the procedure may be reversible.
On average, patients can expect to lose 85% to 90% of excess weight.
Hospital Stay and Recovery
Mexico Bariatric Center® patients receive care at the state-of-the-art Hospital Azar. For the Transit Bipartition procedure, the typical hospital stay is about 2 days, with a total of 5 days in Tijuana. Our board-certified surgeons, including Dr. Eduardo Cardenas Meave, are highly experienced in complex cases, including high BMI patients and revision bariatric surgery.
Before surgery, you’ll follow a pre-op diet to help shrink the liver. After surgery, you’ll follow the post-op diet guidelines and have support from our nutritionist and U.S. surgeon liaison for any questions throughout your recovery.
Is Transit Bipartition the Right Choice for You?
Intestinal Bipartition may be a good option for you if you are:
- Not getting results from their sleeve anymore
- Still struggling with obesity-related health issues
- Need a more effective metabolic surgery
- Wanting to preserve stomach function and reduce malabsorption risks
Potential candidates
- Individuals with a BMI of 35+.
- Patients with a BMI between 30 and 35 may be considered
- Individuals aged 18-65 are typically considered, though this can be re-evaluated on a case-by-case basis.
- Patients with health problems associated with obesity: Type 2 diabetes, Sleep Apnea, Fatty liver disease, Hypertension, and High blood lipids
Your next step is a detailed consultation with a bariatric specialist who can thoroughly evaluate your health, goals, and needs to determine if Transit Bipartition is the best fit for your journey to better health.
Intestinal Bipartition After Failed Sleeve Gastrectomy
Reasons for Intestinal Bipartition After a Sleeve:
- Insufficient Weight Loss or Weight Regain: Some patients’ bodies adapt to the sleeve over time. Hunger hormones can increase again. The stomach can stretch, leading to higher calorie intake.
- Persistent or Return of Diabetes or Metabolic Disease: Transit Bipartition reroutes part of the food stream directly to the last portion of the small intestine, activating powerful metabolic signals that improve insulin resistance. It has demonstrated high diabetes remission rates, sometimes better than a sleeve alone.
- Avoiding Complications of Other Revisions: It maintains the full stomach without heavy bypassing of nutrient absorption. Compared to a traditional bypass or mini bypass. Less risk of dumping syndrome. Lower risk of ulcers. Better nutritional outcomes (less malabsorption)
- Patient Needs a Stronger Bariatric Effect: Provides both restriction (from the sleeve) and metabolic changes (from the intestinal rerouting).
On average, patients can lose up to 70% to 75% of their original excess weight
How Intestinal Bipartition is Done after the Gastric Sleeve
Your stomach has already been narrowed by the Gastric Sleeve. Intestinal Bipartition takes it further:
- We connect the bottom of the small intestine directly to the stomach exit.
- Food now takes two paths: the normal route and a metabolic shortcut to the end of the gut
This shortcut speeds up hormonal signaling, giving you faster, more powerful metabolic improvement! It’s an advanced revision that keeps all the advantages of your original sleeve.
Transit Bipartition vs. Gastric Bypass
Choosing between Transit Bipartition (TB) and Gastric Bypass (Roux-en-Y) means weighing the benefits of two powerful surgeries. The biggest difference is how they handle your food. Gastric Bypass is highly effective because it completely reroutes your digestive system, leading to significant malabsorption. While this often leads to rapid weight loss, it requires a lifelong, strict commitment to vitamin and mineral supplements to avoid serious deficiencies.
Transit Bipartition is unique because it creates a dual pathway for food. This system is considered superior for resolving Type 2 Diabetes because it powerfully triggers metabolic hormones, but crucially, it avoids the radical malabsorption risk of the bypass. Ultimately, TB is a less complex operation that is easier on your digestive system, reducing the burden of future nutritional complications, while the bypass remains a reliable choice for maximum, sustained weight loss.
Transit Bipartition vs. SASI-S
In the Sleeve Gastrectomy with Single Anastomosis Stomach-Ileal (SASI-S) operation, only one anastomosis between the stomach and the small intestine is performed using the omega-loop method. In the Sleeve Gastrectomy with Transit Bipartition (SG-TB) operation, two connections are made: one between the stomach and the small intestine, and another between the small intestine and another part of the small intestine. The Bipartition is preferred to prevent possible bile reflux after SASI-S, which is one of the possible complications after the SASI-S operation.
| Feature | ITB/Santoro | SASI |
|---|---|---|
| Technique | Sleeve + distal bypass + reconnection | Sleeve + distal ileal loop |
| Complexity | More complex (Two anastomoses) | Simpler (One anastomosis) |
| Food Path | Preserves more intestinal pathways | Higher % of food bypasses duodenum |
| Reflux Risk | Lower (due to anatomy) | Higher (due to distal connection) |
| Weight Loss | Very High | Very High |
| Metabolic Impact | Excellent | Excellent |
Final Notes
Intestinal bipartition offers a modern, metabolic-focused approach for treating obesity. By accelerating beneficial gut hormone signals while preserving better nutrient absorption compared to traditional bypasses.
TB is an excellent solution for complex cases and those seeking a strong revision after a sleeve. If you are ready to explore this advanced, cutting-edge option, contact our specialists to determine if Transit Bipartition is the right strategy for your health transformation.
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