Laparoscopic sleeve gastrectomy (LSG) is indicated in patients with a very high BMI (> 60) who may have the most to gain from procedures such as Roux-en-Y gastric bypass (RYGB) or biliopancreatic diversion with duodenal switch (BPD-DS), the increased risk of postoperative complications often renders them poor surgical candidates. As a result, several "bridging" procedures have been proposed to impart clinically effective weight loss and reduce the risk of complications and improve outcomes in the definitive weight-loss procedure. Following initial weight loss and overall improvement, these interventions can be followed by conversion or completion to RYGB or BPD-DS.
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