BARIATRIC SURGERY (A. GHAFERI, SECTION EDITOR) Stomach Intestinal Pyloric Sparing Surgery or SIPS Mitchell Roslin 1 • Sarah Pearlstein 1 • Sarah Sabrudin 1 • Andrew Brownlee 1 Published online: 13 September 2016 Ó Springer Science + Business Media New York 2016 Abstract Purpose of Review As the field of bariatric surgery expands, the demand for a procedure that optimizes weight loss while minimizing complications grows ever higher. This paper proposes to give a rationale for this procedure as a salvage option for vertical sleeve gastrectomies (VSG) or as an initial bariatric procedure for patients requiring more weight loss and reduction in comorbidities than a VSG can offer. Stomach intestinal pyloric sparing surgery (SIPS) is a form of modified duodenal switch which is comprised a slightly larger than average vertical sleeve gastrectomy with a single postpyloric duodenal-enteral anastomosis with a common channel of 300 cm measured from the ileocecal valve. Recent Findings Recent evidence supports robust weight loss of 21 BMI Units in one-year postoperative patients. Additionally, in 80 patients with 1-year postop, it revealed mean vitamin D level of 26 ng/ml. No patient had an albumin level less than 3.0 mg/dl. SIPS shows effective weight loss with minimal long-term issues. Summary By extending the common channel, nutritional results are encouraging without obvious compromise of weight loss. Furthermore, the consistency of results at the various locations highlights the operative efficacy. Hence, we expect an increasing number of bariatric practices to move in a similar direction. Keywords Bariatric surgery Á Sleeve gastrectomy Á Bypass Á SIPS Introduction The search for the ideal bariatric procedure has remained an elusive goal. Stapling procedures can reduce the size of the stomach or bypass portions of the small intestine; however, the best method to calibrate the stomach and the intestine remains an area of conjecture. It is debatable as to what constitutes the ideal gastric pouch. Points to be con- sidered include the size of the pouch left, whether the pyloric valve is preserved, as well as whether resection is either necessary or beneficial. Similarly, there is no con- sensus on how the intestine should be reconstructed. In Roux en Y Gastric Bypass (RYGB) and duodenal switch (DS), there is a bilio-pancreatic limb that only contains bile and pancreatic juice, an alimentary limb that contains food, and a common channel where both meet. These limb lengths are highly variable, especially in RYGB. In gen- eral, most bariatric surgeons measure only the alimentary limb and the bilio-pancreatic limb, but do not measure the common channel. This means that the total intestinal length in contact with food is unknown. Finally, how the gastric pouch and intestine are attached is also an area of This article is part of the Topical collection on Bariatric Surgery. Electronic supplementary material The online version of this article (doi:10.1007/s40137-016-0157-y) contains supplementary material, which is available to authorized users. & Mitchell Roslin MRoslin@northwell.edu Sarah Pearlstein spearlstei@northwell.edu Sarah Sabrudin Ssabrudin@northwell.edu Andrew Brownlee brownleeandrew@gmail.com 1 General and Bariatric Surgery Department, Lenox Hill Hospital, Northwell Health, 186th E 76th Street, 1st Floor, New York, NY 10021, USA 123 Curr Surg Rep (2016) 4:35 DOI 10.1007/s40137-016-0157-y