Ileal and Bipartition Surgeries in the Era of Incretin-Based Therapies: Defining the Future of Metabolic Surgery

Dear Colleagues,

The global burden of obesity and type 2 diabetes continues to rise, while the therapeutic landscape is being reshaped at unprecedented speed by incretin-based pharmacotherapy. GLP-1 receptor agonists, dual GIP/GLP-1 agonists such as tirzepatide, and emerging triple agonists now deliver degrees of weight loss and glycaemic control that were until recently attainable only through surgery. This evolution has prompted a fundamental reappraisal of the role, timing, and indications of metabolic surgery, and has raised a defining question for the field: are these operations and the new pharmacology competitors, complements, or sequential tools within a single treatment continuum?

Against this background, ileal- and bipartition-based procedures occupy a distinctive position. Operations such as transit bipartition, single-anastomosis duodeno-ileal bypass with sleeve (SADI-S), ileal interposition, and, more recently, magnetic compression anastomoses act by accelerating nutrient delivery to the distal bowel, thereby amplifying the endogenous secretion of GLP-1, PYY, and other L-cell hormones. They are, in effect, the surgical counterpart of the very pathways targeted by incretin drugs—making the interface between these procedures and modern pharmacotherapy one of the most compelling and clinically urgent topics in metabolic medicine today.

This Special Issue aims to present and disseminate the most recent advances related to ileal and bipartition metabolic surgery in the era of incretin-based therapies. We consider contributions addressing surgical techniques and long-term outcomes, patient selection, and the evolving relationship—complementary or competitive—between these operations and pharmacological treatment.

Topics of interest for publication include, but are not limited to, the following:

• Transit bipartition and SADI-S: techniques, indications, and long-term metabolic outcomes;
• Ileal interposition and other hindgut-based metabolic procedures;
• Magnetic compression anastomoses (e.g., duodeno-ileal magnetic compression anastomosis) and emerging device-based techniques;
•  Sleeve gastrectomy with transit bipartition: efficacy, GERD, and functional outcomes;
• The mechanistic basis of ileal/bipartition surgery;
• Combination and sequencing strategies: metabolic surgery and incretin-based therapy;
• Management of weight recurrence and metabolic relapse after primary bariatric procedures;
• Revisional ileal and bipartition surgery;
• Type 2 diabetes remission and MASLD outcomes following hindgut-directed surgery;
• Nutritional and long-term safety considerations;
• Comparative effectiveness of surgery versus pharmacotherapy;
• Original research articles and comprehensive reviews.

Dr. Patrick Noel
Guest Editor

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• metabolic surgery
• ileal and bipartition surgeries
• incretin-based therapies
• obesity
• diabetes
• type 2 diabetes
• pharmacological treatment