Magnetic Duodeno‑Ileal Bypass with Sleeve (MagDI + Sleeve) is an emerging metabolic procedure that combines sleeve gastrectomy with a magnet‑assisted duodeno‑ileal bypass. It is designed to enhance metabolic effect beyond sleeve alone while preserving anatomy and reducing surgical complexity compared to traditional DS or SADI‑S.

MagDI + Sleeve works by reducing stomach volume through sleeve gastrectomy and diverting nutrient flow to the ileum using a magnet‑assisted anastomosis, stimulating powerful incretin release, improving insulin sensitivity, and altering bile acid circulation to enhance metabolic outcomes.

Potential benefits include improved metabolic effect compared to sleeve alone, enhanced GLP‑1 and PYY stimulation, preserved anatomy, lower surgical complexity than DS or SADI‑S, and an emerging option for patients seeking metabolic enhancement without traditional malabsorptive bypass.

Candidates may include patients with BMI ≥ 35, BMI 30–34.9 with metabolic disease, inadequate metabolic response to sleeve gastrectomy, or type 2 diabetes requiring enhanced metabolic effect beyond sleeve alone. Patient selection is individualized based on anatomy and metabolic goals.

The procedure begins with a standard sleeve gastrectomy. Magnets are then placed on the duodenum and a loop of ileum to create a controlled duodeno‑ileal bypass without traditional suture or staple anastomosis. The magnet‑assisted connection is designed to enhance metabolic signaling.

Limb lengths are determined by magnet placement and patient anatomy. The bypass configuration is designed to maximize metabolic effect while minimizing nutritional risk.

Potential risks include bleeding, leak, stricture, bile reflux, nutritional deficiencies, magnet migration or device‑related complications, and weight regain. As an emerging procedure, long‑term safety and efficacy data are still accumulating.

Days 1–3: hydration, gentle movement, pain control. Week 1: clear to full liquids. Week 2: soft foods. Weeks 3–4: transition to normal routines. By 30 days: improved energy and early metabolic changes. Nutritional follow‑up begins immediately.

Early studies show promising metabolic improvements and weight‑loss outcomes. Long‑term data are still accumulating. Lifelong nutritional follow‑up, supplementation, and lab monitoring are recommended.

Dr. Nestor de la Cruz‑Muñoz is a nationally recognized bariatric and metabolic surgeon with outcomes that exceed national benchmarks. His high‑volume experience, advanced minimally invasive techniques, and long‑term metabolic support model ensure safe, effective, and compassionate care.

No BMI‑stratified 1‑year TBWL data exist for MagDI + Sleeve. Early studies show meaningful weight loss and metabolic improvement beyond sleeve alone. Results are expected to approach SADI‑S as long‑term data emerge.

MagDI + Sleeve enhances metabolic effect through increased GLP‑1 and PYY release, improved insulin sensitivity, and bile acid pathway modulation. Early data suggest meaningful improvement in type 2 diabetes, hypertension, and dyslipidemia beyond sleeve alone.

MagDI + Sleeve may be preferred for patients seeking enhanced metabolic effect beyond sleeve without the full complexity of SADI‑S or DS.

Potential long‑term issues include bile reflux, vitamin deficiencies, and anastomotic or device‑related complications. As an emerging procedure, surveillance protocols are evolving. Lifelong nutritional follow‑up and lab monitoring are recommended.

Because the procedure includes a sleeve component, reflux may worsen in some patients. Patients with severe pre‑existing GERD should be evaluated carefully. The duodeno‑ileal bypass component may alter bile acid circulation and affect reflux symptoms.

MagDI + Sleeve may be considered for patients with inadequate metabolic response to sleeve gastrectomy. If further metabolic enhancement is needed, conversion to SADI‑S or DS remains an option. Long‑term revision data are still accumulating.

As an emerging procedure, MagDI + Sleeve may not be covered by all insurers. Coverage varies by plan and medical necessity. Our team assists with verification and authorization.