袖状胃切除术（SG）是目前最常使用的减重手术方式，但存在着术后体重下降不足或反弹、术后胃食管反流（GERD）、袖状胃胸腔内上移（ITSM）等问题，亟待改进。为此，笔者提出功能性袖状胃切除术（FSG）这一新概念术式，旨在通过系统性技术优化解决上述问题，实现最大脏器功能保护、最佳减重效果和最少并发症的目的。FSG的核心创新包括：常规探查左侧膈肌角，肋膈角修补缩小、保留距His角约2 cm胃底组织、构建胃体限制环、距幽门3~4 cm起始切割胃、切缘浆肌层包埋缝合及大网膜复位固定。初步应用于12例患者显示：手术安全可行（无严重并发症），术后12个月总体重减少率（%TWL）达（34.8±7.9）%，多余体重减少百分比（%EWL）达（77.2±18.9）%，且无患者报告典型GERD症状。FSG可能是优化SG的一个新方向，但仍需要进一步的研究证据，证明FSG的安全有效，从而为推广该手术方式提供参考依据。

Sleeve gastrectomy (SG) is currently the most frequently performed bariatric procedure, yet it faces limitations such as inadequate weight loss or regain, gastroesophageal reflux disease (GERD), and intrathoracic sleeve migration (ITSM), necessitating refinement. To address these shortcomings, this study proposes the novel concept of functional sleeve gastrectomy (FSG). FSG aims to systematically optimize surgical techniques to resolve these issues, achieving maximal organ function preservation, optimal weight loss outcomes, and minimal complications. The core innovations of FSG include: routine exploration of the left diaphragmatic crus; plication and narrowing of the costodiaphragmatic angle; preservation of approximately 2 cm of gastric fundal tissue proximal to the angle of His; construction of a gastric body restriction ring; initiating gastric transection 3~4 cm proximal to the pylorus; seromuscular imbrication suturing of the staple line; and omentum repositioning and fixation. Preliminary application in 12 patients demonstrates: the procedure is safe and feasible (with no severe complications); at 12 months postoperatively, mean total weight loss (%TWL) reached (34.8±7.9)% and mean excess weight loss (%EWL) was (77.2±18.9)%. Notably, none of the patients reported typical GERD symptoms. FSG may represent a novel direction for optimizing SG, However, further research evidence is still needed to prove the safety and effectiveness of FSG, so as to provide a reference basis for the promotion of this surgical method.