IBC-Oxford University2023_BJSOral_13Efficiency and Safety of Single Anastomosis Sleeve Ileal (SASI) Bypass in the Treatment of Obesity and associated Co-morbidities: A Systematic Review and Meta-analysis

Abstract

Abstract Introduction The Single Anastomosis Sleeve Ileal (SASI) bypass is a new bariatric surgery corresponding to an adaptation of the Santoro approach, consisting of a sleeve gastrectomy (SG) followed by loop gastro-ileostomy. Therefore, we aimed to systematically assess all the current literature on SASI bypass in terms of safety, weight loss, improvement in associated comorbidities, and complications. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) recommendations, we conducted a systematic review and meta- analysis by searching three databases (PubMed, Scopus, and Web of Science). We performed a meta-analysis of risk ratios and mean differences to compare SASI bypass with SG and One-Anastomosis Gastric Bypass (OAGB) for percentage excessive weight loss, improvement/remission in type 2 diabetes mellitus (T2DM), hypertension (HT), dyslipidaemia (DL), obstructive sleep apnoea (OSA) and complications. Heterogeneity was assessed using the I2 statistic. Results Eighteen studies were included in the qualitative analysis and four in the quantitative analysis. Compared to SG, the SASI bypass was associated with improved weight loss (MD=11.32; 95% confidence interval (95%CI) [7.89;14.76]; p< 0.0001), and improvement or remission in T2DM (RR=1.35; 95%CI [1.07;1.69]; p=0.011), DL (RR=1.41; 95%CI [1.00;1.99]; p=0.048) and OSA (RR=1.50; 95%CI [1.01;2.22]; p=0.042). No statistically significant differences in any of the assessed outcomes was observed when compared with OAGB. Conclusion Although studies with longer follow-up periods are needed, this systematic review and meta-analysis showed that SASI bypass has a significant effect on weight loss and metabolic variables. Variations in outcomes between studies reinforce the need for standardisation.