Single Anastomosis Sleeve Ileal Bypass Research Articles

Evaluation of single anastomosis sleeve ileal bypass in the treatment of morbidly obese patients with type 2 diabetes mellitus

Evaluation of single anastomosis sleeve ileal bypass in the treatment of morbidly obese patients with type 2 diabetes mellitus

Outcomes of Single Anastomosis Sleeve Ileal (SASI) Bypass as an Alternative Procedure in Treating Obesity: An Updated Systematic Review and Meta-Analysis.

The Single Anastomosis Sleeve Ileal (SASI) bypass is a novel bariatric procedure that simplifies Santoro's procedure, balancing functional restriction and neuroendocrine modulation while preserving anatomy. We aim to conduct a single-arm meta-analysis of the SASI bypass to explore its moderate-term efficacy, as this might expand the available choices for surgeons to choose the best bariatric surgery that suits the patient's condition. We conducted a comprehensive search on PubMed, Scopus, EMBASE, and Cochrane to identify studies for the SASI bypass surgery focusing on outcomes such as %EWL, %TWL, remission rate of comorbidities, and complications. The statistical analysis was carried out using RStudio version 4.3.2. Heterogeneity was assessed using the Cochrane Q test and I2 statistics. Our findings illuminate SASI's potency by undertaking a single-arm meta-analysis involving 1873 patients across 26 studies. At 12months, we report a noteworthy % Excess Weight Loss (%EWL) (Mean 84.13; 95% CI 78.41-89.85; I2 = 95%), and % Total Weight Loss (%TWL) (Mean 35.17; 95% CI 32.30-38.04; I2 = 97%), highlighting SASI's efficacy on weight loss. Cumulative meta-analyses supported these findings. More weight loss was observed with a 250cm common limb and a greater than 3cm anastomosis. An 88.28% remission rate in type 2 diabetes mellitus (95% CI 79.74-95.03; I2 = 84%) at 12months was observed. Beyond weight outcomes, SASI impacts comorbidities with a good safety profile. Our study positions the SASI bypass as a good alternative option. However, long-term efficacy is yet to be explored in the future.

Comparison of the Effectiveness of Single Anastomosis Sleeve Ileal Bypass and Roux-en-Y Gastric Bypass in Obese Patients with Type 2 Diabetes.

The rapid increase in obesity and related problems has heightened the importance of obesity and metabolic surgery, resulting in a continuing search for the ideal surgical method. This study aimed to compare the effectiveness of Roux-en-Y gastric bypass (RYGB), which is the gold standard method, and the relatively newer method of single anastomosis sleeve ileal (SASI) bypass. The medical records of patients who underwent RYGB and SASI bypass were reviewed and compared regarding excess weight loss (EWL) and HgA1c, fasting glucose, serum iron, ferritin, hemoglobin (Hgb), and vitamin B12 levels. The body mass index was significantly lower (p = 0.003), and the %EWL was significantly higher (p = 0.023) at 6months postoperative in patients who underwent SASI bypass. Both groups had similar results at the other follow-up visits. The mean HgA1c levels at the 6- and 12-month follow-up visits were significantly lower in SASI patients (p = 0.037 and p = 0.012, respectively). At the 24-month follow-up, no difference was detected in HgA1c levels between the groups (p = 0.476). In patients who underwent RYGB, ferritin (p < 0.001), plasma iron (p = 0.001), and Hgb levels (p = 0.001) were significantly lower at 12, 24, and 12months postoperatively, respectively. SASI bypass is effective and comparable to RYGB in terms of EWL and metabolic control and has the advantage of not producing excluded segments and reducing nutritional deficiencies.

Comparative study of Laparoscopic Sleeve Gastrectomy versus Laparoscopic Single Anastomosis Sleeve Ileal Bypass (SASI) as a Treatment Modality for Morbidly Obese Patients with Type 2 Diabetes Mellitus

Abstract Background Bariatric surgery has been shown to be the most successful approach in managing morbid obesity that can achieve and sustain great weight loss for a long period. Furthermore, bariatric surgery can achieve better resolution of type 2 diabetes mellitus (T2DM) than intensive medical therapy alone. The present study aimed to compare the effect of Sleeve Gastrectomy (SG) against Single Anastomosis Sleeve Ileal Bypass (SASI) regarding the control of Diabetes Mellitus and weight loss. Patients and Methods This is a prospective comparative study conducted on 60 obese patients (BMI of 30 kg/m2 associated with obesity-related comorbidities including T2DM) to evaluate the effect of SG Versus SASI on obese patients with type II DM. it was carried out in Misr University Hospital from January 2022 to June 2022. This study included 60 patients which are divided randomly into two groups; one group consisted of 30 patients underwent SASI, the other group consisted of 30 patients underwent SG. The main outcome measures were excess weight loss (EWL) and resolution of T2DM at 6 after surgery. Results The results of this study showed that there was no statistically significant difference between both groups regarding EWL (the mean EWL % was 47.39±8.07 &amp; 48.09 ±1.4 for SASI &amp; SG respectively). Improvement in T2DM after SASI was better than SG (80% vs 66.7%, respectively) with no statistically difference between them. SASI required longer operative time than SG (116.83±19.23 versus 60.5 ±9.77, respectively). Complications occurred in 2 (6.7%) patients after SASI and 5 (16.7%) patients after SASI. Conclusion There was a statistically significant effect of SASI and SG on morbidly obese patients with T2DM; improving both obesity and obesity related co- morbidities with no statically significant difference between both groups regarding EWL and Improvement in T2DM after 6 months. So, large sample size with long-term follow-up period should be performed to better evaluate these technical surgeries and their efficacy regarding postoperative weight loss, metabolic changes, and nutritional status of patients.

Anemia and iron metabolism disorders after single anastomosis sleeve ileal (SASI) bypass. Is it a real problem?

PurposeSASI (single anastomosis sleeve ileal) bypass can lead to nutritional deficiencies, including disorders of iron metabolism and anemia. This study aims to evaluate the effect of SASI bypass on weight loss, anemia, and iron deficiency in patients with obesity during the follow-up period.MethodsThis study is a retrospective analysis of prospectively collected data from patients who underwent SASI bypass at our hospital between January 2020 and February 2022.ResultsThe mean age of the patients was 42 years (range 22–58). The average duration of the follow-up period was 26 months. The mean percentage of excess weight loss (%EWL) was 90.1%, and total weight loss (%TWL) was 30.5%. During the postoperative observation period, anemia was identified in ten patients (25%), comprising 70% with normocytic anemia, 10% with microcytic anemia, and two macrocytic anemia cases (20%). Iron deficiency was observed in two patients (5%).ConclusionSASI bypass is an effective bariatric procedure in weight loss outcomes. However, there may be an increased risk of anemia and iron metabolism disruptions associated with this procedure. The common limb length (250 vs. 300 cm) did not significantly impact hemoglobin, iron, TIBC, ferritin levels, or anemia incidence among patients undergoing SASI bypass. The decrease in postoperative ferritin levels signifies a depletion in tissue iron reserves, thereby emphasizing the necessity for surveillance of iron homeostasis parameters following SASI bypass.

The Alarming Rate of Malnutrition after Single Anastomosis Sleeve Ileal Bypass. A single Centre Experience.

Single anastomosis sleeve ileal (SASI) bypass is a modification of sleeve gastrectomy with transit bipartition (SG + TB). This study aims to assess the safety and efficacy of SASI as a primary metabolic and bariatric surgery (MBS). This is a retrospective case series of 30 patients who underwent SASI bypass from January to December 2021. All patients completed at least 12months of follow-up. Among the 30 patients, 93.3% were women, the mean age was 37.4years, and the mean body mass index (BMI) was 45.6kg/m2. The percentage of total body weight loss (TWL%) was 42.7%, the percent excess body weight loss (EWL%) was 92.7%, and the mean BMI at 12months went from 45.6(35.2-58.4) to 25.8kg/m2 (19.2-33.4). The obesity-associated complications remission rate was 87.5% for type 2 diabetes (T2D), 71.4% for hypertension (HTN) and 100% for obstructive sleep apnea (OSA). Thirteen patients (43.3%) had diarrhea, 7 (23.3%) had hypoalbuminemia, defined as serum albumin < 3g/dl, and 6 (20%) underwent reversal of their index SASI. As for other nutritional issues, iron deficiency anemia was present in 21 patients (70%), while 19 patients (63.3%) had vitamin D, and 2(6.6%) had vitamin B12 deficiency. Despite good short-term weight loss and improvement of obesity-associated complications, SASI is accompanied by high alarming malnutrition, even in short-term follow-up. Novel MBS should be judged for their long-term effects and compared to well-tested standard operations before they are used in routine clinical practice.

Effect of laparoscopic mini gastric bypass versus laparoscopic single anastomosis sleeve ileal bypass on serum iron and calcium levels

Background Although bariatric surgery techniques are very effective in the treatment of obesity, they are usually associated with evident nutritional deficiencies. Such operations require ongoing medical care along with vitamin (Vit) and nutrition supplements. Aim Is to determine and compare the effect of Laparoscopic mini gastric bypass (MGB) versus laparoscopic single anastomosis sleeve ileal bypass (SASI) on serum iron and calcium levels. Methodology The current prospective Randomized controlled study included 62 patients who were randomly allocated into one of two equal groups. Group A (n=31) underwent MGB while group B (n=31) underwent SASI. Follow-up was designed for 6 and 12 months in both groups for the serum iron profile, serum folate, Vit B12, Vit D, parathyroid hormone, and calcium level. Results There was a statistically significant decrease in Excess weight loss (EWL)% in both groups after 1, 6, and 12 months and a significant EWL % in group A more than group B (P=0.045*). There was a statistically significant drop in the Iron profile components’ levels in both groups after 1, 6, and 12 months in comparison with the corresponding baseline levels. There was a statistically significant decrease in the calcium level as well as Vit D3 within both groups at 1, 6, and 12 months follow-up with a significant increase in Parathyroid hormone in both groups at the same interval of follow-up. Conclusion Both MGB and SASI are effective methods for the treatment of morbid obesity. However, adherent follow-up for the Iron profile, Vit B12, Vit D3, parathyroid hormone, and calcium levels are mandatory.

Effects Of Single Anastomosis Sleeve Ileal (SASI) Bypass on Morbid Obese Patients with Metabolic Syndrome

Background Metabolic syndrome (MetS) is a silent epidemic that is a major global public health concern. Bariatric surgery is an approved treatment for obesity where weight reduction is crucial for the control of metabolic syndrome. This study aimed to report our institutional experience in the effect of single anastomosis sleeve ileal (SASI) on metabolic syndrome. Patients and methods The current prospective study included 50 Morbid Obese Patients with MetS who were eligible for SASI. Follow-up was planned for 1 year. Results The mean age of patients was 41.56±6.32 years. The mean % EWL was 56.94±4.65 and 83.16±8.09 at 6 and 12 months, respectively. HbA1c showed significant improvement which decreased from 8.34±1.23 to 5.04±0.38 after 1 year follow-up. Triglycerides (mg/dl) and LDL-C (mg/dl) show significant reduction at 6 months and 1 year postoperative from 177.48±30.95 preoperative to 131.98±17.65 and 104.10±14.03 for Triglycerides, and from 180.76±21.04 preoperative to 104.64±7.13 and 77.56±8.93 for low density lipoprotein-C (LDL-C) (&lt;0.001). HDL-C (mg/dl) showed a significant increase from 40.44±10.93 preoperative to 49.58±8.71 and 57.96±6.64 (&lt;0.001). As regards the blood pressure; mean arterial pressure showed a significant decrease from a baseline of 103.38±11.38 to 88.36±5.72 at 6 months and to 74.46±5.83 at 1 year of follow-up. Conclusion As demonstrated by this study, all MetS characteristics significantly improved following the SASI bypass treatment.

Analysis of the efficacy of sleeve gastrectomy, one-anastomosis gastric bypass, and single-anastomosis sleeve ileal bypass in the treatment of metabolic syndrome

The objective of this study was to evaluate and compare the effectiveness of three different types of bariatric surgeries, namely, sleeve gastrectomy (SG), one-anastomotic gastric bypass (OAGB), and single anastomosis sleeve ileal (SASI) bypass, in the treatment of metabolic syndrome (MS). The optimal approach for managing MS remains uncertain, and thus this study aimed to provide a recent analysis of the efficacy of these surgical procedures. This retrospective study evaluated data of individuals who underwent SG, OAGB, and SASI bypass. The primary outcome measures included weight, body mass index (BMI), glucolipid metabolic index, and the occurrence of treatment-related complications within 6 to 12 months post-surgery. A total of 324 patients were included in this study. Of these, 264 patients underwent SG, 30 underwent OAGB, and 30 underwent SASI bypass. A significant decrease in weight was observed at the 6-month and 12-month marks following all three surgical procedures. Of these, patients who underwent SASI bypass exhibited the greatest reduction in weight and BMI post-surgery. Furthermore, the SASI bypass was associated with a significantly higher percentage of total weight loss (%TWL) and excess body mass index loss (%EBMIL) compared to SG and OAGB. Patients who underwent OAGB and SASI bypass demonstrated notable improvements in type 2 diabetes mellitus (T2DM). Patients who underwent SASI bypass and OAGB experienced greater postoperative comfort and reported fewer complaints of discomfort compared to the other procedure. Based on the retrospective analysis of the data, SASI bypass was associated with greater reductions in weight and BMI, higher percentages of %TWL and %EBMIL, and better improvement in T2DM compared to SG and OAGB. Therefore, both SASI bypass and OAGB were found to be more effective than SG in the treatment of MS.

Single anastomosis sleeve ileal bypass a single anastomosis sleeve jejunal bypass in the surgical treatment of severe obesity.

Bariatric surgery has been proven to be an effective method in the treatement of morbid obesity. The ideal bariatric procedure should be effective, easy to perform and safe. Sleeve gastrectomy and RYGB currently represent the most frequently used bariatric/metabolic procedures. However, they have a certain percentage of complications and post-operative morbidity and also they fail in some patients. These facts lead to the development of new surgical procedures, which also include single anastomosis sleeve ileal bypass (SASI) and single anastomosis sleeve jejunal bypass (SASJ). These procedures combines the advantages of restrictive and malabsorptive operations at the same time reducing the risk of nutrient deficiencies by maintaining passage through all the alimentary tract. The results so far are encouraging, further research and especially longer-term results are necessary.

Laparoscopic single anastomosis sleeve ileal bypass in the surgical management of morbid obesity: A single‐centre experience

AbstractBackgroundSingle anastomosis sleeve ileal (SASI) bypass is a recently developed two‐step bariatric operation that involves a sleeve gastrectomy followed by a side‐to‐side sleeve‐ileal anastomosis. While the primary outcomes are promising, more evidence is required before SASI can be considered a standard bariatric procedure.ObjectiveThis study aims to evaluate short‐term outcomes of SASI bypass regarding safety, efficacy and complications.MethodsThis retrospective study involved the analysis of 75 patients who underwent SASI between January 2019 and January 2022. The study examined patients’ characteristics, comorbidities, surgical technique, operative details, post‐operative weight loss and complications.ResultsOf the 88 patients who underwent SASI, 13 were excluded, leaving 75 participants for analysis. The mean age was 36.9 ± 8.3 years, and the mean body mass index was 49.23 ± 5.5 kg/m2. Among the participants, 19 patients (25.3%) had diabetes and 8 patients (10.6%) had hypertension. The mean operative time was 78.42 ± 13.18 min. The mean excess weight loss percentage was 25.53 ± 3.63, 43.33 ± 8.78, 63.51 ± 10.85, 82.11 ± 11.42 and 88.95 ± 8.69 at 1, 3, 6, 12 and 24 months, respectively. The diabetic remission rate was 100%, and the hypertension remission rate was 75%. Post‐operative complications were observed in 12 patients (16%), with most being minor. Notably, two patients underwent SASI reversal to sleeve gastrectomy due to excessive weight loss, and one patient experienced weight regain in the second post‐operative year.ConclusionSASI bypass emerges as a straightforward and highly effective bariatric procedure, with an acceptable complication rate. It is easy to perform and revise, offering not only excellent and sustained weight loss outcomes during short‐term follow‐up but also the resolution or improvement of obesity‐associated comorbidities.

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 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&amp;lt; 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.

Comparison of three different anastomotic methods of sleeve gastrectomy with transit bipartition using an obese rodent model

The long-term effects and safety of single-anastomosis sleeve ileal (SASI) bypass have not been confirmed. The one anastomosis procedure carries the risk of bile reflux, and Braun anastomosis has the capacity to reduce bile reflux. This study was designed to compare the influences of bile reflux and histological changes in the esogastric sections of rats. Obese Sprague–Dawley rats underwent sleeve gastrectomy with transit bipartition (RYTB) (n = 12), SASI (n = 12), SASI bypass with Braun anastomosis (BTB) (n = 12), esojejunostomy (EJ) (n = 12), and SHAM (n = 8) surgery. During the 12-week follow-up period, weight changes, glucose improvement, and changes in serum nutrition were evaluated. Histological expression and bile acid concentration in the rats in all groups were also evaluated. No significant differences in weight loss and glucose improvements were observed in the RYTB, SASI, and BTB groups. The RYTB and BTB groups had significantly lower bile acid concentration and albumin levels than the SASI group. In addition, mucosal height in the RYTB and BTB groups was significantly lower than in the SASI group. Braun anastomosis had a significant effect on anti-reflux. BTB may be a superior primary procedure due to its potential for parallel bariatric and metabolic improvements, effective anti-reflux effects, simplified operations, and avoidance of severe malnutrition. Further clinical studies are needed to confirm these findings.

IBC-Oxford University2023_BJSOral_11Video Presentation: Laparoscopic Total Gastrectomy after Single Anastomosis Sleeve Jejunal Bypass

Abstract Introduction Amongst today's bariatric surgery procedures is the single anastomosis jejunal bypass operation (SASJ), which was first introduced by Professors Abdolreza Pazouki and Mohammad Kermansaravi. Single anastomosis sleeve ileal bypass (SASI) is a combined bariatric metabolic technique, in which few studies have shown its outcomes efficacy. However, this technique has a high risk of malnutrition due to long biliopancreatic limb. Single anastomosis sleeve jejunal bypass (SASJ) has a shorter limb. Therefore, it seems to have a lower risk of nutrient deficiency. Furthermore, this technique is relatively new, and little is known about the efficacy and safety of SASJ. Obesity is a significant risk factor for cancer incidence and mortality. The number of patients with obesity who undergo bariatric surgery is increasing; however, the impact of such a procedure in affecting the risk of cancer is not completely understood yet. The association between obesity and malignancies has been identified epidemiologically. Meanwhile, the increasing global number of bariatric surgeries is reported annually; bariatric surgery’s effect on different types of cancers is not well understood. Unfortunately, nonspecific presentations and difficulties regarding investigations make diagnosis challenging. Methods In this video case report, the patient was 62-year-old female with an initial BMI 44.2 kg/m2, weight: 116 kg and Height: 162 cm at the time of SASJ 6 years ago, upper gastrointestinal Endoscopy from 2017 before SASJ operation showed reflux esophagitis grade A and erosive erythematous hyperaemic mucosa gastritis. She underwent primary laparoscopic SASJ bypass in 2017. However, she had adequate weight loss for 5 years post-operative, and then she had excessive weight loss during past year. According to the patient history she suffers heart burn, anorexia, nausea and vomiting since1 year back, usually vomiting is present 2 hours postprandial with dark and black coloured content, and now her BMI is 21kg/m2. She had an upper GI endoscopy during past year, the last endoscopy report in 2023 commented on active and focally ulcerative mucosa with some atypical cells with signet ring pattern and chronic inflammatory responses, and biopsy showed adenocarcinoma of the stomach. Thorax, abdomen and pelvic CT scans were normal with no pathology is seen in upper GI contrast study. Laboratory findings were normal. A Laparoscopic Roux-en Y oesophago-jejunal bypass with a 75cm biliopancreatic limb and 75cm alimentary limb were performed. The patient was under complete screening for all over the last 1 so surgery is performed in first after confirmation of histopathology report before chemoradiotherapy (CRT). Results The operative time was 210 min and blood loss were 150ml. There were no intraoperative or postoperative complications. The patient had an uneventful postoperative course and was discharged on postoperative day 8. Conclusion Laparoscopic total gastrectomy with dissection of all lymph node from gastric stations is performed prior to the chemoradiotherapy for reaching the purpose of early malignancy control.

Comparative Study between Laparoscopic Single Anastomosis Sleeve Ileal Bypass (SASI Bypass) versus Laparoscopic Mini-Gastric Bypass (MGB/OAGB) in Controlling Type 2 Diabetes in Morbidly Obese Patients

Abstract Background In our opinion, the most important criteria in the selection of a bariatric procedure remain the safety and efficacy in achieving both weight loss and remission of the metabolic consequences of obesity. Despite the intrinsic limitation imposed by a retrospective study, our results seem to confirm that LMGB is both safe and effective for the treatment of morbidly obese diabetic patients. Laparoscopic SASI bypass has been shown to be an effective, safe, and simple procedure for the treatment of morbid obesity and its associated metabolic consequences. Moreover, it results in minimal postoperative nutritional complications in comparison to other bariatric procedures. However, long-term follow-up period should be performed to evaluate postoperative weight loss, metabolic changes, and nutritional status of patients. Objective To compare Laparoscopic Single Anastomosis Sleeve Ileal (SASI) Bypass with Minigastric bypass (MGB/OAGB) in controlling type 2 Diabetes Mellitus in morbidly obese patients. Patients and Methods This study is a retrospective comparative study in which morbidly obese Patients with type 2 DM who underwent either Mini-gastric bypass or Single Anastomosis Sleeve Ileal (SASI) bypass with available preoperative Fasting blood Glucose, Hemoglobin A1c&amp; serum cpeptide (As predictive measures for remission of diabetes after surgery) was collected &amp; their data and results was compared to this1,3, 6 &amp; 12 months postoperatively. Results As regard glycemic and lipid profile pre and postoperative mean values in MGB group, the present study showed that there were significant differences between before and after surgery as regard FBG, HbA1C, triglyceride, cholesterol, HDL and LDL. Laparoscopic mini-gastric bypass (MGB) is a technically simple and safe procedure in SSO patients. LMGB has the advantages of being a single stage procedure, being easily reversible and revisable in a laparoscopic procedure and does not sacrifice portions of the stomach or implant foreign materials. SASI bypass is a promising operation that offers excellent weight loss and metabolic result. The elimination of two ways for passage of food and one anastomosis decrease nutritional deficiency and the possibility of surgically related complications. Conclusion Metabolic surgery is a safe option for carefully selected patients with metabolic syndrome. The increased risk for type 2 diabetes and cardiovascular disease demands therapeutic attention for those at high risk. Our study suggests that both SASI and MGB are highly effective in controlling Diabetes mellitus, Hypertension and Hyperlipidemia.

Single-centre, non-randomised clinical trial at a tertiary care centre to investigate 1-year changes in social experiences and biomarkers of well-being after bariatric surgery in individuals with severe obesity: protocol for the Bariatric Surgery and Social Experiences (BaSES) study

IntroductionObesity is linked to increased loneliness and less enjoyment of social interactions. While bariatric surgery is the most effective treatment targeting severe obesity, there is limited understanding as to whether...

Safety and Efficacy of Single Anastomosis Sleeve Ileal (SASI) Bypass Surgery on Obese Patients with Type II Diabetes Mellitus during a One-Year Follow-up Period: A Single Center Cohort Study.

We aimed to evaluate the safety and efficacy of single anastomosis sleeve ileal (SASI) bypass surgery on obese patients with type II diabetes mellitus during a one-year follow-up period. We included patients with a body mass index (BMI) more than 35 kg/m2 and at least one-year history of type II diabetes mellitus. We excluded patients aged under 25 or above 66 years, those who were not candidates for surgery, needed another bariatric surgery, and those not willing to participate in the study. All the patients were visited in the outpatient office on the 10th and 45th days as well as the 3rd month of the post-operative period until the end of the first year. in this study, we investigated 14 male (23.0%) and 47 female (77.0%) morbidly obese patients with type II diabetes mellitus who underwent SASI bypass. The mean excess weight loss (%EWL) was 60.99±15.69 and the mean total weight loss (%TWL) was 30.39±6.52 at the end of the one-year follow up. Finally, 44 patients (72.1%) had a complete and 15 patients (24.6%) had partial remission of type II diabetes mellitus. Of note, severe complications were recorded in two patients (3.2%). Paired t test analysis demonstrated a significant decrease for fasting plasma sugar (FBS) after one-year follow-up in comparison with FBS before surgery (P<0.0001). Furthermore, this difference was observed in HbA1c (P<0.0001). SASI bypass is an effective method for weight loss and controlling type II diabetes mellitus.

Unpredictable Malnutrition and Short-Term Outcomes after Single Anastomosis Sleeve Ileal (SASI) Bypass in Obese Patients.

The aim of this study is to present the clinical outcomes of SASI bypass as a treatment alternative for patients with morbid obesity. This study was a prospective follow-up of morbidly obese patients who underwent SASI bypass at Helwan University Hospital between March 1, 2019, and March 2020. The surgical procedure involved sleeve gastrectomy, followed by the anastomosis of the ileum, which was brought and hand-sewn 4 cm length side to side with the antrum, at a distance of 250 cm from the ileocecal valve. The data collected for the study included the resolution of comorbidities, incidence of gallstones, and one-year morbidity. The mean age of the studied patients (n = 30) was 44.13 ± 8.9 years. The mean BMI of the studied patients was 47.3 ± 7.6 kg/ht2. All patients were morbidly obese for an average of 24 years. Postoperatively, 48% of the patients (n = 13) developed gallstones (GS), and the formation of GS was significantly higher in patients with longer durations of obesity (P = 0.009) and rapid weight loss. There was a significant decrease in the incidence of GS after 12 months postoperatively (P < 0.05). 63% of the patients (n = 19) had malnutrition, and 15 cases required revision due to the fear of further weight loss. Revision and malnutrition were significantly higher among male patients than female patients and among patients with longer durations of obesity (P ≤ 0.001). The SASI bypass may be an effective bariatric and metabolic surgery that can achieve satisfactory weight loss and improvement in medical comorbidities. However, our study highlights the potential risks of severe malnutrition and unpredictable weight loss; patient selection and duration of obesity may play a role in mitigating these risks.

One Year Follow-up of Laparoscopic Single Anastomosis Sleeve Ileal Bypass in Super-morbidly Obese Patients

One Year Follow-up of Laparoscopic Single Anastomosis Sleeve Ileal Bypass in Super-morbidly Obese Patients

Mid-term outcomes after single anastomosis sleeve ileal (SASI) bypass in treatment of morbid obesity

BackgroundAccording to several short-term studies, single-anastomosis sleeve ileal (SASI) bypass offers similar weight loss to Roux-en-Y Gastric Bypass (RYGB) with fewer complication and better comorbidity reduction/resolution. Long-term data on this operation is lacking in the literature. The purpose of this study was to analyze the outcomes of SASI bypass up to 4 years.MethodsThis study is a retrospective cohort analysis of 366 patients with morbid obesity who underwent primary SASI bypass from January 2018 to February 2022.ResultsThe mean age and preoperative body mass index (BMI) were 41 years (range 22–71 years) and 43.9 ± 6.5 kg/m2, respectively. Follow-up was available for 229 patients at 1-year (89%), 112 patients at 2-year (75%), 61 patients at 3-year (75%), and 35 patients at 4-year (71%). The intraoperative, short-term, and long-term complication rates were 0%, 2.5%, 4.6%, respectively. After 4 years, mean percentage excess weight loss (%EWL) was 93.3% and total weight loss (%TWL) was 41.2%. Remission of comorbidities was 93% for type 2 diabetes mellitus, 73% for hypertension, 83% for hyperlipidemia, 79% for sleep apnea, and 25% for gastroesophageal reflux disease (GERD). Biliary gastritis and ulcers are seldom. Eight patients developed de novo GERD symptoms requiring proton pump inhibitor treatment. None of the patients in our study had hypoalbuminemia or malabsorption that did not respond to increased protein intake and vitamin or mineral supplementation.ConclusionSASI bypass appears to be safe, and one of the most effective bariatric procedures regarding weight loss and obesity related comorbidities. The double-outlet created in this procedure seemingly minimizes nutritional complications.Graphical abstract