The single anastomosis sleeve ileal (SASI) bypass: A review of the current literature on outcomes and statistical results

Attia, Najmeddine; Khlifa, Meriem Ben Hadj; Fadhel, Najah Ben

doi:10.1016/j.obmed.2021.100370

Cited by 5 publications

(3 citation statements)

References 29 publications

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“…Both procedures maintain, at least in part, gastric digestion, pyloric function and all duodenal, jejunal and ileal physiology without any degree of clinically detectable malabsorption. Recent review articles [ 16 , 17 ] strongly support the recommendation of SASI bypass more than other bariatric operations. However, most current evidence consists of small to medium-sized cohort studies with short follow-ups.…”

Section: Discussionmentioning

confidence: 99%

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

Aghajani¹,

Schou²,

Gíslason³

et al. 2023

Surg Endosc

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Background According 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. Methods This study is a retrospective cohort analysis of 366 patients with morbid obesity who underwent primary SASI bypass from January 2018 to February 2022. Results The 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. Conclusion SASI 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

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Section: Discussionmentioning

confidence: 99%

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

Aghajani¹,

Schou²,

Gíslason³

et al. 2023

Surg Endosc

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“…Various studies showed the efficacy of SASI bypass in terms of excessive weight loss and remission of comorbidities. [7][8][9]15 The complication rate after SASI bypass is reported between 10.1% to 13.2% in the literature, and studies declared bile reflux as the most frequent morbidity following surgery, with an incidence of .5 to 3.4%, [6][7][8][9] so bile reflux remains the predominant cause of reoperations in SASI bypass. 14 Therefore, by adding the Braun anastomosis, a feasible modification of the SASI bypass technique was evaluated to prevent or reduce bile reflux and its potential consequences.…”

Section: Discussionmentioning

confidence: 99%

“…5 Some studies have investigated the outcomes of SASI bypass, showing satisfactory weight loss and comorbidity remission. [6][7][8] However, some concerns have been related to SASI bypass. As this procedure allows the entrance of bile through the stomach, bile reflux, bile gastritis, or ulcer may be seen postoperatively.…”

Section: Introductionmentioning

confidence: 99%

Braun Anastomosis: A Technique for Bile Reflux Improvement After Single Anastomosis Sleeve Ileal (SASI) Bypass; a Pilot Study

et al. 2023

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Background. Single anastomotic surgeries can increase the risk of reflux, marginal ulceration, and gastrointestinal complications. Braun anastomosis prevents bile reflux after gastric resection and gastrojejunal anastomosis surgeries. The present pilot study evaluated Braun’s efficacy in a single anastomosis sleeve ileal (SASI) bypass surgery. Methods. 28 patients with a history of SASI bypass surgery from October 2017 to September 2021 were included in the study. Patients were divided into 2 groups based on having Braun anastomosis to this surgical procedure; group A: underwent SASI bypass without Braun anastomosis; group B: underwent SASI bypass with Braun anastomosis. The surgical complications in terms of bile reflux, marginal ulcer, reflux esophagitis, and gastritis were evaluated and compared between the groups. Results. Bile reflux and reflux esophagitis were seen more in group A than in group B (37.5% vs 8.3% and 18.8% vs 8.3%, respectively). In contrast, 2 patients (16.7%) in group B had marginal ulcers compared to 1 (6.3%) in group A. Also, gastritis was seen in 1 patient in each group (6.3% in group A vs 8.3% in group B). However, the differences were not statistically different. Conclusions. Braun anastomosis is probably an effective procedure to reduce bile reflux, a concern of SASI bypass. Besides, further studies with a larger study population are needed.

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Outcomes of revisional surgery options after inadequate sleeve gastrectomy: A comprehensive network meta‐analysis

Salman,

Elewa

et al. 2024

World j. surg.

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BackgroundDespite the success of sleeve gastrectomy (SG) in of weight loss and treatment of the medical problems associated with obesity, some concerns have arisen about the need for revisional surgeries after SG in some patients. This study aimed to present an updated and comprehensive comparison among the presently available revisional surgeries employed explicitly in cases of inadequate outcomes after SG, which is the most frequently performed bariatric surgery in contemporary practice.MethodsThis network meta‐analysis included studies that compared the outcomes of different revisional bariatric procedures after an inadequate outcome of SG.ResultsSearching across the electronic databases yielded 31 eligible articles. Re‐SG was associated with the highest rate of significant complications. Patients treated with single anastomosis duodenal‐ileal bypass (SADI) had a significantly higher percentage of total weight loss (%TWL) than those treated with one anastomosis gastric bypass (OAGB) and Roux‐en‐Y gastric bypass (RYGB). The percentage of excess weight loss (%EWL) at the end of the follow‐up period was significantly higher in patients in the SADI group compared to those in the RYGB group and the OAGB, and re‐SG exhibited the least values compared to SADI, biliopancreatic diversion with duodenal switch (BPD/DS), and OAGB. Significantly lower rates of reflux worsening/de novo development were observed in the SADI group compared to the OAGB group and the re‐SG group, which showed significantly higher rates than SADI and RYGB.ConclusionOur comprehensive network meta‐analysis highlights SADI as a promising revisional option post‐SG, demonstrating superior weight loss outcomes, lower significant complication rates, and a favorable impact on reflux compared to other procedures. While acknowledging the limitations of our study, these findings support the potential efficacy of SADI in addressing the challenges of inadequate weight loss after sleeve gastrectomy.

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The single anastomosis sleeve ileal (SASI) bypass: A review of the current literature on outcomes and statistical results

Cited by 5 publications

References 29 publications

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

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

Braun Anastomosis: A Technique for Bile Reflux Improvement After Single Anastomosis Sleeve Ileal (SASI) Bypass; a Pilot Study

Outcomes of revisional surgery options after inadequate sleeve gastrectomy: A comprehensive network meta‐analysis

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