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

Abstract

Background: Single 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.

Objective: This study aims to evaluate short-term outcomes of SASI bypass regarding safety, efficacy and complications.

Methods: This 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.

Results: Of 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.

Conclusion: SASI 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.

Keywords

laparoscopic single anastomosis sleeve ileal / morbid obesity / weight loss

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