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.