Single-Anastomosis Sleeve Ileal (SASI) Bypass: Hopes and Concerns after a Two-Year Follow-up
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Single-Anastomosis Sleeve Ileal (SASI) Bypass: Hopes and Concerns after a Two-Year Follow-up Mohamed Khalaf 1 & Hosam Hamed 2 Received: 18 May 2020 / Revised: 18 August 2020 / Accepted: 18 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Single-anastomosis sleeve ileal (SASI) bypass is a simplification of sleeve gastrectomy with transit bipartition. Both share a metabolic foundation through early postprandial ileal brake, and SASI bypass has the advantages of shorter operative time and less incidence of internal herniation. This study evaluates the safety and outcome of SASI bypass with 2-year follow-up. Methods A retrospective cohort study of all patients who underwent SASI bypass in the period between June 2016 and January 2019. The primary outcome was weight loss and diabetic remission. Results Three hundred twenty-two patients underwent SASI bypass with a mean age of 37.4 ± 15 years and a mean body mass index of 50.1 ± 7.7 kg/m2. Thirteen patients (4%) had early major postoperative complications. The 1-year percentage of excess weight loss (%EWL) was 86.9 ± 9.2, and diabetic remission rate was 98.2%. The 2-year %EWL was 96.7 ± 5, and diabetic remission rate was 97.9%. Twenty-six patients had gastroesophageal reflux that improved in 21 (80.7%) patients, remained stationary in 4 (15.4%) patients, and worsened in one patient who required reversal. One patient (0.3%) had severe protein-energy malnutrition and is prepared for reversal. Technical variations had no significant impact on %EWL or diabetic remission. Conclusion SASI bypass had a promising outcome in terms of 2-year %EWL, diabetic remission, and improvement of preoperative GERD. However, stationary or progressive course of GERD is a substantial possibility. Although the double-outlet for the gastric content allows duodenal access, it may be an obstacle to the standardization of postoperative care. The double-outlet is not a guarantee for absence of malnutrition. Keywords Single-anastomosis sleeve ileal bypass . SASI bypass . Diabetic remission . Metabolic surgery . Bariatric innovations
Introduction Obesity is a worldwide preventable pandemic associated with chronic metabolic disorders as type II diabetes mellitus (T2DM), dyslipidemia, and hypertension (HTN) [1]. Bariatric surgery was superior to conservative measures in the management of obesity in terms of outcome and health expenses [2]. Many randomized controlled trials showed the superiority of bariatric surgery over medical treatment in * Hosam Hamed [email protected] Mohamed Khalaf [email protected] 1
Surgery Department, Faculty of Medicine, Minia University, Minia, Egypt
2
Gastrointestinal surgical center (GISC), Faculty of medicine, Mansoura University, Jehan street, Mansoura 35516, Egypt
diabetic remission [3]. However, the quest for the ideal bariatric procedure is ongoing since the dawn of bariatric surgery in the 1950s [4]. Santoro IIIB procedure, a simplification of digestive adaptation procedure
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