Single Anastomosis Sleeve Ileal (SASI) Bypass: Patient Selection
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LETTER TO EDITOR/LED REPLY
Single Anastomosis Sleeve Ileal (SASI) Bypass: Patient Selection Mohammad Kermansaravi 1,2,3,4 & Ali Kabir 4 Received: 28 July 2020 / Revised: 28 July 2020 / Accepted: 28 July 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Dear Editor, We would like to thank Sameh Hany Emile and Tarek Mahdy [1] for their valuable comments on our study [2]. We are happy to have a more detailed discussion for better clarification and open new windows we did not speak about because of space limitation. We expressed single anastomosis sleeve ileal (SASI) bypass as an investigational procedure because of its position in comparison to other established procedures by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) [3], although we believe that it can be a standard and established procedure in the future. Anyway, words such as investigational and newly introduced have no clear definition. Recommendation of using SASI as a conversional procedure was added during review process based on the reviewers’ comments, albeit we are in agreement. Even though it is not based on our data, it seems logical, and we added this issue to our discussion because we believe it shapes a better image from different aspects of indications of SASI. We used sentences like “it can be considered de novo in carefully selected patients and as a conversion procedure following the failure of sleeve gastrectomy (SG) in experienced bariatric surgery centers” [2],
* Mohammad Kermansaravi [email protected]; [email protected] * Ali Kabir [email protected]; [email protected] 1
Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
2
Iran National Center of Excellence for Minimally Invasive SurgeryEducation, Iran University of Medical Sciences, Tehran, Iran
3
Center of Excellence of European Branch of International Federationfor Surgery of Obesity, Tehran, Iran
4
Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
showing that it can be considered and do not express it as a definite indication. SASI can be done as a primary procedure, as we did, but needs careful selection of patients who are cooperative in their closed follow-up by the multidisciplinary team for the possibility of hypoalbuminemia and excessive weight loss and need long-term esophagogastroduodenoscopy (EGD) follow-up. We have also discussed about different viewpoints about hypoalbuminemia as a challenging issue in our paper [2]. Previous similar studies have mentioned both lower [4] and higher [5] percentages of hypoalbuminemia after SASI I comparison with our study. Moreover, mean albumin level, which has mentioned in some studies, does not show number (percentage) of cases with hypoalbuminemia. All patients who were included in our study were operated in an accredited center of excellence of the European branch o
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