The present study aimed to compare the outcome of single anastomosis sleeve ileal (SASI) bypass and sleeve gastrectomy (SG) in regards weight loss, improvement in comorbidities at 12 months of follow-up, and postoperative complications. This was a case-matched, multicenter analysis of the outcome of patients who underwent SG or SASI bypass. Patients who underwent SASI bypass were matched with an equal number of patients who underwent SG in terms of age, sex, BMI, and comorbidities. The main outcome measures were excess weight loss (EWL) at 6 and 12 months after surgery, improvement in medical comorbidities, and complications. A total of 116 patients (97 female) of a mean age of 35.8 years were included. Fifty-eight patients underwent SASI bypass and an equal number underwent SG. %EWL at 6 months postoperatively was similar between the two groups. SASI bypass conferred significantly higher %EWL at 12 months than SG (72.6 Vs 60.4, p < 0.0001). Improvement in type 2 diabetes mellitus (T2DM) and gastroesophageal reflux disease (GERD) after SASI bypass was better than SG (95.8% Vs 70% and 85.7% Vs 18.2%, respectively). SASI bypass required longer operation time than SG (108.7 Vs 92.8 min, p < 0.0001). Complications occurred in 12 (20.7%) patients after SG and 4 (6.9%) patients after SASI bypass (p = 0.056). The %EWL at 12 months after SASI bypass was significantly higher than after SG. SASI bypass conferred better improvement in T2DM and GERD than SG. Both procedures had similar weight loss at 6 months postoperatively and comparable complication rates.

Single anastomosis sleeve ileal (SASI) bypass versus sleeve gastrectomy: a case-matched multicenter study

BACKGROUND Morbid obesity has been recognized as a public health crisis, particularly in developed countries. Single anastomosis sleeve ileal (SASI) bypass has been introduced as a novel bariatric and metabolic procedure. The present study aimed to describe the technical steps and assess the short-term outcomes of SASI bypass in patients with super morbid obesity. PATIENTS AND METHODS Adult patients of both sexes with body mass index (BMI) ≥50 kg/m underwent SASI bypass and were followed for 12 months postoperatively. Changes in BMI, excess weight loss (EWL), and improvement in comorbidities were recorded on follow-up. RESULTS Twenty patients (17 female) of the mean age of 35.4 years were included in the study. The mean preoperative BMI (53.7±5.9) showed a significant decrease at 6 months (39.9±5.2) and then at 12 months (33.6±6) postoperatively. The mean %EWL was 44.3±7.8 at 6 months and 65.2±12.6 at 12 months. All patients with diabetes mellitus, osteoarthritis, and reflux esophagitis showed resolution at 12 months after the SASI bypass. Complications were recorded in 2 patients and no mortality was reported. CONCLUSIONS SASI bypass is an effective and safe bariatric procedure that confers significant loss of weight and improvement in medical comorbidities. As compared with previous studies on patients with lower BMI, patients with super morbid obesity attained lower %EWL but similar resolution of diabetes mellitus at 12 months after SASI bypass.

Laparoscopic Single Anastomosis Sleeve Ileal (SASI) Bypass for Patients With Morbid Obesity: Technical Description and Short-term Outcomes.

Is transit bipartition a better alternative to biliopancreatic diversion with duodenal switch for superobesity? Comparison of the early results of both procedures.

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. 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. 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. 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.

Single-Anastomosis Sleeve Ileal (SASI) Bypass: Hopes and Concerns after a Two-Year Follow-up.

Systematic review of the outcome of single-anastomosis sleeve ileal (SASI) bypass in treatment of morbid obesity with proportion meta-analysis of improvement in diabetes mellitus.

Objective: This study is aimed to evaluate the safety, feasibility, and efficacy of a novel technique: laparoscopic sleeve gastrectomy with loop gastroileal bypass. Summary of Background Data: Stan...

A Feasibility Study of Novel “Laparoscopic Sleeve Gastrectomy with Loop Gastroileal Bypass” for Obesity: An Indian Experience

Background Laparoscopic sleeve gastrectomy with loop duodenojejunal bypass (SG LDJB) is a loop modification of biliopancreatic diversion with duodenal switch. The aim of this study was to analyze weight loss response and factors predicting weight loss outcomes after SG LDJB. Methods This was a retrospective study analyzing SG LDJB surgeries performed between May 2013 and December 2017 in 126 Indians suffering from obesity. The collected data was analyzed to understand weight loss efficacy and the factors predicting weight loss. Surgery was considered successful when percentage excess weight loss (%EWL) was ≥50% or percentage total weight loss (%TWL) was ≥25%. Results %EWL was 95.77% and 83.84% and %TWL was 34.64% and 30.32% at the 1-year and 3-year follow-up, respectively. %EWL ≥50% was 99.04% and 96.47% and %TWL ≥25% was 91.35% and 75.29% at the 1-year and 3-year follow-up, respectively. Patient age and sex did not independently predict %EWL or %TWL. Preoperative body mass index (BMI), weight, and excess weight negatively predicted %EWL and positively predicted %TWL at the 1-year and 3-year follow-up. Multiple regression analysis showed that these parameters were independent predictors of %EWL and %TWL at 1 year, while preoperative weight and excess weight also independently predicted %EWL at the 3-year follow-up. In diabetic patients, %EWL was significantly lower at the 3-year follow-up and %TWL was significantly lower at the 1-year and 3-year follow-up. Conclusion SG LDJB was an effective bariatric surgery to treat obesity. Preoperative BMI, weight, excess weight, and the presence of diabetes were the significant factors associated with the weight loss outcomes.

Factors Predicting Weight Loss after "Sleeve Gastrectomy with Loop Duodenojejunal Bypass" Surgery for Obesity.

Response: Factors Predicting Weight Loss after “Sleeve Gastrectomy with Loop Duodenojejunal Bypass” Surgery for Obesity (J Obes Metab Syndr 2020;29:208-14)

Background and aims Metabolic surgery improves glycemic control in patients with type 2 diabetes (T2DM) and severe obesity. Sleeve gastrectomy with loop duodenal switch (SLDS), a loop modification of biliopancreatic diversion with duodenal switch, is aimed to reduce the malabsorption, without compromising the efficacy. This study was designed to analyze the metabolic efficacy following SLDS. Methods Eighty patients, who underwent SLDS for T2DM and severe obesity between January 2014 and February 2020 were retrospectively analyzed. Complete T2DM remission was defined as HbA1C Results Following SLDS, HbA1C significantly reduced from 8.7% to 5.5% at the 6-month and 5.1% at the 1-year follow-ups. T2DM remission was 82.5% at the 6-month and 90.8% at the 1-year follow-ups. Preoperative glycemic control positively predicted, while T2DM duration and preoperative insulin use negatively predicted T2DM remission. Higher ABCD score, lower DiaRem and IMS scores predicted higher T2DM remission. Severe hypoalbuminemia was 20% in patients with 250 cm common channel and 02% in patients with ≥300 cm common channel at the 1-year follow-up. Conclusions SLDS is an effective surgery to treat T2DM with severe obesity. Shorter T2DM duration, better preoperative glycemic control and the absence of insulin use were associated with better T2DM remission. Malabsorption was significantly lesser, when common channel was ≥300 versus 250 cm.

Metabolic efficacy following laparoscopic sleeve gastrectomy with loop duodenal switch surgery for type 2 diabetes in Indian patients with severe obesity

Amar Vennapusa

Papers

A Feasibility Study of Novel “Laparoscopic Sleeve Gastrectomy with Loop Gastroileal Bypass” for Obesity: An Indian Experience

Factors Predicting Weight Loss after "Sleeve Gastrectomy with Loop Duodenojejunal Bypass" Surgery for Obesity.

Response: Factors Predicting Weight Loss after “Sleeve Gastrectomy with Loop Duodenojejunal Bypass” Surgery for Obesity (J Obes Metab Syndr 2020;29:208-14)

Metabolic efficacy following laparoscopic sleeve gastrectomy with loop duodenal switch surgery for type 2 diabetes in Indian patients with severe obesity

Safety and feasibility of laparoscopic sleeve gastrectomy with loop duodenojejunal bypass for obesity