International journal of surgery (London, England) · 2025
Reviving weight loss and metabolic obesity-related comorbidities: mid-term results of single anastomosis sleeve ileal (SASI) bypass for failed sleeve gastrectomy. A retrospective cohort study.
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История · было → стало
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Carandina Sergio, Ferro Silvia, DE Palma Massimiliano, Sartori Andrea, Zulian Viola, Iannelli Antonio
Аннотация
BACKGROUND: The single anastomosis sleeve ileal (SASI) bypass, a hybrid bariatric procedure combining sleeve gastrectomy (SG) and ileal bypass, has emerged as a potential solution for SG failure, offering both restrictive and malabsorptive effects. This study investigates the mid-term outcomes of SASI in patients undergoing conversion due to SG failure, with a focus on weight loss, metabolic improvement, and postoperative complications.
METHODS: This retrospective study included 44 consecutive patients who underwent SASI after SG failure at a tertiary bariatric referral center between May 2019 and June 2024. Patients were assessed for demographic, anthropometric, and comorbidity data, with follow-up at 6, 12, 18, and 24 months. Primary outcomes included weight loss and improvement in comorbidities, while secondary outcomes focused on surgical complications and procedure-related issues.
RESULTS: The mean BMI decreased from 39.1 ± 7.2 kg/m 2 at the time of SASI to 30.5 ± 5.9 kg/m 2 and 27.5 ± 4.8 kg/m 2 at 12 and 24 months, respectively, with a %TWL of 21.5 ± 7.8% at 12 months and 29.7 ± 9.5% at 24 months. Significant improvements were observed in obesity-related comorbidities, including remission of type 2 diabetes, sleep apnea, and hypertension. Short-term complications occurred in 11.3% of patients, with no postoperative mortality. Mid-term follow-up revealed that 65% of patients experienced resolution of gastroesophageal reflux disease (GERD), although 11.3% developed de novo GERD symptoms.
CONCLUSION: SASI conversion after SG failure is associated with significant weight loss and favorable metabolic outcomes. However, GERD remains a challenge, and careful patient selection and surgical technique are crucial. Larger, multi-center studies with longer follow-up are needed to further refine the role of SASI in revisional bariatric surgery.
METHODS: This retrospective study included 44 consecutive patients who underwent SASI after SG failure at a tertiary bariatric referral center between May 2019 and June 2024. Patients were assessed for demographic, anthropometric, and comorbidity data, with follow-up at 6, 12, 18, and 24 months. Primary outcomes included weight loss and improvement in comorbidities, while secondary outcomes focused on surgical complications and procedure-related issues.
RESULTS: The mean BMI decreased from 39.1 ± 7.2 kg/m 2 at the time of SASI to 30.5 ± 5.9 kg/m 2 and 27.5 ± 4.8 kg/m 2 at 12 and 24 months, respectively, with a %TWL of 21.5 ± 7.8% at 12 months and 29.7 ± 9.5% at 24 months. Significant improvements were observed in obesity-related comorbidities, including remission of type 2 diabetes, sleep apnea, and hypertension. Short-term complications occurred in 11.3% of patients, with no postoperative mortality. Mid-term follow-up revealed that 65% of patients experienced resolution of gastroesophageal reflux disease (GERD), although 11.3% developed de novo GERD symptoms.
CONCLUSION: SASI conversion after SG failure is associated with significant weight loss and favorable metabolic outcomes. However, GERD remains a challenge, and careful patient selection and surgical technique are crucial. Larger, multi-center studies with longer follow-up are needed to further refine the role of SASI in revisional bariatric surgery.