Skip to main content
SpringerLink
Log in

The outcomes of single anastomosis sleeve jejunal bypass as a treatment for morbid obesity (Two-year follow-up)

  • 2020 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

Santoro's operation is a sleeve gastrectomy with transit bipartition. The aim of the procedure is to keep pass to the duodenum to decrease nutritional deficiency and to allow endoscopic management of obstructive jaundice. To be easier, this procedure was rapidly altered to a single anastomosis sleeve ileal bypass (SASI). In this study, we shifted the anastomosis up to the jejunum to evaluate the effect of laparoscopic single anastomosis sleeve jejunal (SASJ) bypass as a treatment for morbid obesity and related comorbidities. In addition, the effect of the SASJ procedure on nutritional deficiency was examined.

Methods

In this study, 150 morbidly obese patients underwent SASJ bypass with a biliary limb length of 200–250 cm. All patients were followed up at 1, 3, 6, 12, 18, and 24 months. We evaluated all cases by assessing BMI, complications, nutritional status, and obesity-related comorbidities.

Results

The mean age of participants was 30.6 years, and the mean body mass index (BMI) was 44.6 kg/m2. Of the patients, 35 (23.2%) had type two diabetes and 47 (31.3%) were hypertensive. Postoperative bleeding occurred in two cases (1.3%). One patient developed a gastric leak (0.7%), and five patients developed biliary gastritis (3.3%). One patient (0.7%) developed a pulmonary embolism. The %EWL reached 85% in 1 year. Normalization of blood glucose occurred within 2 months after surgery in all diabetic patients. Hypertension underwent remittance in 89% of hypertensive patients. All patients were gradually weaned from four types of multivitamin regimens to only one multivitamin regimen without apparent nutritional deficiency.

Conclusions

Laparoscopic SASJ bypass is an effective, safe, and simple procedure for treating morbid obesity and comorbid conditions with least nutritional deficiency. However, long-term studies are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lupoli R, Lembo E, Saldalamacchia G, Avola CK, Angrisani L, Capaldo B (2017) Bariatric surgery and long-term nutritional issues. World J Diabetes. 8(11):464–474

    Article  Google Scholar 

  2. Bray GA, Frühbeck G, Ryan DH, Wilding JP (2016) Management of obesity. Lancet 387:1947–1956

    Article  Google Scholar 

  3. Ashrafian H, Toma T, Rowland SP, Harling L, Tan A, Efthimiou E, Darzi A, Athanasiou T (2015) Bariatric surgery or non-surgical weight loss for obstructive sleep apnoea? a systematic review and comparison of meta-analyses. Obes Surg 25:1239–1250

    Article  Google Scholar 

  4. Wang FG, Yu ZP, Yan WM, Yan M, Song MM (2017) Comparison of safety and effectiveness between laparoscopic mini-gastric bypass and laparoscopic sleeve gastrectomy: A meta-analysis and systematic review. Medicine (Baltimore) 96(50):e8924

    Article  Google Scholar 

  5. Wang F-G, Yan W-M, Yan M, Song M-M (2018) Outcomes of mini vs Roux-en-Y gastric analysis and systematic review. Int J Surg. 56:7–14

    Article  Google Scholar 

  6. Brown WA, Ooi G, Higa K, Himpens J, Torres A (2019) Single-anastomosis duodenal ileal bypass with sleeve gastrectomy / one anastomosis duodenal switch (SADI-S/OADS) – IFSO Position Statement. Obes Surg. 28(5):1207–1216

    Article  Google Scholar 

  7. Mahdy T, Al wahedi A, Schou C, (2016) Efficacy of single anastomosis sleeve ileal (SASI) bypass for type-2 diabetic morbid obese patients: Gastric bipartition, a novel metabolic surgery procedure: A retrospective cohort study. Int J Surg. 34:28–34

    Article  CAS  Google Scholar 

  8. Mui WL-M, Lee DW-H, Lam KK-Y (2014) Laparoscopic sleeve gastrectomy with loop bipartition: a novel metabolic operation in treating obese type II diabetes mellitus. IntJ Surg Case Rep 5(2):56–58

    Article  Google Scholar 

  9. Pazouki A, Kermansaravi M (2019) Single anastomosis sleeve-jejunal bypass: a new method of bariatric/metabolic surgery. OBES SURG 29:3769–3770

    Article  Google Scholar 

  10. Iannelli A, Schneck A-S, Topart P, Carles M, Hébuterne X, Gugenheim J (2013) Laparoscopic sleeve gastrectomy followed by duodenal switch in selected patients versus single-stage duodenal switch for superobesity: case-control study. Surg Obes Relat Dis 2013(9):531–538

    Article  Google Scholar 

  11. Biertho L, Lebel S, Marceau S, Hould F-S, Lescelleur O, Moustarah F, Simard S, Biron S, Marceau P (2013) Perioperative complications in a consecutive series of 1000 duodenal switches. Surg Obes Relat Dis 9(1):63–68. https://doi.org/10.1016/j.soard.2011.10.021

    Article  PubMed  Google Scholar 

  12. Jung Suk Oh, Lee HG, Chun HJ, Choi BG, Lee SH, Hahn ST, Ohm JY (2013) Percutaneous management of postoperative duodenal stump leakage with foley catheter. Cardiovasc Intervent Radiol 36:1344–1349. https://doi.org/10.1007/s00270-012-0518-6

    Article  Google Scholar 

  13. Brethauer SA, Kim J, El Chaar M, Papasavas P, Eisenberg D, Rogers A, Ballem N, Kligman M, Kothari S (2015) Standardized outcomes reporting in metabolic and bariatric surgery. Obes Surg 25(4):587–606

    Article  Google Scholar 

  14. Salama TMS, Sabry K, Ghamrini YE (2017) Single anastomosis sleeve ileal bypass: new step in the evolution of bariatric surgeries. J Investig Surg 30(5):291–296. https://doi.org/10.1080/08941939.2016.1241841

    Article  Google Scholar 

  15. Sánchez-Pernaute A, Herrera MAR, Pérez-Aguirre PT, Cabrerizo L, Matía P, Díez-Valladares L, Barabash A, Martín-Antona E, García-Botella A, Garcia-Almenta EM, Torres A (2010) Single anastomosis duodeno-Ileal bypass with sleeve gastrectomy (SADI-S) one to three-year follow-up. OBES SURG 20:1720–1726. https://doi.org/10.1007/s11695-010-0247-3

    Article  PubMed  Google Scholar 

  16. Sigstad H (1970) (1970) A clinical diagnostic index in the diagnosis of the dumping syndrome Changes in plasma volume and blood sugar after a test meal. Acta Med Scand. 188(6):479–486

    CAS  PubMed  Google Scholar 

  17. Emile SH, Elfeki H, Elalfy K, Abdallah E (2017) Laparoscopic sleeve gastrectomy then and now: an updated systematic review of the progress and short-term outcomes over the last 5 years. Surg Laparosc Endosc Percutan Tech 27(5):307–317

    Article  Google Scholar 

  18. Elbanna H, Ghnnam W, Negm A, Youssef T, Emile S, El Metwally T, Elalfy K (2016) Impact of preoperative body mass index on the outcome after laparoscopic sleeve gastrectomy for morbid obesity. Ulus Cerrahi Derg 32(4):238

    PubMed  PubMed Central  Google Scholar 

  19. Lauti M, Kularatna M, Hill AG, MacCormick AD (2016) Weight regain following sleeve gastrectomy-a systematic review. Obes Surg 26(6):1326–1334. https://doi.org/10.1007/s11695-016-2152-x

    Article  PubMed  Google Scholar 

  20. Lee W, Ser K, Lee Y, Tsou JJ, Chen SC, Chen JC (2012) Laparoscopic Roux-en-Y Vs. mini-gastric bypass for the treatment of morbid obesity: a 10-year experience. OBES SURG. 22:1827–1834

    Article  Google Scholar 

  21. Mahawar KK, Carr WR, Balupuri S, Small PK (2014) Controversy surrounding ’mini’ gastric bypass. Obes Surg 24:324–333

    Article  Google Scholar 

  22. Ramos AC, Chevallier J, Mahawar K, Brown W, Kow L, White KP, Shikora S (2020) IFSO (International Federation for surgery of obesity and metabolic disorders) consensus conference statement on one-anastomosis gastric bypass (OAGB-MGB): results of a modified delphi study. OBES SURG. https://doi.org/10.1007/s11695-020-04519-y

    Article  PubMed  PubMed Central  Google Scholar 

  23. Frederiksen NA, Tveskov L, Helgstrand F, Naver L, Floyd A (2017) Treatment of common bile duct stones in gastric bypass patients with laparoscopic transgastric endoscopic retrograde cholangiopancreatography. OBES SURG 27:1409–1413. https://doi.org/10.1007/s11695-016-2524-2

    Article  PubMed  Google Scholar 

  24. Papasavas PK, Gagne DJ, Ceppa FA, Caushaj PF (2006) Routine gallbladder screening not necessary in patients undergoing laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2006(2):41–46

    Article  Google Scholar 

  25. Tucker ON, Fajnwaks P, Szomstein S, Rosenthal RJ (2008) Is concomitant cholecystectomy necessary in obese patients undergoing laparoscopic gastric bypass surgery? Surg Endosc 22:2450–2454. https://doi.org/10.1007/s00464-008-9769-3

    Article  CAS  PubMed  Google Scholar 

  26. Tarantino I, Warschkow R, Steffen T, Bisang P, Schultes B, Thurnheer M (2011) Is routine cholecystectomy justified in severely obese patients undergoing a laparoscopic Roux-en-Y gastric bypass procedure? A comparative cohort study. OBES SURG 21:1870–1878. https://doi.org/10.1007/s11695-011-0495-x

    Article  PubMed  Google Scholar 

  27. Uy MC, Talingdan-Te MC, Espinosa WZ, Ma LO, Daez JP, Ong, (2008) Ursodeoxycholic acid in the prevention of gallstone formation after bariatric Surgery: A meta-analysis. OBES SURG 18:1532–1538. https://doi.org/10.1007/s11695-008-9587-7

    Article  PubMed  Google Scholar 

  28. Metcalfe MS, Ong T, Bruening MH, Iswariah H, Wemyss-Holden SA, Maddern GJ (2004) Is laparoscopic intraoperative cholangiogram a matter of routine? Am J Surg. 187(4):475–481. https://doi.org/10.1016/j.amjsurg.2003.12.047

    Article  PubMed  Google Scholar 

  29. Riciardi R, Islam S, Canete JJ, Arcand PL, Stoker ME (2003) Effectiveness and long-term results of laparoscopic common bile duct exploration. Surg Endosc 17(1):19–22. https://doi.org/10.1007/s00464-002-8925-4

    Article  CAS  PubMed  Google Scholar 

  30. Schirmer BD, Winters KL, Edlich RF (2005) Cholelithiasis and cholecystitis. J Long-Term Eff Med Implants. 15(3):329–338

    Article  Google Scholar 

  31. Sundbom M, Nyman R, Hedenström H, Gustavsson S (2001) Investigation of the excluded stomach after Roux-en-Y gastric bypass. OBES SURG. 11:25–27. https://doi.org/10.1381/096089201321454060

    Article  CAS  PubMed  Google Scholar 

  32. Balibrea JM, Vilallonga R, Hidalgo M, Ciudin A, González Ó, Caubet E, Sánchez-Pernaute A, Fort JM, Armengol-Carrasco M (2017) Mid-term results and responsiveness predictors after two-step single-anastomosis Duodeno-Ileal bypass with sleeve gastrectomy. OBES SURG 27:1302–1308. https://doi.org/10.1007/s11695-016-2471-y

    Article  PubMed  Google Scholar 

  33. Fischer L, Hildebrandt C, Bruckner T, Naver L, Floyd A (2012) Excessive weight loss after sleeve gastrectomy: A systematic review. OBES SURG. 22:721–731

    Article  Google Scholar 

  34. Mahdy T, Emile SH, Madyan A, Schou C, Alwahidi A, Ribeiro R, Sewefy A, Büsing M, Al-Haifi M, Salih E, Shikora S (2020) Evaluation of the efficacy of single anastomosis sleeve ileal (SASI) bypass for patients with morbid obesity: a multicenter study. OBES SURG. 30:837–845

    Article  Google Scholar 

  35. Scopinaro N, Marinari GM, Camerini GB, Papadia FS, Adami GF (2005) Specific effects of biliopancreatic diversion on the major components of metabolic syndrome: a long-term follow-up study. Diabetes Care 28:2406–2411

    Article  Google Scholar 

  36. Sista F, Abruzzese V, Clementi M, Guadagni S, Montana L, Carandina S (2018) Resolution of type 2 diabetes after sleeve gastrectomy: a 2-step hypothesis. Surg Obes Relat Dis 14(3):284–290

    Article  Google Scholar 

  37. Peterli R, Wölnerhanssen BK, Peters T, Vetter D, Kröll D, Borbély Y, Schultes B, Beglinger C, Drewe J, Schiesser M, Nett P, Bueter M (2018) Effect of laparoscopic sleeve Gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: The SM-BOSS randomized clinical trial. JAMA 319(3):255–265

    Article  Google Scholar 

  38. Carbajo MA, Luque-de-León E, Jiménez JM, Ortiz-de-Solórzano J, Pérez-Miranda M, Castro-Alija MJ (2017) Laparoscopic one-anastomosis gastric bypass: technique, results, and long-term follow-up in 1200 patients. OBES SURG 27:1153–1167

    Article  Google Scholar 

  39. Swartz DE, Mobley E, Felix EL (2009) Bile reflux after Roux-en-Y gastric bypass: an unrecognized cause of postoperative pain. Surg Obes Relat Dis 5(1):27–30

    Article  Google Scholar 

  40. Saarinen T, Räsänen J, Salo J, Loimaala A, Pitkonen M, Leivonen M, Juuti A (2017) Bile reflux scintigraphy after mini-gastric bypass. Obes Surg 27(8):2083–2089. https://doi.org/10.1007/s11695-017-2608

    Article  PubMed  Google Scholar 

Download references

Funding

We did not receive any funding for this study.

Author information

Authors and Affiliations

  1. Department of Surgery, Minia University Hospital, Minia, Egypt

    Alaa M. Sewefy & Abdelfattah Saleh

Authors
  1. Alaa M. Sewefy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Abdelfattah Saleh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alaa M. Sewefy.

Ethics declarations

Disclosures

Alaa M. Sewefy and Abdelfattah Saleh declares no conflict of interest and has not received any funding.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 217473 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sewefy, A.M., Saleh, A. The outcomes of single anastomosis sleeve jejunal bypass as a treatment for morbid obesity (Two-year follow-up). Surg Endosc 35, 5698–5704 (2021). https://doi.org/10.1007/s00464-020-08029-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-020-08029-x

Keywords

Search

Navigation