Clinical Report: Efficacy and Safety of Single Anastomosis Sleeve Ileal Bypass

Overview

This systematic review and meta-analysis evaluated the Single Anastomosis Sleeve Ileal (SASI) bypass for obesity treatment, analyzing 18 studies including one randomized controlled trial. SASI bypass demonstrated effective weight loss and improvement in obesity-related comorbidities with a favorable safety profile compared to other bariatric procedures.

Background

Obesity is a growing public health concern with limited success from conservative treatments. Bariatric surgery remains the most effective intervention, with Sleeve Gastrectomy (SG) and Roux-en-Y Gastric Bypass (RYGB) being the most common procedures. The SASI bypass, introduced in 2014, combines SG with a loop gastroileostomy, offering a simpler and potentially safer alternative. This review aims to systematically assess SASI bypass outcomes and compare them with other bariatric surgeries.

Data Highlights

Key Findings

• SASI bypass is associated with significant weight loss measured by %EWL.
• Improvement or remission of type 2 diabetes mellitus, hypertension, dyslipidemia, GERD, and obstructive sleep apnea was observed.
• The procedure involves a simpler loop anastomosis, potentially reducing operative complexity and risks.
• Comparative studies suggest SASI bypass has a favorable safety profile relative to SG and OAGB.
• Variations in common limb length (200–350 cm) exist, with different terminologies used across studies.
• The meta-analysis included 18 studies with diverse designs, including retrospective, prospective, and one RCT.

Clinical Implications

SASI bypass offers an effective surgical option for obesity and related comorbidities with potentially fewer complications due to its simpler technique. Clinicians should consider SASI bypass as a viable alternative to traditional bariatric surgeries, especially in patients where procedural simplicity and safety are priorities. Standardization of the technique and limb length may further optimize outcomes.

Conclusion

The Single Anastomosis Sleeve Ileal bypass is a promising bariatric surgery technique demonstrating effective weight loss and comorbidity improvement with a favorable safety profile. Further high-quality studies are warranted to standardize the procedure and confirm long-term outcomes.

References

1. Mui et al. 2014 -- Description of SASI bypass technique
2. Mahdy et al. 2016 -- First case series of SASI bypass
3. PRISMA 2020 -- Preferred Reporting Items for Systematic Reviews and Meta-analyses