Top

Surgical Endoscopy

Published in:

01-10-2021 | Obesity | 2020 SAGES Oral

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

Authors: Alaa M. Sewefy, Abdelfattah Saleh

Published in: Surgical Endoscopy | Issue 10/2021

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.

Available only for authorised users

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):464–474CrossRef

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

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 25:1239–1250CrossRef

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):e8924CrossRef

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. 56:7–14CrossRef

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):1207–1216CrossRef

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. 34:28–34CrossRef

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):56–58CrossRef

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

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):531–538CrossRef

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.2011.10.021CrossRefPubMed

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/s00270-012-0518-6CrossRef

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):587–606CrossRef

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/10.1080/08941939.2016.1241841CrossRef

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/s11695-010-0247-3CrossRefPubMed

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):479–486PubMed

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):307–317CrossRef

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):238PubMedPubMedCentral

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-xCrossRefPubMed

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. 22:1827–1834CrossRef

21.

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

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-yCrossRefPubMedPubMedCentral

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/s11695-016-2524-2CrossRefPubMed

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):41–46CrossRef

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/s00464-008-9769-3CrossRefPubMed

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-xCrossRefPubMed

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/s11695-008-9587-7CrossRefPubMed

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.2003.12.047CrossRefPubMed

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/s00464-002-8925-4CrossRefPubMed

30.

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

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/10.1381/096089201321454060CrossRefPubMed

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-yCrossRefPubMed

33.

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

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. 30:837–845CrossRef

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 28:2406–2411CrossRef

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):284–290CrossRef

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):255–265CrossRef

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 27:1153–1167CrossRef

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):27–30CrossRef

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/s11695-017-2608CrossRefPubMed

Title: The outcomes of single anastomosis sleeve jejunal bypass as a treatment for morbid obesity (Two-year follow-up)
Authors: Alaa M. Sewefy
Abdelfattah Saleh
Publication date: 01-10-2021
Publisher: Springer US
Keywords: Obesity
Obesity
Sleeve Gastrectomy
Gastroesophageal Reflux Disease
Published in: Surgical Endoscopy / Issue 10/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-08029-x

At a glance: The STEP trials

Springer Medicine

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

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2021

Using a standardized intra-operative endoflip protocol during fundoplication to identify factors that affect distensibility

Preoperative opioid, sedative, and antidepressant use is associated with increased postoperative hospital costs in colorectal surgery

Impact of Body Mass Index (BMI) on perioperative outcomes following minimally invasive retromuscular abdominal wall reconstruction: a comparative analysis

Influence of sociodemographic variables on weight loss outcomes up to 3-years following primary bariatric surgery

Totally extra-peritoneal repair versus trans-abdominal pre-peritoneal repair for the laparoscopic surgical management of sportsman’s hernia: A systematic review and meta-analysis

Regression of Barrett’s esophagus after magnetic sphincter augmentation: intermediate-term results