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Parkitna J, Binda A, Gonciarska A, Jaworski P, Kudlicka E, Barski K, Wawiernia K, Jankowski P, Wąsowski M, Kuryłowicz A, Tarnowski W. Anemia and iron metabolism disorders after single anastomosis sleeve ileal (SASI) bypass. Is it a real problem? Langenbecks Arch Surg 2024; 409:195. [PMID: 38904793 PMCID: PMC11192672 DOI: 10.1007/s00423-024-03384-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 06/15/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE SASI (single anastomosis sleeve ileal) bypass can lead to nutritional deficiencies, including disorders of iron metabolism and anemia. This study aims to evaluate the effect of SASI bypass on weight loss, anemia, and iron deficiency in patients with obesity during the follow-up period. METHODS This study is a retrospective analysis of prospectively collected data from patients who underwent SASI bypass at our hospital between January 2020 and February 2022. RESULTS The mean age of the patients was 42 years (range 22-58). The average duration of the follow-up period was 26 months. The mean percentage of excess weight loss (%EWL) was 90.1%, and total weight loss (%TWL) was 30.5%. During the postoperative observation period, anemia was identified in ten patients (25%), comprising 70% with normocytic anemia, 10% with microcytic anemia, and two macrocytic anemia cases (20%). Iron deficiency was observed in two patients (5%). CONCLUSION SASI bypass is an effective bariatric procedure in weight loss outcomes. However, there may be an increased risk of anemia and iron metabolism disruptions associated with this procedure. The common limb length (250 vs. 300 cm) did not significantly impact hemoglobin, iron, TIBC, ferritin levels, or anemia incidence among patients undergoing SASI bypass. The decrease in postoperative ferritin levels signifies a depletion in tissue iron reserves, thereby emphasizing the necessity for surveillance of iron homeostasis parameters following SASI bypass.
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Affiliation(s)
- Joanna Parkitna
- Department of General, Oncological and Bariatric Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, Warsaw, 00-416, Poland
| | - Artur Binda
- Department of General, Oncological and Bariatric Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, Warsaw, 00-416, Poland.
| | - Agnieszka Gonciarska
- Department of General, Oncological and Bariatric Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, Warsaw, 00-416, Poland
| | - Paweł Jaworski
- Department of General, Oncological and Bariatric Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, Warsaw, 00-416, Poland
| | - Emilia Kudlicka
- Department of General, Oncological and Bariatric Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, Warsaw, 00-416, Poland
| | - Krzysztof Barski
- Department of General, Oncological and Bariatric Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, Warsaw, 00-416, Poland
| | - Karolina Wawiernia
- Department of General, Oncological and Bariatric Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, Warsaw, 00-416, Poland
| | - Piotr Jankowski
- Department of General Medicine and Gerontocardiology, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, 00-416, Warsaw, Poland
| | - Michał Wąsowski
- Department of General Medicine and Gerontocardiology, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, 00-416, Warsaw, Poland
| | - Alina Kuryłowicz
- Department of General Medicine and Gerontocardiology, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, 00-416, Warsaw, Poland
| | - Wiesław Tarnowski
- Department of General, Oncological and Bariatric Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, Warsaw, 00-416, Poland
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Zhu J. Kill Three Birds with One Stone: Sleeve Reduction, Cruroplasty, Gastropexy, and Concomitant Sleeve Ileal Bypass for Patients with Gastroesophageal Reflux, Constipation, and Weight Regain After Laparoscopic Sleeve Gastrectomy. Obes Surg 2024; 34:1961-1963. [PMID: 38523170 DOI: 10.1007/s11695-024-07186-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 02/16/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Jiangfan Zhu
- Bariatric and Metabolic Surgery Center, The 10th Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, China.
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Ribeiro R, Viveiros O, Taranu V, Rossoni C. One Anastomosis Transit Bipartition (OATB): Rational and Mid-term Outcomes. Obes Surg 2024; 34:371-381. [PMID: 38135740 DOI: 10.1007/s11695-023-06988-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/29/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND The "One-anastomosis transit bipartition" (OATB) is a promising emerging technique in the metabolic syndrome treatment. OBJECTIVE To demonstrate the results achieved with OATB in the first 5 years after surgery. METHOD Cross-sectional, retrospective study, with individuals undergoing primary OATB. Individuals included in the study were: ≥ 18 years, BMI ≥ 35 kg/m2; and excluded smoking habits, drug dependence, inflammatory bowel diseases. The data analyzed demographic, anthropometric, surgical, clinical, and nutritional. RESULTS Sixty eight participants, 75% women, average age 45.5 years and BMI 41 kg/m2. Associated diseases: osteoarthritis (52.9%), hypertension (48.5%) and type 2 diabetes mellitus-T2DM (39.7%). All underwent laparoscopy, without conversions. Average operative time is 122.6 ± 31.7 min, and hospital stay is 2.2 ± 0.8 days. The common channel length 27 and 41 patients with 250 cm and 300 cm respectively. We registered no intraoperative complications, 2 (2.9%) early complications, and 14 (20.6%) late complications. In the first 6 months, 94.7% (250 cm) and 88.9% (300 cm) of the patients no longer used medication for T2DM, with no statistical difference between the two groups. The incidence of nutritional disorders at any time during follow-up: hypovitaminosis D (14.7%), folate hypovitaminosis (14.7%), elevated PTH (7.4%), hypoproteinemia (5.9%) and anemia (5.9%). We found no statistically significant difference between 250 and 300 cm common channel groups. CONCLUSION We conclude that OATB is a safe and effective technique, demonstrating good control of T2DM and metabolic syndrome. There is a requirement to treat previous nutritional deficits. We need more long-term evidence and comparison to other surgical techniques.
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Affiliation(s)
- Rui Ribeiro
- Multidisciplinary Center for Obesity Treatment, Hospital Lusíadas, 2724-002, Amadora, Portugal
- General Surgery Department, Hospital Lusíadas, Amadora, Portugal
- Multidisciplinary Center for Obesity Treatment, Hospital Lusíadas, Lisbon, Portugal
| | - Octávio Viveiros
- Multidisciplinary Center for Obesity Treatment, Hospital Lusíadas, 2724-002, Amadora, Portugal
- General Surgery Department, Hospital Lusíadas, Amadora, Portugal
- Multidisciplinary Center for Obesity Treatment, Hospital Lusíadas, Lisbon, Portugal
| | - Viorel Taranu
- Multidisciplinary Center for Obesity Treatment, Hospital Lusíadas, 2724-002, Amadora, Portugal
- General Surgery Department, Hospital Lusíadas, Amadora, Portugal
| | - Carina Rossoni
- Multidisciplinary Center for Obesity Treatment, Hospital Lusíadas, 2724-002, Amadora, Portugal.
- School of Sciences and Health Technologies, Universidade Lusófona de Humanidades e Tecnologias, Lisbon, Portugal.
- Institute of Environmental Health (ISAMB) - Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
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Chu Y, Widjaja J, Wang J, Wu W, Hong J, Zhu X, Yao L. Comparison of three different anastomotic methods of sleeve gastrectomy with transit bipartition using an obese rodent model. Sci Rep 2023; 13:21247. [PMID: 38040907 PMCID: PMC10692095 DOI: 10.1038/s41598-023-48059-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023] Open
Abstract
The long-term effects and safety of single-anastomosis sleeve ileal (SASI) bypass have not been confirmed. The one anastomosis procedure carries the risk of bile reflux, and Braun anastomosis has the capacity to reduce bile reflux. This study was designed to compare the influences of bile reflux and histological changes in the esogastric sections of rats. Obese Sprague-Dawley rats underwent sleeve gastrectomy with transit bipartition (RYTB) (n = 12), SASI (n = 12), SASI bypass with Braun anastomosis (BTB) (n = 12), esojejunostomy (EJ) (n = 12), and SHAM (n = 8) surgery. During the 12-week follow-up period, weight changes, glucose improvement, and changes in serum nutrition were evaluated. Histological expression and bile acid concentration in the rats in all groups were also evaluated. No significant differences in weight loss and glucose improvements were observed in the RYTB, SASI, and BTB groups. The RYTB and BTB groups had significantly lower bile acid concentration and albumin levels than the SASI group. In addition, mucosal height in the RYTB and BTB groups was significantly lower than in the SASI group. Braun anastomosis had a significant effect on anti-reflux. BTB may be a superior primary procedure due to its potential for parallel bariatric and metabolic improvements, effective anti-reflux effects, simplified operations, and avoidance of severe malnutrition. Further clinical studies are needed to confirm these findings.
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Affiliation(s)
- Yuxiao Chu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, People's Republic of China
| | - Jason Widjaja
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, People's Republic of China
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, 200040, People's Republic of China
| | - Jian Wang
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, People's Republic of China
| | - Wei Wu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, People's Republic of China
| | - Jian Hong
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, People's Republic of China
| | - Xiaocheng Zhu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, People's Republic of China
| | - Libin Yao
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, People's Republic of China.
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Parkitna J, Jaworski P, Binda A, Barski K, Tarnowski W. Effect of SASI procedure (Single Anastomosis Sleeve Ileal) on the symptoms of gastroesophageal reflux disease in bariatric patients - a review of the literature. POLISH JOURNAL OF SURGERY 2023; 96:60-64. [PMID: 38348987 DOI: 10.5604/01.3001.0053.3998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
The problem of gastroesophageal reflux disease among bariatric patients is constantly growing. While bariatric surgery is the most effective method of treating obesity and related diseases, not all surgical procedures lead to improvement or resolution of gastroesophageal reflux disease. The search for the "ideal" surgical procedure for this group of patients is ongoing. The relatively recently introduced SASI procedure seems to have a beneficial effect on GERD symptoms and may be an alternative anti-reflux procedure in obese patients. The presented paper is a review of the latest literature on the impact of SASI procedure on the symptoms of gastroesophageal reflux disease.
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Affiliation(s)
- Joanna Parkitna
- Clinical Department of General, Oncological and Bariatric Surgery CMKP, Warsaw, Poland
| | - Paweł Jaworski
- Clinical Department of General, Oncological and Bariatric Surgery CMKP, Warsaw, Poland
| | - Artur Binda
- Clinical Department of General, Oncological and Bariatric Surgery CMKP, Warsaw, Poland
| | - Krzysztof Barski
- Clinical Department of General, Oncological and Bariatric Surgery CMKP, Warsaw, Poland
| | - Wiesław Tarnowski
- Clinical Department of General, Oncological and Bariatric Surgery CMKP, Warsaw, Poland
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Suh HR, Mui J, Cheng E, Liu D, Sun SL, Loi K, Magdy M, Gagner M. Outcomes of single anastomosis duodeno ileal bypass and single anastomosis stomach ileal bypass for type II diabetes: a systematic review. Expert Rev Endocrinol Metab 2023; 18:337-346. [PMID: 37276132 DOI: 10.1080/17446651.2023.2218919] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 05/24/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Bariatric surgery has demonstrated long-term effectiveness in inducing weight loss and improving metabolic parameters for obesity. Single anastomosis duodeno-ileal (SADI) bypass and single anastomosis sleeve-ileal (SASI) bypass have both emerged as new promising bariatric procedures. In this paper, we review the existing literature and compare the outcomes of SADI and SASI bypass procedures in regard to weight loss, complication rate, and improvement of type II diabetes (T2DM). This has not yet been done in the preexisting literature. AREAS COVERED We conducted a systematic literature search of electronic databases focusing on weight loss outcomes, rate of complications and remission, or improvement of T2DM and other obesity-related comorbidities. Seventeen studies on SADI and nine studies on SASI were included. Both are similar in terms of surgical technique and have demonstrated fewer complications when compared to other bariatric procedures. Mean preoperative BMI was similar in both study groups: 46.4 kg/m2 in SADI and 48.8 kg/m2 in SASI. Mean %EWL at 12 months in the SADI group was 74.1% compared to 77.4% in the SASI group. Preoperative severity of T2DM appeared to be higher in the SASI patient group, with a higher preoperative HbA1c and fasting blood glucose levels. T2DM resolution was achieved in a significant proportion of both SADI and SASI patient populations (78.5% in SADI and 89.0% in SASI). Complication rates were comparable for both procedures. EXPERT OPINION Both SADI and SASI are effective in inducing weight loss at 12 months, with a low rate of major complications and mortality. From the studies included in this review, the SASI procedure had a higher impact on T2DM resolution compared to SADI.
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Affiliation(s)
- Hye Rim Suh
- Department of Surgery, St George Hospital, Kogarah, NSW, Australia
- St George Clinical School, University of New South Wales, Kogarah, NSW, Australia
| | - Jasmine Mui
- Department of Surgery, St George Hospital, Kogarah, NSW, Australia
- St George Clinical School, University of New South Wales, Kogarah, NSW, Australia
| | - Ernest Cheng
- Department of Surgery, St George Hospital, Kogarah, NSW, Australia
- St George Clinical School, University of New South Wales, Kogarah, NSW, Australia
| | - Daniel Liu
- Department of Surgery, St George Hospital, Kogarah, NSW, Australia
- St George Clinical School, University of New South Wales, Kogarah, NSW, Australia
| | - Si Louise Sun
- Department of Surgery, St George Hospital, Kogarah, NSW, Australia
- St George Clinical School, University of New South Wales, Kogarah, NSW, Australia
| | - Ken Loi
- Department of Surgery, St George Hospital, Kogarah, NSW, Australia
- St George Clinical School, University of New South Wales, Kogarah, NSW, Australia
| | - Mark Magdy
- Department of Surgery, The Sutherland Hospital, Caringbah, NSW, Australia
| | - Michel Gagner
- Department of Surgery, Westmount Square Surgical Center, Westmount, Quebec, Canada
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Yildirak MK, Şişik A, Demirpolat MT. Comparison of Laparoscopic Sleeve Gastrectomy and Single Anastomosis Sleeve Ileal Bypass in Type 2 Diabetes Mellitus Remission Using International Criteria. J Laparoendosc Adv Surg Tech A 2023; 33:768-775. [PMID: 37155616 DOI: 10.1089/lap.2023.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Introduction: Single anastomosis sleeve ileal (SASI) bypass procedure is recommended in the treatment of patients with obesity, who have comorbidities such as type 2 diabetes mellitus (T2DM). Meanwhile, laparoscopic sleeve gastrectomy (LSG) has become the most preferred contemporary bariatric procedure. Research comparing these two techniques are scarce in the literature. In this study, we aimed to compare LSG and SASI procedures in terms of weight loss and diabetes remission. Materials and Methods: Thirty patients, who underwent LSG and 31 patients, who underwent SASI, with a body mass index (BMI) of 35 and above, and under unsuccessful medical treatment, in terms of T2DM, were included in the study. Patients' demographic data were recorded. Oral antidiabetic drugs and insulin use, HbA1c and fasting blood glucose values, and BMI values were recorded preoperatively, at thd sixth month and at first year. According to these data, patients were compared in terms of primarily diabetes remission and secondarily weight loss. Results: At the sixth month and first year, the mean excess weight loss (EWL) values of the SASI group were 55.2% ± 12.45% and 71.67% ± 15.75%, respectively, while EWL values of the LSG group were 57.41% ± 16.22% and 69.73% ± 16.65%, respectively (P > .05). T2DM evaluations revealed that in the SASI group, 25 (80.65%) patients at the sixth month and 26 (83.87%) patients at the first year had either clinical improvement or remission, whereas 23 (76.67%) patients at the sixth month and 26 (86,67%) patients at the first year in the LSG group had the same outcomes (P > .05). Conclusion: The short-term comparison of LSG and SASI procedures revealed similar results in terms of weight loss and T2DM remission. Hence, LSG can be considered as the first-step treatment of morbid obesity accompanied by T2DM, since it is a simpler surgical procedure.
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Affiliation(s)
- Muhammed Kadir Yildirak
- Department of General Surgery, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Abdullah Şişik
- Department of General Surgery, Dr. HE Obesity Clinic, Istanbul, Turkey
| | - Muhammed Taha Demirpolat
- Department of General Surgery, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Aghajani E, Schou C, Gislason H, Nergaard BJ. Mid-term outcomes after single anastomosis sleeve ileal (SASI) bypass in treatment of morbid obesity. Surg Endosc 2023:10.1007/s00464-023-10112-y. [PMID: 37171643 PMCID: PMC10338567 DOI: 10.1007/s00464-023-10112-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/30/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND According to several short-term studies, single-anastomosis sleeve ileal (SASI) bypass offers similar weight loss to Roux-en-Y Gastric Bypass (RYGB) with fewer complication and better comorbidity reduction/resolution. Long-term data on this operation is lacking in the literature. The purpose of this study was to analyze the outcomes of SASI bypass up to 4 years. METHODS This study is a retrospective cohort analysis of 366 patients with morbid obesity who underwent primary SASI bypass from January 2018 to February 2022. RESULTS The mean age and preoperative body mass index (BMI) were 41 years (range 22-71 years) and 43.9 ± 6.5 kg/m2, respectively. Follow-up was available for 229 patients at 1-year (89%), 112 patients at 2-year (75%), 61 patients at 3-year (75%), and 35 patients at 4-year (71%). The intraoperative, short-term, and long-term complication rates were 0%, 2.5%, 4.6%, respectively. After 4 years, mean percentage excess weight loss (%EWL) was 93.3% and total weight loss (%TWL) was 41.2%. Remission of comorbidities was 93% for type 2 diabetes mellitus, 73% for hypertension, 83% for hyperlipidemia, 79% for sleep apnea, and 25% for gastroesophageal reflux disease (GERD). Biliary gastritis and ulcers are seldom. Eight patients developed de novo GERD symptoms requiring proton pump inhibitor treatment. None of the patients in our study had hypoalbuminemia or malabsorption that did not respond to increased protein intake and vitamin or mineral supplementation. CONCLUSION SASI bypass appears to be safe, and one of the most effective bariatric procedures regarding weight loss and obesity related comorbidities. The double-outlet created in this procedure seemingly minimizes nutritional complications.
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Affiliation(s)
- Ebrahim Aghajani
- Department of Surgery, Aleris Obesity Clinic, Aleris Hospital, Fredriks Stangs Gate 11-13, 0246, Oslo, Norway.
| | - Carl Schou
- Department of Surgery, Aleris Obesity Clinic, Aleris Hospital, Fredriks Stangs Gate 11-13, 0246, Oslo, Norway
| | - Hjortur Gislason
- Metabolic and Bariatric Unit, GB Obesitas, Skeppsbron 11, 211 20, Malmo, Sweden
| | - Bent Johnny Nergaard
- Department of Surgery, Aleris Obesity Clinic, Aleris Hospital, Fredriks Stangs Gate 11-13, 0246, Oslo, Norway
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Finze A, Otto M, Reissfelder C, Blank S. [Therapeutic Options for Regaining Weight after Bariatric Surgery]. Zentralbl Chir 2022; 147:547-555. [PMID: 36479651 DOI: 10.1055/a-1957-5570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this article is to create an overview of diagnostic and therapeutic options for weight regain (WR) and insufficient weight loss (IWL) after bariatric surgery (BS). With increasing popularity of BS, WR is becoming more relevant. METHODS We combined recent literature on WR and IWL with personal experience to suggest possible proceedings if WR or IWL is diagnosed. RESULTS If an anatomical-pathological cause can be detected, surgical therapy is the most effective. If WR or IWL is idiopathic, a multimodal therapeutic concept is necessary for sufficient therapeutic success. Depending on the initial BS, a combination of lifestyle intervention, medication and surgical therapy seems most effective. CONCLUSIONS Extensive diagnostic testing is necessary prior to any surgical intervention. In idiopathic WR after Roux-en-Y Gastric Bypass (RYGB), we suggest lengthening the biliopancreatic limb and shortening the common channel. After Sleeve-Gastrectomy (SG), we currently see RYGB as most effective in patients with gastroesophageal reflux disease (GERD) and SADI-S as a feasible option if no GERD is present.
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Affiliation(s)
- Alida Finze
- Chirurgische Klinik, Universitätsklinikum Mannheim, Mannheim, Deutschland
| | - Mirko Otto
- Chirurgische Klinik, Universitätsklinikum Mannheim, Mannheim, Deutschland
| | | | - Susanne Blank
- Chirurgische Klinik, Universitätsklinikum Mannheim, Mannheim, Deutschland
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Goudarzi H, Obney JR, Hemmatizadeh M, Anbara T. Endoscopic Self-Expanding Metallic Stent Placement in the Management of Post Laparoscopic Sleeve Gastrectomy Complications. JOURNAL OF DIGESTIVE ENDOSCOPY 2022. [DOI: 10.1055/s-0042-1754333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Abstract
Introduction Endoscopic treatments have become popular by providing the best solution for healing complications while allowing oral nutrition. In this study, we aim to evaluate outcomes of the endoscopic-covered stents for staple line complications following bariatric surgery.
Methods A prospective evaluation was performed for all patients treated for staple line complications after bariatric surgery. Bariatric patients with acute leaks, chronic gastrocutaneous fistulas, and anastomotic strictures refractory to endoscopic dilation after sleeve gastrectomy were included in this survey.
Results From January 2019 to June 2020, 41 patients (12 with acute leaks, 16 with chronic fistulas, and 13 with strictures) were treated with endoscopic silicone-covered stents (polyester or nitinol). The mean follow-up was 3.5 months. Immediate symptomatic improvement occurred in 95.2% (91.7% of acute leaks, 81.2% of fistulas, and 92.3% of strictures). In addition, 87.8% of patients initiated oral feeding immediately after stenting. There was no mortality case in this population.
Conclusion Although stent migration rarely occurs in subjects, the endoscopic silicone-covered stents strategy is one of the best treatments for anastomotic complications after bariatric surgery, providing rapid healing while simultaneously allowing for oral nutrition.
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Affiliation(s)
| | - Jacob R. Obney
- Department of Biology, Texas Tech University, Lubbock, Texas, United States
| | | | - Taha Anbara
- Department of Surgery, Erfan Niayesh Hospital, Tehran, Iran
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Hosseini SV, Moeinvaziri N, Medhati P, Salem SA, Hosseini E, Clark CCT, Haghighat N. The Effect of Single-Anastomosis Sleeve Ileal (SASI) Bypass on Patients with Severe Obesity in Three Consecutive Years. World J Surg 2022; 46:2744-2750. [DOI: 10.1007/s00268-022-06706-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2022] [Indexed: 01/18/2023]
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12
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Hosseini SV, Moeinvaziri N, Medhati P, Hesameddini I, Kamran H, Akool MAZ, Haghighat N. Optimal Length of Biliopancreatic Limb in Single Anastomosis Sleeve Gastrointestinal Bypass for Treatment of Severe Obesity: Efficacy and Concerns. Obes Surg 2022; 32:2582-2590. [PMID: 35583584 DOI: 10.1007/s11695-022-06107-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The present study aimed to compare two newly introduced procedures, single anastomosis sleeve jejunal (SASJ) with ileal (SASI) bypass in terms of weight loss, remission of obesity-associated medical problems, complications, and nutritional status. MATERIALS AND METHODS This retrospective study was carried out with 162 patients who underwent single anastomosis sleeve gastrointestinal bypass from October 2017 to September 2021, either single anastomosis sleeve jejunal bypass (SASJ) or single anastomosis sleeve ileal bypass (SASI). The main outcome measures were weight loss and improvement in obesity-associated medical problems, nutritional status, and complications at 12 months post-surgery. RESULTS At 12 months, both groups showed significant weight loss and remission in obesity-associated medical problems. There were significant differences in body mass index (BMI), total weight loss (TWL), and excess weight loss (EWL) between SASI and SASJ bypass (P < 0.05). Improvements in associated medical problems after the two procedures were similar except for hypertension. The reversal surgery rate of the SASI group was significantly higher than that of the SASJ group (5.5% vs. 0.0%, p = 0.03). CONCLUSIONS SASJ and SASI bypass achieved satisfactory weight loss and improvement in obesity-associated medical problems that were comparable between the two groups. SASI bypass was followed by a significant difference in the rate of reversal surgery at 1 year due to a short common channel, which was not observed after SASJ bypass.
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Affiliation(s)
- Seyed Vahid Hosseini
- Laparascopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nader Moeinvaziri
- Laparascopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pourya Medhati
- Laparascopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Iman Hesameddini
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hooman Kamran
- Laparascopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammed Abd Zaid Akool
- Department of Surgery, Faculty of Medicine, Jabir Ibn Hayyan Medical University, Najaf, Iraq
| | - Neda Haghighat
- Laparascopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Abdalaziz A, Sarhan MD, Abou-Eisha HA, Abdelsalam A, Saqr A, Fathy E. Laparoscopic Single Anastomosis Sleeve Ileal Bypass with Follow-up of Weight Loss and Metabolic Impact. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Bariatric surgery has been an effective safe management for severe obesity. The newly developed single-anastomosis sleeve ileal (SASI) bypass has shown efficacy as a functional as well as mechanical restrictive bariatric procedure, with a neuroendocrine modulation effect. SASI bypass is still an investigational procedure, hence, more evidence is needed till it is declared as a standard bariatric procedure by the IFSO. Aim of the study: The current work aimed to describe our experience regarding the technical steps, the efficacy and the short-term outcome of SASI bypass procedure in patients with severe obesity. Patients and methods: Forty seven patients with severe obesity underwent SASI bypass procedure. They were followed till 1 year postoperatively. The weight loss, comorbidities and laboratory changes were assessed. Results: Patients evaluation at the 1-year postoperative follow up revealed a mean %TWL of 37.55 ± 6.17 and a mean %EBWL of 76.21 ± 9.8. The remission rates of T2DM, hyperlipidemia and hypertension were 85.7%, 94.7% and 89.66%, respectively, with statistically high significant differences between the preoperative and 1-year postoperative comorbidities rate. Stepwise regression analysis demonstrated that only the preoperative HbA1C remained in the model predicting the %TWL, and the preoperative BMI was the remaining factor in the model predicting the %EBWL in the study patients. Conclusion: The present study adds a new evidence to the promising outcome of the newly introduced SASI bypass procedure. After one year, the study patients showed excellent weight loss and comorbidities remission together with acceptable major complication rates.
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Comparison of the Outcomes of Single Anastomosis Duodeno-Ileostomy with Sleeve Gastrectomy (SADI-S), Single Anastomosis Sleeve Ileal (SASI) Bypass with Sleeve Gastrectomy, and Sleeve Gastrectomy Using a Rodent Model with Diabetes. Obes Surg 2022; 32:1209-1215. [PMID: 35050482 DOI: 10.1007/s11695-022-05920-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Single anastomosis duodeno-ileostomy with sleeve gastrectomy (SADI-S) is a powerful form of bariatric surgery; however, it has a high risk of malnutrition. Single anastomosis sleeve ileal (SASI) bypass with sleeve gastrectomy may be used as an alternative procedure to avoid malnutrition associated with SADI-S; however, no comparison between the two procedures has been performed. METHODS Sprague-Dawley rats with diabetes (n = 32) were divided into four groups: SADI-S (n = 8), SASI (n = 8), SG (n = 8), and SHAM (n = 8). Body weight, food intake, and fasting blood glucose were measured, and the oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) were performed before and after surgery. Blood samples were collected before and after the surgery to assess the levels of glucagon-like peptide-1 (GLP-1), hemoglobin, albumin, vitamin B12, calcium, and iron. RESULTS The SADI-S and SASI groups showed significantly greater weight loss and better glucose control than the SG group postoperatively. The SADI-S and SASI groups showed similar improvements in glucose control throughout the study. The SADI-S and SASI groups had significantly higher GLP-1 levels than the SG group at 6 months. The SADI-S and SASI groups presented with various degrees of deficiencies, with the SADI-S group showing a higher risk for hypoalbuminemia and iron deficiency than the SASI group. CONCLUSIONS The SASI procedure may be a better alternative as it has excellent bariatric and metabolic results with lower risk for hypoalbuminemia and can be easily converted into either SADI-S or SG procedures. Nevertheless, further clinical results are needed.
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