Single-Anastomosis Sleeve Jejunal Bypass, a Novel Bariatric Surgery, Versus Other Familiar Methods: Results of a 6-Month Follow-up-a Comparative Study

Single-Anastomosis Sleeve Jejunal Bypass as a Treatment for Morbid Obesity: A Systematic Review and Meta-Analysis

Single-anastomosis sleeve jejunal (SASJ) bypass is a bariatric surgery technique with promising results. However, evidence of its efficacy and safety is still lacking. This study aimed to summarize the evidence regarding the efficacy and safety of SASJ bypass surgery in the treatment of morbid obesity. The literature was searched for English-language studies published from inception till November 26, 2023, on MEDLINE/PubMed, Cochrane Library, Web of Science, ProQuest, Scopus, SCINAPSE, and Google Scholar. The search terms included "morbid obesity," "bariatric surgery," and "single anastomosis sleeve jejunal bypass." Extracted data included the body mass index (BMI) before and after surgery, percent total weight loss (%TWL), percent excess weight loss (%EWL), and improvement in preoperative comorbidities. Pooling of the data was done using random effects or fixed-effect models based on the presence of significant heterogeneity. Nine studies were included in this systematic review and meta-analysis. The change in BMI from baseline at 12 months after SASJ bypass was significant (standardized mean difference (SMD) = -3.576, 95% confidence interval (CI) = -5.423, -1.730; I² = 99.23%). At 12 months after surgery, the pooled %TWL was 42.526 (95% CI = 37.948, 47.105; I² = 97.15%), and the pooled %EWL was 75.258 (95% CI = 67.061, 83.456; I² = 99.26%). The pooled incidence of postoperative improvement in diabetes mellitus was 91% (95% CI = 79.6%, 98%, I² = 82%). The overall rate of complications was 9.9% (95% CI = 2.5%, 21.6%; I² = 92.64%). Regarding the short- and mid-term outcomes, SASJ bypass is a safe and effective procedure for weight loss in patients with morbid obesity, with an acceptable rate of complications. The procedure is also associated with a marked improvement in obesity-related comorbidities.

BRAZILIAN MULTI-SOCIETY POSITION STATEMENT ON EMERGING BARIATRIC AND METABOLIC SURGICAL PROCEDURES

This Brazilian multi-society position statement on emerging bariatric and metabolic surgical procedures was issued by the Brazilian Society of Bariatric and Metabolic Surgery (SBCBM), the Brazilian College of Digestive Surgery (CBCD), and the Brazilian College of Surgeons (CBC). This document is the result of a Brazilian Emerging Surgeries Forum aimed at evaluating the results of surgeries that are not yet listed in the Federal Council of Medicine (CFM), the regulatory agency that oversees and regulates medical practice in Brazil. The Forum integrated more than 400 specialists and academics with extensive knowledge about bariatric and metabolic surgery, representing the three surgical societies: SBCBM, CBC, and CBCD. International speakers participated online and presented their experiences with the techniques under discussion, emphasizing the regulatory policies in their countries. The indications for surgery and the subsequent procedures were carefully reviewed, including one anastomosis gastric bypass (OAGB), single anastomosis duodeno-ileal with sleeve gastrectomy (SADI-S or OADS), sleeve gastrectomy with transit bipartition (SGTB), and sleeve gastrectomy with ileal interposition (SGII). The recommendations of this document are based on an extensive literature review and discussions among bariatric surgery specialists from the three surgical societies. We concluded that patients with a body mass index over 30 kg/m2 may be candidates for metabolic surgery in the presence of comorbidities (arterial hypertension and type 2 diabetes) with no response to clinical treatment of obesity or in the control of other associated diseases. Regarding the surgical procedures, we concluded that OAGB, OADS, and SGTB are associated with low morbidity rates, satisfactory weight loss, and resolution of obesity-related comorbidities such as diabetes and arterial hypertension. SGII was considered a good and viable promising surgical alternative technique. The recommendations of this statement aim to synchronize our societies with the sentiments and understandings of most of our members and also serve as a guide for future decisions regarding bariatric surgical procedures in our country and worldwide.

Single-anastomosis Sleeve Jejunal: a Mid-term Follow-up Report of a New Surgical Technique

INTRODUCTION

Single anastomosis sleeve ileal bypass (SASI) is a combined bariatric metabolic technique, in which few studies have shown its outcomes efficacy. However, this technique has a high risk of malnutrition due to long biliopancreatic limb. Single anastomosis sleeve jejunal bypass (SASJ) has a shorter limb. Therefore, it seems to have a lower risk of nutrient deficiency. Furthermore, this technique is relatively new, and little is known about the efficacy and safety of SASJ. We aim to report our mid-term follow-up of SASJ from a high-volume center for bariatric metabolic surgery in the Middle East region.

METHODS

For the current study, the 18-month follow-up data of 43 patients with severe obesity who underwent SASJ was collected. The primary outcome measures were demographic data, weight change variables according to ideal body mass index (BMI) of 25 kg/m² at 6, 12, and 18 months, laboratory assessments, remission of obesity-associated medical problems, and other potential bariatric metabolic complications after the surgery.

RESULTS

No patient was lost due to follow-up. After 18 months, patients lost 43.4 ± 11 kg of their weight and 68 ± 14% of their excess weight, and their BMI decreased from 44.9 ± 4.7 to 28.6 ± 3.8 kg/m² (p < 0.001). The percentage of total weight loss till 18 months was 36.3%. The T2D remission rate at 18 months was 100%. Patients neither faced deficiency in significant markers for nutrition state nor represented major bariatric metabolic surgery complications.

CONCLUSION

SASJ bypass achieved satisfactory weight loss and remissions in obesity-associated medical problems within 18 months after surgery without major complications and malnutrition.

Optimal Length of Biliopancreatic Limb in Single Anastomosis Sleeve Gastrointestinal Bypass for Treatment of Severe Obesity: Efficacy and Concerns

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.

Severe malnutrition after single anastomosis sleeve jejunal bypass (SASJ) surgery due to a rare surgical complication: Report of the case

Introduction

Bariatric procedures rates are increased due to the epidemic in obesity. Up to 50% of patients operated with vertical banded gastroplasty (VBG) procedures experience failure or complications in the mid- and long-term and present for revision bariatric surgery. Despite the increase in revisions, their safety and efficacy remain controversial.

Case presentation

A 44-year-old female patient with severe malnutrition after single anastomosis sleeve jejunal bypass (SASJ) surgery was referred to this center. SASJ was the chosen bariatric procedure for her after the first failed VBG. She was unable to swallow anything. Upper GI endoscopy was done and the laparoscopic prolene mesh used in the first bariatric surgery (VBG) was seen inside the gastric lumen. Total parental nutrition was initiated and continued for 12 days in this medical center and then she was candidate for exploratory laparoscopy.

Clinical discussion

Using prophylactic preperitoneal Prolene mesh during wound closure in bariatric surgery is safe and effective in preventing incisional hernia development. During the revision bariatric surgeries, surgeons should be careful about the used mesh in the first bariatric surgery.

Conclusion

Surgeons should be aware of the management of rare surgical complications that might lead to malnutrition which is insidious.

Level of evidence

V

•

Bariatric surgeries have increased life expectancy and reduced the complications of obesity.

•

Up to 50% of patients operated with vertical banded gastroplasty (VBG) procedures experience failure or complications and present for revision bariatric surgery.

•

During the revision bariatric surgeries, surgeons should be careful about the used mesh in the first bariatric surgery.

Nutritional Complications After Laparoscopic Roux-en-Y Gastric Bypass and One-Anastomosis Gastric Bypass: A Comparative Systematic Review and Meta-Analysis

A systematic review and meta-analysis were carried out involving studies that compared the nutritional complications of Roux-en-Y gastric bypass (RYGB) and one-anastomosis gastric bypass (OAGB); these included the incidence of malnutrition as well as deficiencies of other nutritional elements, such as total protein, albumin, calcium and iron. A comprehensive search strategy was implemented in PubMed, Embase, and the Cochrane Library. Effect sizes included the pooled odds ratios (ORs) and 95% confidence intervals (95% CIs), as well as mean differences (MDs) and 95% CIs of the percentage total weight loss (%TWL) and excess weight loss percentage (%EWL).

Thirteen studies were included (12,964 patients, 66.27% females, 53.82% underwent OAGB). At the longest follow-up period (≥3 years), OAGB was associated with significantly higher %TWL (MD=5.41%, 95%CI, 1.52 to 9.29) and %EWL (MD=13.81%, 95%CI, 9.60 to 18.02) compared to RYGB. However, OAGB procedures were associated with malnutrition (OR=3.00, 95%CI, 1.68 to 5.36, p<0.0001), hypoalbuminemia (OR=2.38, 95%CI, 1.65 to 3.43, p<0.0001), hypoproteinemia (OR=1.85, 95%CI, 1.09 to 3.14, p=0.022), anemia (OR=1.38, 95%CI, 1.08 to 1.77, p=0.011), and hypocalcemia (OR=1.78, 95%CI, 1.01 to 3.12, p=0.046). On subgroup analyses, the proportions of anemia and hypoalbuminemia remained significantly higher at longer follow-up periods and in studies published in Asia.

Despite the favorable weight loss profile, the unfavorable nutritional consequences of OAGB merits further investigations to explore the malabsorptive element, ethnic variation, and the role of biliopancreatic limb length.