Single Anastomosis Sleeve Ileal Bypass (SASI): The Alarming Rate of Malnutrition

Abstract

We thank Abokhozima and Zidan for their comments on our study, and we are happy to address their questions.Single anastomosis sleeve ileal bypass (SASI) has a low perioperative complication rate, short-term significant weight loss, and resolution of obesity-related complications. However, this comes with a high expense of malnutrition, even in our short-term follow-up series with a 20% revision rate [1].The size of the gastro-ileal anastomosis in our series was 40 mm and not 60 mm. According to a systematic review and meta-analysis of 941 patients that underwent SASI, examining the effect of the size of the gastro-ileal anastomosis on % excess weight loss (EWL) and complications, comparing 4 to 3 cm anastomosis, revealed that a 4-cm anastomosis had better EWL at 12 months (94.3% vs 79.7%) and less complication rate (2.6% vs 14.4%) [2].The site of the gastro-ileal anastomosis in our series was at the greater curve of the antrum, as seen in the video. Ribeiro et al., in a retrospective study of 68 patients with 5 years of follow-up, with a similar technique as we presented, showed 5.9% hypoproteinemia and 14.7% low vitamin D and folate levels. Thus, the site of anastomosis has no significant impact on the passage of food or malnutrition rates [3].Preoperative workup with protein and vitamin levels, including serum albumin, iron, ferritin, vitamin B12, zinc, magnesium, vitamin D, and calcium, were measured and corrected for all patients before the index operation.The alarming outcomes in our series derived from the adverse effects of the Achilles heel of SASI and all emerging procedures that rely on malabsorption [4] and are unrelated to the size or site of the anastomosis.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.