The Alarming Rate of Malnutrition after Single Anastomosis Sleeve Ileal Bypass. A single Centre Experience

Wafa, Ala; Bashir, Ahmad; Cohen, Ricardo V.; Haddad, Ashraf

doi:10.1007/s11695-024-07192-7

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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.

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contrasting

confidence: 49%

“…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].…”

mentioning

confidence: 66%

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

Wafa,

Bashir,

Cohen

et al. 2024

OBES SURG

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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.

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“…The extent of the common loop formed during the SASI bypass can range between 250 and 350 cm [ 7 , 14 , 15 ]. A shorter common limb may increase malabsorption and enhanced weight loss but could also elevate the risk of complications [ 14 , 16 ]. The decision-making process for the common limb length during SASI bypass should consider the balance between achieving adequate weight loss and minimizing the risk of nutritional complications such as protein-caloric malnutrition or iron metabolism disorders.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the potential adverse effects on iron metabolism parameters in some patients, it is worth emphasizing that SASI bypass has promising outcomes, particularly in addressing metabolic disorders such as type 2 diabetes [5,[14][15][16][17][18]. As a malabsorptive surgery, SASI bypass may benefit individuals with a preference for sweets.…”

Section: Discussionmentioning

confidence: 99%

Anemia and iron metabolism disorders after single anastomosis sleeve ileal (SASI) bypass. Is it a real problem?

Parkitna,

Binda,

Gonciarska

et al. 2024

Langenbecks Arch Surg

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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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SASI Is a Successful Metabolic Surgery but with Many Variables

Abokhozima,

Zidan,

Selim

2024

OBES SURG

1

0

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The Alarming Rate of Malnutrition after Single Anastomosis Sleeve Ileal Bypass. A single Centre Experience

Cited by 5 publications

References 15 publications

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

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

Anemia and iron metabolism disorders after single anastomosis sleeve ileal (SASI) bypass. Is it a real problem?

SASI Is a Successful Metabolic Surgery but with Many Variables

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