Malnutrition After Single Anastomosis Sleeve Ileal Bypass: A Single-Center Experience

The authors raise concerns regarding the study by Wafa et al. on the high rates of malnutrition and revisional surgery after single anastomosis sleeve ileal (SASI) bypass. The small sample size (30 patients), single-center design, and lack of multicenter data limit the generalizability of the findings. The authors question the learning curve of the surgeon and whether the high complication rates are due to the surgeon's experience or inherent to the SASI technique. The involvement and contribution of co-authors from different institutions are unclear, potentially introducing bias. The study lacks preoperative nutritional assessment data, making it difficult to determine if postoperative deficiencies are due to SASI or preexisting issues. The nutritional management and supplementation protocols are not detailed, and the mechanisms behind the high incidence of malnutrition are not discussed. A comparison with well-established bariatric procedures is missing, making it challenging to assess the relative risks and benefits of SASI. The authors conclude that more extensive, multicenter studies with comprehensive preoperative nutritional assessments, detailed management protocols, and long-term follow-up are needed to fully evaluate SASI. Until such data are available, SASI should be considered experimental and performed only in well-designed clinical trials with rigorous patient selection and monitoring.