[Experiences with a novel bariatric bypass procedure (SASI)]

Introduction: Obesity is a problem of endemic proportions, which is not simply an aesthetic problem, but rather a systemic disease. Regarding its treatment, surgery is more effective than conservative methods. Laparoscopic „single anastomosis sleeve ileal” (SASI) bypass is a novel bariatric procedure not yet broadly in practice that combines advantageous features of restrictive and malabsorptive techniques. SASI can be effective for both „amount eaters” and „sweet eaters”, while the risk of impaired absorption remains minimal. Objective: In this report, we present the results of SASI bypass procedures performed by our team between August 1, 2022 and September 1, 2024. Methods: Regarding criteria of qualification and conducting the study, the protocol of the international bariatric society was followed. After creating a gastric sleeve in the first stage, an anastomosis with a maximal width of 4 cm was created between the ileum and remaining stomach. Follow-ups were carried out 3 and 6 months after surgery. Gastric emptying was examined with isotopic method in two voluntary patients. Results: A group of 25 patients (17 women, 8 men) who underwent SASI bypass surgery were evaluated in the study (mean age 40.1 ± 11.3 years). Mean preoperative BMI was 43.7 ± 6.7 kg/m2. Postoperative BMI decreased by 6.1 ± 3.4 kg/m2 (13.9 ± 6.3%) at 3 months and 11.6 ± 6.2 kg/m2 (26.1 ± 12.0%) at 6 months. Hypertension resolved in 9 out of 11 cases, prediabetes normalized in 2 out of 2 cases. We observed postoperative reflux in 6, sleep disorder in 1, fatigue in 5, hair loss in 9 cases. Lasting diarrhea did not occur. With isotopic examination we found that 90% of gastric content empties into the efferent ileum and 10% goes into the duodenum. Discussion: SASI bypass combines advantages of restrictive and malabsorptive bariatric procedures effectively, while – according to our experience so far – the risk of impaired absorption, vitamin- and mineral-deficiency remains minimal. A significant regression can be expected regarding comorbidities and required medications in the first 6 months after surgery. Conclusions: SASI bypass is a safe procedure that achieves effective weight loss and quick resolution of comorbidities, thus it may become the leading bariatric procedure in the near future. Orv Hetil. 2025; 166(2): 67–76.