Obesity has become a major public health concern, and bariatric surgery is currently the most effective treatment, with Sleeve Gastrectomy and Roux-en-Y Gastric Bypass being the most common procedures. The Single Anastomosis Sleeve Ileal (SASI) bypass is a newer, simpler technique that combines sleeve gastrectomy with loop gastroileostomy and may offer similar benefits in weight loss and comorbidity improvement while maintaining safety. Studies involving adult patients with obesity who underwent SASI bypass were included to evaluate weight loss, BMI changes, comorbidity improvement and complications.
Written and Fact-Checked by Board-Certified Surgeon, Dr. Jesus Ceja
SASI Bypass: Clinical Efficacy and Advantages
An ideal bariatric surgery should be safe, simple, and effective for weight loss and improvement of comorbidities. SASI bypass, derived from the Santoro technique, was designed to simplify the procedure by using a single anastomosis and reducing complications. Studies showed a median excess weight loss of about 87% after 12 months, which is higher than that reported for sleeve gastrectomy. SASI bypass also demonstrated high rates of improvement or remission of type 2 diabetes, hypertension, dyslipidemia, and obstructive sleep apnea.
The technique also offers several advantages, including shorter operative time, fewer anastomosis-related complications, and preservation of endoscopic access to the stomach and duodenum. However, variations in surgical technique such as limb length and anastomosis size can influence outcomes. Because of these differences, recent international recommendations aim to standardize the SASI bypass procedure to improve safety and long-term results.
SASI vs. Gastric Sleeve
Studies comparing SASI bypass and sleeve gastrectomy (SG) showed that SASI achieved significantly greater percentage of excess weight loss after 12 months. In addition, SASI demonstrated a higher probability of improvement or remission of type 2 diabetes mellitus, dyslipidemia, and obstructive sleep apnea compared with SG. However, there was no significant difference in hypertension improvement between the two procedures.
Regarding safety, the analysis of complications after 12 months showed no significant differences between SASI bypass and SG, although some variability between studies was observed. Overall, these findings suggest that SASI bypass may provide better metabolic outcomes and weight loss than SG while maintaining a similar safety profile.
SASI vs. One Anastomosis Gastric Bypass
In the comparison between SASI bypass and One Anastomosis Gastric Bypass (OAGB), a direct comparison of weight loss could not be performed due to insufficient data. However, studies evaluating metabolic outcomes after 12 months showed no significant differences between the two procedures in the improvement or remission of type 2 diabetes, hypertension, dyslipidemia, and obstructive sleep apnea, suggesting that both techniques provide similar benefits in the management of obesity-related comorbidities.
Regarding safety, the analysis of complications after 12 months also showed no significant differences between SASI Bypass and OAGB. Overall, complications were reported in 11.7% of patients, a rate comparable to other bariatric procedures such as sleeve gastrectomy. Most complications were rare and included vomiting, bleeding, diarrhea, leakage, stomal ulcers, and intestinal obstruction, while severe complications and the need for reversal surgery due to excessive weight loss or hypoalbuminemia were very uncommon.
Wrapping Up
SASI bypass shows significant weight loss and strong metabolic improvement, and it appears to be a safe bariatric surgical technique. However, further mid- and long-term studies comparing it with established procedures such as Roux-en-Y gastric bypass (RNY) are needed to confirm its long-term effectiveness and define appropriate patient selection.
Sources:
- Emile SH et al (2021) Single anastomosis sleeve ileal (SASI) bypass versus sleeve gastrectomy: a case-matched multicenter study. Surg Endosc 35(2):652–660.
- Mahdy T et al (2021) Sleeve gastrectomy, one-anastomosis gastric bypass (OAGB), and single anastomosis sleeve ileal (SASI) bypass in treatment of morbid obesity: a Retrospective Cohort Study. Obes Surg 31(4):1579–1589
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