Laparoscopic Roux-en-Y gastric bypass versus single anastomosis sleeve ileal bypass for the treatment of morbidly obese patients: a prospective randomized comparative study

Mohamed H. Arakeeb; Mostafa M. El-sheikh; Hamdy A. Elhady; Soliman M. Soliman; Amir F. Abdelhamid

doi:10.18203/2349-2902.isj20243226

Authors

Mohamed H. Arakeeb Department of General Surgery, University of Tanta, Tanta, AL Gharbia, Egypt
Mostafa M. El-sheikh Department of General Surgery, University of Tanta, Tanta, AL Gharbia, Egypt
Hamdy A. Elhady Department of General Surgery, University of Tanta, Tanta, AL Gharbia, Egypt
Soliman M. Soliman Department of General Surgery, University of Tanta, Tanta, AL Gharbia, Egypt
Amir F. Abdelhamid Department of General Surgery, University of Tanta, Tanta, AL Gharbia, Egypt

DOI:

https://doi.org/10.18203/2349-2902.isj20243226

Keywords:

Morbid obesity, Roux-En-Y gastric bypass, Single anastomosis sleeve ileal bypass, Sleeve ileal

Abstract

Background: Bariatric surgery has proven to be the most effective long-term treatment of morbid obesity, after bariatric surgery, weight loss and remission of obesity-related comorbidities is significantly higher than after non-surgical measures. The present study aimed to compare single-anastomosis sleeve ileal (SASI) bypass and Roux-en-Y gastric bypass (RYGB) in terms of weight loss, remission of comorbidities, complications, and nutritional status.

Methods: This prospective randomized comparative study was carried out at gastrointestinal and laparoscopic surgery unit, General Surgery Department, Tanta University Hospitals, during the period from October 2020 to October 2022 and included 40 morbidly obese patients who accepted to participate in the study and signed an informed consent. Patients were randomly assigned into 2 equal groups by the closed envelope method, group I: were submitted to laparoscopic RYGB, group II: were submitted to laparoscopic SASI bypass.

Results: The mean age of RYGB group was 39.20±6.56 years, compared to 34.75±7.91 in SASI group. A highly statistically significant difference was present in operative time between both groups; RYGB Group had operative time mean of 194.25±27.11 minutes, compared to 153.15±23.74 minutes in SASI group. Both procedures were followed by a significant decrease in body mass index at 12 months and were comparable in terms of excess and total weight loss. Improvement in comorbidities after the two procedures was similar.

Conclusions: RYGB and SASI bypass cause weight loss by both restriction and malabsorption mechanisms. Early results with the two procedures are encouraging with acceptable weight loss, comorbidity improvement rates with disadvantages as malnutrition, biliary reflux and dumping, yet the risk of malnutrition was more likely after SASI bypass.

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References

Ford ND, Patel SA, Narayan KM. Obesity in low- and middle-income countries: burden, drivers, and emerging challenges. Annu Rev Public Health. 2017;38:145-64.

Arterburn D, Bogart A, Coleman KJ, Haneuse S, Selby JV, Sherwood NE, et al. Comparative effectiveness of bariatric surgery vs. nonsurgical treatment of type 2 diabetes among severely obese adults. Obes Res Clin Pract. 2013;7:258-68.

Mihmanli M, Isil RG, Bozkurt E, Demir U, Kaya C, Bostanci O, et al. Postoperative effects of laparoscopic sleeve gastrectomy in morbid obese patients with type 2 diabetes. Springer plus. 2016;5:497.

Mahawar KK, Borg CM, Agarwal S, Riebeiro R, De Luca M, Small PK. Criteria For inclusion of newer bariatric and metabolic procedures into the mainstream: a survey of 396 bariatric surgeons. Obes Surg. 2017;27:873-80.

Santoro S, Castro LC, Velhote MC, Malzoni CE, Klajner S, Castro LP, et al. Sleeve gastrectomy with transit bipartition: a potent intervention for metabolic syndrome and obesity. Ann Surg. 2012;256:104-10.

Mahdy T, Emile SH, Alwahedi A, Gado W, Schou C, Madyan A. Roux-En-Y gastric bypass with long biliopancreatic limb compared to single anastomosis sleeve ileal (sasi) bypass in treatment of morbid obesity. Obes Surg. 2021;31:3615-22.

Khalaf M, Hamed H. Single-anastomosis sleeve ileal (sasi) bypass: hopes and concerns after a two-year follow-up. Obes Surg. 2021;31:667-74.

Thereaux J, Corigliano N, Poitou C, Oppert JM, Czernichow S, Bouillot JL. Comparison of results after one year between sleeve gastrectomy and gastric bypass in patients with BMI≥50 kg/M². Surg Obes Relat Dis. 2015;11:785-90.

Kothari SN, Borgert AJ, Kallies KJ, Baker MT, Grover BT. Long-term (>10-year) outcomes after laparoscopic roux-en-y gastric bypass. Surg Obes Relat Dis. 2017;13:972-8.

Arapis K, Macrina N, Kadouch D, Ribeiro Parenti L, Marmuse JP, Hansel B. Outcomes of Roux-En-Y gastric bypass versus sleeve gastrectomy in super-super-obese patients (BMI≥60 kg/m(2)): 6-year follow-up at a single university. Surg Obes Relat Dis. 2019;15:23-33.

Vennapusa A, Panchangam BR, Madivada MS. A feasibility study of novel “Laparoscopic sleeve gastrectomy with loop gastroileal bypass” for obesity: an indian experience. International Surgery. 2017;102:504-13.

Romero RJ, Colorado-Subizar R, De Uriarte-Lorente M, Barradas-Lagunes M, Bravo-De Ávila P, Romero-Espejo JJ. Single anastomosis sleeve ileal bypass (sasi bypass): short-term outcomes and concerns. Obes Surg. 2021;31:2339-43.

Rheinwalt KP, Plamper A, Rückbeil MV, Kroh A, Neumann UP, Ulmer TF. One anastomosis gastric bypass-mini-gastric bypass (oagb-mgb) versus roux-en-y gastric bypass (rygb)-a mid-term cohort study with 612 patients. Obes Surg. 2020;30:1230-40.

Joo P, Guilbert L, Sepúlveda EM, Ortíz CJ, Donatini G, Zerrweck C. Unexpected intraoperative findings, situations, and complications in bariatric surgery. Obes Surg. 2019;29:1281-6.

Hamad GG, Ikramuddin S, Gourash WF, Schauer PR. Elective cholecystectomy during laparoscopic roux-en-y gastric bypass: is it worth the wait. Obes Surg. 2003;13:76-81.

Emile SH, Mahdy T, Schou C, Kramer M, Shikora S. Systematic review of the outcome of single-anastomosis sleeve ileal (sasi) bypass in treatment of morbid obesity with proportion meta-analysis of improvement in diabetes mellitus. Int J Surg. 2021;92:106024.

Puzziferri N, Roshek TB, 3rd, Mayo HG, Gallagher R, Belle SH, Livingston EH. Long-term follow-up after bariatric surgery: a systematic review. JAMA. 2014;312:934-42.

Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366:1567-76.

Disse E, Pasquer A, Espalieu P, Poncet G, Gouillat C, Robert M. Greater weight loss with the omega loop bypass compared to the roux-en-y gastric bypass: a comparative study. Obes Surg. 2014;24:841-6.

Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724-37.

Mahdy T, Al Wahedi A, Schou C. Efficacy of single anastomosis sleeve ileal (SASI) bypass for type-2 diabetic morbid obese patients: gastric bipartition, a novel metabolic surgery procedure: a retrospective cohort study. Int J Surg. 2016;34:28-34.

Emile SH, Madyan A, Mahdy T, Elshobaky A, Elbanna HG, Abdel-Razik MA. Single anastomosis sleeve ileal (SASI) bypass versus sleeve gastrectomy: a case-matched multicenter study. Surg Endosc. 2021;35:652-60.

Schiavon CA, Bersch-Ferreira AC, Santucci EV, Oliveira JD, Torreglosa CR, Bueno PT, et al. Effects of bariatric surgery in obese patients with hypertension: the gateway randomized trial (gastric bypass to treat obese patients with steady hypertension). Circulation. 2018;137:1132-42.

Mui WL, Lee DW, Lam KK. Laparoscopic Sleeve Gastrectomy With Loop Bipartition: A Novel Metabolic Operation In Treating Obese Type Ii Diabetes Mellitus. Int J Surg Case Rep 2014;5:56-8.