# Ten-Year Outcomes of Single-Anastomosis Sleeve Ileal (SASI) Bypass: Surgical Configuration Determines Long-Term Efficacy and Safety

## TL;DR

A 10-year study shows that the surgical configuration of SASI bypass significantly affects long-term weight loss and diabetes remission, with one configuration being optimal.

## Contribution

The study identifies the optimal surgical configuration for SASI bypass to ensure long-term efficacy and safety.

## Key findings

- The SASI bypass with a 3.5 m ileum and 2.5 cm anastomosis had the best outcomes with no nutritional complications.
- A shorter ileum (2.5 m) led to high malnutrition rates and frequent surgical reversals.
- Diabetic remission was sustained in 88% of patients over 10 years.

## Abstract

The metabolic foundation of Single Anastomosis Sleeve Ileal (SASI) bypass is based on the combination of sleeve gastrectomy with a loop gastroileal bypass. The short- and mid-term outcomes were reported in favor of adequate weight loss and safe nutritional profile. The long-term efficacy and safety remain uncertain, particularly regarding optimal limb length and anastomosis size.

A retrospective cohort study of patients who underwent SASI bypass between 2013 and 2014. Three groups based on the surgical technique: Group1: 2.5 m ileum, 4–6 cm anastomosis, Group2: 3.0 m ileum, 2.5 cm anastomosis, and Group3: 3.5 m ileum, 2.5 cm anastomosis. The primary outcome included weight loss, diabetic remission, and nutritional deficiencies requiring intervention.

Ninety-five patients were eligible with 10-year follow-up data available for 89 (93.7%). The mean percentage of excess weight loss (%EWL) was 58.6 ± 20.3%. Diabetic remission was sustained in 88%. Group1 had a 60% malnutrition rate and 40% reversal rate. Group2 and group3 showed significantly fewer nutritional complications, with no surgical revisions in Group 3. In this group, all diabetic patients remained in complete remission at 10 years. Weight outcomes between Groups 2 and 3 were comparable, though Group 3 had a slightly higher mean %EWL at 10 years (62.5% vs. 57.0%; p = 0.21).

SASI bypass offers durable long-term weight loss and diabetic remission rates at 10 years. Outcomes are highly dependent on surgical technique. The current data suggests the optimal outcome is offered with the 3.5 ileum/ 2.5 cm anastomosis configuration. Standardization of technique is critical to ensure long-term efficacy and safety.

Surgical configuration dictates SASI’s long-term safety and efficacy.

Optimized SASI (350 cm/2.5 cm) yields durable weight loss and T2DM remission.

Short common channel (250 cm) caused severe malnutrition and high reversal rates.

Standardization of SASI anatomy is essential to minimize nutritional risk.