Artur Binda

Purpose Single Anastomosis Sleeve Ileal (SASI) bypass effectively alleviates GERD symptoms but may increase bile reflux risk. This study evaluates the effects of SASI bypass impact on endoscopic GERD features and GERD-related quality of life. Methods This single-center study is a retrospective analysis of prospectively collected data from patients who underwent SASI bypass between March 2020 and August 2022. Results Esophagitis prevalence significantly decreased from 51.4% preoperatively to 20.0% after SASI bypass, p = 0.010. Notably, esophagitis grade B, present in 17.1% of patients before surgery, was utterly absent postoperatively, p = 0.041. Bile reflux significantly increased from 11.4% preoperatively to 62.9% postoperatively, p < 0.001, with de novo bile reflux occurring in 20 cases. Proton pump inhibitor use increased from 31.4% before surgery to 45.7% after, p = 0.302. An analysis of factors affecting the postoperative quality of life, assessed by the GERD-HRQL General Scale, identified preoperative PPI use as a significant predictor, with users being significantly less likely to achieve a higher postoperative quality of life (OR = 0.07, 95% CI [0.01–0.44]), p = 0.009. Preoperative bile reflux was associated with a 95% lower likelihood of improved postoperative quality of life (OR = 0.05, 95% CI [0.00–0.67]), p = 0.038. Conclusion SASI bypass may be considered a suitable option for selected patients with mild GERD. Although endoscopic bile reflux increased postoperatively, most patients reported minimal reflux symptoms. Preoperative PPI use and bile reflux were associated with reduced postoperative quality of life, emphasizing the importance of appropriate patient selection and close follow-up.

Background/Objectives: To estimate the long-term prevalence of the most common nutrient deficiencies following bariatric surgery. Methods: Consecutive patients who underwent bariatric surgery were followed for 10 years. Anthropometric measurements, laboratory tests, and comorbidities were assessed at baseline and during follow-up visits. Results: A total of 155 patients were included (74.2% women; mean age 43.6 ± 9.3 years; mean body mass index [BMI]: 41.9 kg/m²). Patients underwent either sleeve gastrectomy (SG, n = 112) or gastric bypass (GB, n = 43). Over a median follow-up period of 10 (10–12) years, BMI decreased by 7.4 ± 5.8 kg/m². In the GB group, serum iron levels decreased significantly, whereas in the SG group, a reduction was observed in total iron-binding capacity (TIBC). Serum calcium, phosphorus, and 25-hydroxyvitamin D3 levels increased during follow-up. The prevalence of deficiencies in iron (9.0% vs. 18.7%, p < 0.05), folic acid (1.3% vs. 11.6%, p < 0.001), and vitamin B12 (7.1% vs. 17.4%, p < 0.01) increased, while the prevalence of hypocalcemia and 25-hydroxyvitamin D3 deficiency decreased. Conclusions: A significant increase in the prevalence of iron, folic acid, and vitamin B12 deficiencies was observed over a 10-year follow-up after bariatric surgery. SG and GB appear to have different long-term effects on iron metabolism.

Background: The long-term follow-up studies investigating the risk of anemia and iron deficiency following bariatric procedures are scarce. This study aimed to determine the influence of body weight reduction and type of bariatric surgery on iron metabolism parameters. Methods: We included 138 consecutive patients who underwent bariatric surgery (120 underwent sleeve gastrectomy and 18 underwent other types of bariatric surgery) between 2010 and 2016. At baseline and at follow-up (median observation: 10 years), examination weight and height were measured, and blood samples for iron metabolism parameters were taken. Results: Red blood cells (4.75 [4.59–4.96] 10⁶/μL vs. 4.51 [4.25–4.83] 10⁶/μL, p < 0.0001), hemoglobin (14.0 [13.3–14.7] g/dL vs. 13.0 [12.1–14.3] g/dL, p < 0.0001), and folic acid (7.4 [5.9–10.4] ng/ml vs. 6.0 [4.5–9.1] ng/mL, p = 0.01) were significantly lower, while anemia prevalence (6.52% vs. 28.99%, p < 0.0001) was significantly higher at the follow-up examination compared to the baseline values. In contrast, iron concentration (86.5 [68.0–109.0] µg/dL vs. 86.5 [55.0–110.0] µg/dL, p = 0.42) and TIBC values (351 [326–391] µg/dL vs. 345 [5311–387] µg/dL, p = 0.08) did not change significantly. The multivariable regression analyses showed that the only factors independently related to the hemoglobin concentration change were initial hemoglobin concentration, age, and bariatric procedures other than sleeve gastrectomy. Similarly, in the multivariable logistic analysis, the only variables independently related to the risk of anemia were age (adjusted odds ratio 0.93 [95% confidence intervals 0.89–0.97]), initial hemoglobin concentration (0.69 [0.49–0.97]), and procedures other than sleeve gastrectomy bariatric procedures (6.12 [1.86–20.15]). Conclusions: Age, initial hemoglobin concentration, and type of bariatric procedure but not sex, baseline iron serum level, or weight change are related to the risk of anemia in the long-term follow-up following bariatric surgery.

Purpose: SASI (single anastomosis sleeve ileal) bypass can lead to nutritional deficiencies, including disorders of iron metabolism and anemia. This study aims to evaluate the effect of SASI bypass on weight loss, anemia, and iron deficiency in patients with obesity during the follow-up period. Methods: This study is a retrospective analysis of prospectively collected data from patients who underwent SASI bypass at our hospital between January 2020 and February 2022. Results: The mean age of the patients was 42 years (range 22–58). The average duration of the follow-up period was 26 months. The mean percentage of excess weight loss (%EWL) was 90.1%, and total weight loss (%TWL) was 30.5%. During the postoperative observation period, anemia was identified in ten patients (25%), comprising 70% with normocytic anemia, 10% with microcytic anemia, and two macrocytic anemia cases (20%). Iron deficiency was observed in two patients (5%). Conclusion: SASI bypass is an effective bariatric procedure in weight loss outcomes. However, there may be an increased risk of anemia and iron metabolism disruptions associated with this procedure. The common limb length (250 vs. 300 cm) did not significantly impact hemoglobin, iron, TIBC, ferritin levels, or anemia incidence among patients undergoing SASI bypass. The decrease in postoperative ferritin levels signifies a depletion in tissue iron reserves, thereby emphasizing the necessity for surveillance of iron homeostasis parameters following SASI bypass.

The study aimed to evaluate the mid-term weight loss outcomes and complications of revisional one-anastomosis gastric bypass (OAGB) following failed laparoscopic sleeve gastrectomy (LSG). A total of 586 patients underwent LSG from January 2010 to February 2018. Revisional OAGB (rOAGB) was performed in 22 (3.8%) patients. A retrospective analysis of prospectively collected data from 20 patients with at least 12 months of follow-up after the revisional OAGB was carried out. The indications for revisional surgery were as follows: insufficient weight loss—4 (20%), weight regain—13 (65%), weight regain and symptoms of gastroesophageal reflux disease (GERD)—2 (10%), and dysphagia with gastroesophageal reflux—1 (5%). The mean interval between the LSG and rOAGB was 35.3 ± 15.4 months (range 4–64). The mean follow-up time after rOAGB was 45.5 ± 17.1 months (range 12–54). At the end of the follow-up after rOAGB, %TWL was 26.4 ± 8.9%, and %EWL was 58.5 ± 21.6%, based on pre-LSG body weight. In all three patients with intractable GERD, the clinical symptoms of reflux retreated after revisional OAGB. The overall complication rate was 20%. In conclusion, the main indications for revision after LSG are weight regain, insufficient weight loss, and intractable GERD. Revisional OAGB emerges as a viable surgical alternative for unsuccessful LSG, presenting notable weight loss outcomes; however, it may be linked to an increased incidence of complications. Graphical abstract

Purpose SASI (single anastomosis sleeve ileal) bypass can lead to nutritional deficiencies, including disorders of iron metabolism and anemia. This study aims to evaluate the effect of SASI bypass on weight loss, anemia, and iron deficiency in patients with obesity during the follow-up period. Methods This study is a retrospective analysis of prospectively collected data from patients who underwent SASI bypass at our hospital between January 2020 and February 2022. Results The mean age of the patients was 42 years (range 22–58). The average duration of the follow-up period was 26 months. The mean percentage of excess weight loss (%EWL) was 90.1%, and total weight loss (%TWL) was 30.5%. During the postoperative observation period, anemia was identified in ten patients (25%), comprising 70% with normocytic anemia, 10% with microcytic anemia, and two macrocytic anemia cases (20%). Iron deficiency was observed in two patients (5%). Conclusion SASI bypass is an effective bariatric procedure in weight loss outcomes. However, in our follow-up period, there may be an elevated risk of anemia and disruptions in iron metabolism associated with this procedure. This indicates the need to monitor iron homeostasis parameters periodically and consider permanent supplementation in patients after SASI bypass, especially at prolonged postoperative intervals.

The problem of gastroesophageal reflux disease among bariatric patients is constantly growing. While bariatric surgery is the most effective method of treating obesity and related diseases, not all surgical procedures lead to improvement or resolution of gastroesophageal reflux disease. The search for the "ideal" surgical procedure for this group of patients is ongoing. The relatively recently introduced SASI procedure seems to have a beneficial effect on GERD symptoms and may be an alternative anti-reflux procedure in obese patients. The presented paper is a review of the latest literature on the impact of SASI procedure on the symptoms of gastroesophageal reflux disease.

Background and Objectives: Although the technical simplicity of laparoscopic sleeve gastrectomy is relatively well understood, many parts of the procedure differ according to bariatric surgeons. These technical variations may impact postoperative weight loss or the treatment of comorbidities and lead to qualification for redo procedures. Materials and Methods: A multicenter, observational, retrospective study was conducted among patients undergoing revision procedures. Patients were divided into three groups based on the indications for revisional surgery (insufficient weight loss or obesity-related comorbidities treatment, weight regain and development of complications). Results: The median bougie size was 36 (32–40) with significant difference (p = 0.04). In 246 (51.57%) patients, the resection part of sleeve gastrectomy was started 4 cm from the pylorus without significant difference (p = 0.065). The number of stapler cartridges used during the SG procedure was six staplers in group C (p = 0.529). The number of procedures in which the staple line was reinforced was the highest in group A (29.63%) with a significant difference (0.002). Cruroplasty was performed in 13 patients (p = 0.549). Conclusions: There were no differences between indications to redo surgery in terms of primary surgery parameters such as the number of staplers used or the length from the pylorus to begin resection. The bougie size was smaller in the group of patients with weight regain. Patients who had revision for insufficient weight loss were significantly more likely to have had their staple line oversewn. A potential cause could be a difference in the size of the removed portion of the stomach, but it is difficult to draw unequivocal conclusions within the limitations of our study.