Krzysztof Barski

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.

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

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.

Introduction: The aim of the study is to assess the effect of shortening the excluded loop of the small intestine to 150 cm on the effectiveness of one anastomosis gastric bypass (OAGB) in remission of type 2 diabetes with I^o obesity. Material and methods: The study included 25 patients with a body mass index (BMI) 30–35 kg/m², with a diagnosis of diabetes mellitus type 2 (T2DM), and undergoing OAGB with excluded 150 cm of the small intestine. Results: There were no deaths in the study group, bleeding during the postoperative period requiring reoperation, anastomotic leakage/leakage throught mechanical stitching. The mean a glycated haemoglobin (HbA1C) level 12 months after surgery was 6.16 ± 0.96%, corresponding to a 2.29 ± 3.3% decrease. In more than 85% of the patients taking insulin before surgery, the insulin was discontinued in the postoperative period. Additionally, the level of glycaemia was assessed in patients on the day of surgery (163 ± 58 mg/dl) and on the day of discharge from the hospital (4.7 ± 1.3 days)—it was lower by over 18% (133 ± 39.2 mg). Over the period of 12 months following OAGB, there was a reduction in the mean BMI value from 33.5 ± 2 to 25.5 ± 2.5 kg/m² and improvement in lipid parameters and mean values of blood pressure. Conclusion: OAGB with excluded 150 cm of the small intestine has beneficial effect on the remission of T2DM in patients with a BMI of 30–35kg/m² and is associated with an acceptable level of complications. The achieved weight loss after surgery is satisfactory.