IBC-Oxford University2023_BJSOral_13Efficiency and Safety of Single Anastomosis Sleeve Ileal (SASI) Bypass in the Treatment of Obesity and associated Co-morbidities: A Systematic Review and Meta-analysis

Abstract

Introduction: The Single Anastomosis Sleeve Ileal (SASI) bypass is a new bariatric surgery corresponding to an adaptation of the Santoro approach, consisting of a sleeve gastrectomy (SG) followed by loop gastro-ileostomy. Therefore, we aimed to systematically assess all the current literature on SASI bypass in terms of safety, weight loss, improvement in associated comorbidities, and complications. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) recommendations, we conducted a systematic review and meta- analysis by searching three databases (PubMed, Scopus, and Web of Science). We performed a meta-analysis of risk ratios and mean differences to compare SASI bypass with SG and One-Anastomosis Gastric Bypass (OAGB) for percentage excessive weight loss, improvement/remission in type 2 diabetes mellitus (T2DM), hypertension (HT), dyslipidaemia (DL), obstructive sleep apnoea (OSA) and complications. Heterogeneity was assessed using the I2 statistic. Results: Eighteen studies were included in the qualitative analysis and four in the quantitative analysis. Compared to SG, the SASI bypass was associated with improved weight loss (MD=11.32; 95% confidence interval (95%CI) [7.89;14.76]; p< 0.0001), and improvement or remission in T2DM (RR=1.35; 95%CI [1.07;1.69]; p=0.011), DL (RR=1.41; 95%CI [1.00;1.99]; p=0.048) and OSA (RR=1.50; 95%CI [1.01;2.22]; p=0.042). No statistically significant differences in any of the assessed outcomes was observed when compared with OAGB. Conclusion: Although studies with longer follow-up periods are needed, this systematic review and meta-analysis showed that SASI bypass has a significant effect on weight loss and metabolic variables. Variations in outcomes between studies reinforce the need for standardisation.