I performed LAPAROSCOPIC SINGLE ANASTOMOSIS SLEEVE ILEAL BYPASS (SLEEVE GASTRECTOMY WITH LOOP BIPARTITION) as a REVISION BARIATRIC SURGERY on Mrs. KIMBERLY MICHELLE on 09th June 2017. Please listen to her review, recorded on 11th Post Operative Day (20th June 2017) – Dr. V. AMAR, www.drvamar.com.
Single Anastomosis Sleeve Ileal (SASI) Bypass is a novel bariatric/ metabolic surgery (Research Procedure). It is also known as Sleeve Gastrectomy with Loop Bipartition (SG LB). It is a technical modification of Single Anastomosis Duodeno-ileal Bypass with Sleeve (SADI S), which in turn is a modification of Bilio-pancreatic Diversion with Duodenal Switch (BPD DS). Difference between SADI S and SASI Bypass is that duodenum is not transected in SASI Bypass and terminal ileum is anastomosed to pyloric antrum rather than to transected 1st part of duodenum as in SADI S.
Procedure – Sleeve gastrectomy is done. Terminal ileum at 250 to 300 cm point is anastomosed to antero-inferior aspect of pyloric antrum in a loop fashion using hand sewn or stapled anastomosis in an ante-colic fashion.
Physiology – In this surgery sleeve has two outlets. Most of the undigested food reaches terminal ileum through anastomosis leading to increased hormonal changes (Increased GLP 1, Peptide YY etc). So weight loss is more, risk of weight regain is less and chances of resolution of type 2 diabetes are more. Since duodenal pathway is also intact, part of the food goes through proximal intestine leading to reduced malabsorption. Main advantage is that endoscopic access to biliary tract is maintained. Since food is passes through duodenum, anti-incretin effect is intact, and as a result hypoglycemia risk is less.
SASI Bypass is very easy to perform. Learning curve is short. Surprisingly diarrhoea and dumping syndrome are also less. Its place is between Mini-gastric bypass and SADI S.