Technically it is similar to Single anastomosis duodenoileal bypass with sleeve (SADI S). Difference being duodenum is not disconnected and anastomosis is gastroileal instead of duodenoileal. Gastric sleeve is formed using staplers. Distal ileum (last part of small intestine) is anastomosed to pyloric antrum of gastric sleeve in a loop fashion 250 – 350 cm proximal to ileocecal junction (loop gastroileal anastomosis).
Hormonal and genetic changes responsible for long lasting weight loss and durable diabetes remission are very high in SG LGIB (SASI Bypass) compared to Sleeve gastrectomy (SG), Roux en y gastric bypass (RYGB), Mini gastric bypass – One anastomosis gastric bypass (MGB – OAGB) and Sleeve gastrectomy with loop duodenojejunal bypass (SG LDJB) because bypassed bowel is relatively longer compared to these procedures. So weight loss is more effective & long lasting and diabetes remission is more & durable. Chances of weight regain and diabetes recurrence are very low. Effect of SG LGIB is comparable to that of SADI S and Biliopancreatic diversion with duodenal switch (BPD DS). It has several advantages compared to RYGB and MGB – OAGB. There is no ‘at risk’ stomach remnant, calcium and iron deficiency risk is low since some food enters duodenum and jejunum, risk of dumping syndrome is less because of increased gastric inhibitory peptide (GIP) compensating for hypoglycemia, risk of marginal ulcers and internal hernias is low. It is technically very simple surgery. Access to biliary tract is maintained.
Compared to BPD DS, risk of protein energy malnutrition, malabsorption and vitamin & mineral deficiencies is low because, it is partial bypass and part of the food enters natural duodenojejunal pathway leading to sufficient absorption of essential nutrients, vitamins and minerals.
Disadvantage of this surgery is risk of reflux of ileal contents into gastric sleeve. Long term consequences of this reflux is not known. Protein energy malnutrition, malabsorption, foul smelling oily stools, diarrhea and incontinence are high if common channel length is 250 cm or less. These problems are significantly reduced but efficacy remains same when common channel is increased to 300 – 350 cm.
LAPAROSCOPIC SLEEVE GASTRECTOMY WITH LOOP GASTROILEAL BYPASS
(Laparoscopic SG LGIB)
(DRAWN BY Dr. V. AMAR)
SURGERY VIDEO :
PLEASE WATCH LAPAROSCOPIC SLEEVE GASTRECTOMY WITH LOOP GASTROILEAL BYPASS – SLEEVE GASTRECTOMY WITH LOOP BIPARTITION BY Dr. AMAR (SG LGIB, HD 1080P, AUDIO)
PLEASE WATCH LAPAROSCOPIC SLEEVE GASTRECTOMY WITH LOOP GASTROILEAL BYPASS – SINGLE ANASTOMOSIS SLEEVE ILEAL BYPASS BY Dr. AMAR (SG LGIB, HD 1080P, AUDIO)