Laparoscopic Single Anastomosis Sleeve-Jejunal (SASJ) Bypass

Document Type : Original Article

Authors

Department of General Surgery, Faculty of Medicine, Mansoura University, Egypt

Abstract

Background: Bariatric and metabolic operations have gained distinctive and worldwide approval given the confirmed
efficiency and safety of bariatric approaches and the increasing prevalence of obesity and its accompanying co-morbidities.
A novel procedure was developed to form an anastomosis between the sleeve gastrectomy (SG) and the jejunum instead
of the ileum (SASJ).
Patients and Methods: This prospective study enrolled 30 cases diagnosed with morbid obesity and scheduled for
laparoscopic SASJ. All patients received standard preoperative preparation including history taking, clinical examination,
laboratory investigations, pelviabdominal ultrasound, and upper gastrointestinal (UGI) endoscopy. The operation
was conducted for all of them, and they were followed for one year after the procedure. We recorded postoperative
complications, the %EWL, and changes in obesity-related comorbidities.
Results: The mean values of %EWL were 21.39, 40.44, 54.46, and 71.86% at one-, three-, six-, and twelve-month
follow-up visits respectively. Late postoperative complications included dumping syndrome (6.67%), hair loss (10%), and
hypocalcemia (6.67%), while no patients developed sleeve tube stenosis during the follow-up period. The SASJ procedure
was accompanied by excellent diabetic outcomes. All patients with pre-existing dyslipidaemia showed remission or
improvement after twelve months. All patients with pre-existing OSAS showed improvement in their condition, and that
improvement persisted till the twelve-month follow-up visit. There was a significant improvement in the quality of life
(QoL) after the procedure as manifested by the increased QOLOS 1 questionnaire values after the procedure compared
to the preoperative one. Also, QOLOS 2 questionnaire also showed significantly increased values after the procedure.
Conclusion: SASJ is a safe and efficacious bariatric approach, as it yields excellent weight loss (WL) outcomes,
improvement of obesity-related comorbidities, with low risk of postsurgical complications.

Keywords

The Egyptian Journal of Surgery
Volume 44, Issue 2
April 2025
Pages 659-666

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