What is SASI bypass operation?
Single anastomosis sleeve ileal (SASI) bypass is a new bariatric procedure that reduces the risk of nutrient deficiencies by preserving the passage of food through the digestive tract.
SASI combines the benefits of a gastric sleeve and gastric bypass in one procedure. SASI has a lower risk of causing nutritional deficiencies because your surgeon leaves the duodenum, which absorbs most of the nutrients into the body, intact.
Surgeons can perform SASI as a stand-alone procedure or to correct existing gastric surgery.
What are the benefits of SASI?
While it is important to remember that not every operation is suitable for every patient, the benefits of SASI, which is newly developed and combines the advantages of previous types of operations, can be listed as follows:
- SASI bypass is easy to apply and revise. It not only provides sustainable weight loss, but also improves obesity-related comorbidities.
- Reducing the stomach volume and 80% of the food bypassing the beginning of the small intestine leads to changes in intestinal hormone secretion. These hormonal changes affect our hunger, satiety and food preferences, allowing weight loss without experiencing hunger or food-related stress.
- Reducing the stomach volume provides an earlier and longer-lasting feeling of satiety. Stomach capacity may increase slightly over a few months, but it usually does not return to its previous level.
- Since a significant portion of ingested food bypasses the small intestine, not all of it is digested and absorbed, especially when it comes to fats. It is also well known that food reaching the middle part of the small intestine directly from the stomach causes a strong feeling of fullness, reduces appetite and affects food choices.
- The risk of nutritional problems or deficiencies is lower in the long term.
- It has a relatively greater effect on reducing type 2 diabetes and high cholesterol.
- Reflective reflux decreases as the pressure on the stomach is reduced.
- It is a surgery that can be converted to a gastric sleeve.
- The risk of internal hernia is low.
- The risk of leakage is low.
- According to a study conducted in 2019, 75% of 20 patients with high body weight and type 2 diabetes who had SASI surgery experienced complete remission of their type 2 diabetes within a year, and this rate reached 95% at the end of the third month after surgery.
Who is SASI suitable for?
SASI is a procedure designed to help obese or extremely obese individuals resolve their weight-related issues. As with all bariatric procedures, SASI is appropriate for:
- Patients with a body mass index (BMI) greater than 35
- Patients with a BMI between 30 and 35 who have one or more obesity-related health conditions (high blood pressure, sleep apnea, type 2 diabetes, hyperlipidemia, heart disease, etc.)
- Patients who are healthy enough for surgery, without serious heart, lung, or other organ problems that could increase surgical risks
- Patients who are not pregnant or planning to become pregnant soon after surgery
- Patients who do not have uncontrolled psychological conditions or eating disorders or substance abuse problems
The surgery may not be appropriate for:
- Patients who have had certain stomach or intestinal surgeries
- Patients with conditions such as inflammatory bowel disease (e.g. Crohn’s disease)
Patients must be willing to adopt a strict diet and healthy lifestyle after surgery to maximize the success of the procedure. They should stay in touch with their doctor to monitor their progress and make new adjustments.
These are general surgical fitness guidelines. We evaluate each patient on a case-by-case basis based on their medical history, current health status, and needs.
How do you prepare for SASI surgery?
During your consultation with your doctor, you will be asked to list all medications, vitamins, or supplements you are currently taking. There may be restrictions on what you can take before and after surgery. So be sure to give us complete information.
Your doctor will also ask you about your medical history and any current medical conditions you may have. If you have diabetes, you may need to take or adjust your medications before and after surgery. You should stop smoking at least two weeks before surgery.
Two weeks before your surgery, your doctor may prescribe a specific diet to reduce the size of your liver. The liver sits above your stomach. When you gain weight, your liver grows. A pre-operative diet helps to shrink the liver and gives your surgeon more visibility and more room to work. You will usually be asked to follow a pure liquid diet for one day before surgery.
How is SASI performed?
SASI is performed laparoscopically under general anesthesia. The surgeon makes several small incisions in your abdomen to perform the procedure. Laparoscopic procedures are less invasive, require a shorter recovery time, and usually leave no scars.
In the SASI procedure, the surgeon first performs a sleeve gastrectomy. About 75% of the stomach is removed, leaving a banana-shaped pouch in its place. Reducing the size of the stomach will limit the amount of food you take in and reduce levels of the hunger hormone (ghrelin).
The surgeon will then perform a mini gastric bypass, which involves connecting the lower part of the stomach (antrum) to the lower part of the small intestine (ileum). This way, half of the food you eat will bypass the small intestine, reducing the absorption of fat, sugar, and calories. The new stomach is then connected to the small intestine. A leak test may be performed at the end of the surgery.
What do you experience after SASI surgery?
Although it varies from patient to patient, the general process after SASI is as follows:
- You are encouraged to move around for about 3-4 hours after surgery.
- You are usually discharged 24 hours after SASI surgery. You will receive a comprehensive post-operative diet and exercise plan to follow in the weeks and months following surgery. This is an important part of your weight loss journey. These guidelines will support a balanced and healthy lifestyle that will help you enter a new phase in your life.
- In general, you will be on a liquid diet for the first week, start pureed foods in the second week, and switch to soft foods that are not too solid in the third and fourth weeks. Unless your doctor requests otherwise, you can start eating solid foods starting from the 5th week.
- Patients usually return to their daily routines after 5 to 7 days.
- You may experience fatigue in the first week after surgery. This is normal because you are reducing your calorie intake with a liquid diet. You will notice that your energy levels increase rapidly as you gradually transition to a soft diet.
- In terms of exercise, you will be advised to do light exercises in the weeks following surgery and slowly transition to more intense exercises approximately two months after surgery.
Are there any complications of SASI surgery?
SASI is a new bariatric surgery method. Although there is limited information about its side effects, several studies have identified some side effects, including the following:
Nausea and vomiting: After SASI surgery, some patients may experience nausea and vomiting attacks, which are typical side effects seen after various surgical procedures. However, these symptoms can usually be effectively managed with medication.
Diarrhea: SASI surgery can cause changes in bowel movements, including diarrhea attacks. However, we can state that this is usually a temporary problem that resolves within a few weeks after surgery.
Nutritional deficiencies: The effect of this surgery on nutrient absorption can cause deficiencies of essential vitamins and minerals. To prevent such deficiencies, patients may need to take supplements recommended by their doctors.
When will I start seeing results?
Most patients see results right away. The most significant weight loss usually occurs within the first three months. Of course, this will depend greatly on how well the patient follows the diet and exercise program after surgery. Obesity-related health problems also usually go into remission 3 to 12 months after surgery.
Are the results permanent?
The results of SASI bypass are usually long-lasting if the patient is committed to following the diet and exercise program after surgery. However, longevity also requires commitment to a new routine, way of thinking and eating.