Roux-en-Y Gastric Bypass with Long Biliopancreatic Limb Compared to Single Anastomosis Sleeve Ileal (SASI) Bypass in Treatment of Morbid Obesity

Purpose: Bariatric surgery is the most effective treatment of morbid obesity. Bariatric procedures employ different mechanisms of action to induce weight loss. The present study aimed to compare single-anastomosis sleeve ileal (SASI) bypass and roux-en-Y gastric bypass RYGB with long biliopancreatic limb (BPL) in terms of weight loss, remission of comorbidities, complications, and nutritional status. Methods: This was a single-center cohort study on patients with morbid obesity who underwent RYGB with long BPL of 150 cm or SASI bypass. The main outcome measures were weight loss and improvement in comorbidities at 12 months, nutritional status, and complications. Results: The present study included 92 patients (59.8% females) of a mean age of 38.4 years and mean BMI of 42 kg/m². RYGB and SASI bypass were followed by a significant decrease in body mass index at 12 months and were comparable in terms of excess and total weight loss. Improvement in comorbidities after the two procedures was similar. The serum albumin levels showed a significant decline after RYGB, but not after SASI bypass. The postoperative serum iron levels were higher after SASI bypass than after RYGB. There was no significant difference in regard to complication rates (13% vs 4.3%, p = 0.27). Conclusions: RYGB with long BPL and SASI bypass achieved satisfactory weight loss and improvement in comorbidities that were comparable among the two groups. Long BPL RYGB was followed by a significant decrease in serum albumin and iron levels at one year, which was not observed after SASI bypass.