Single-Anastomosis Sleeve Jejunal Bypass for the Treatment of Morbid Obesity: A Surgeon's Experiential Insights

Abstract

Background:

The surge in morbid obesity has propelled innovations in bariatric procedures. This study evaluated the clinical outcomes, safety, and efficacy of single-anastomosis sleeve jejunal (SASJ) bypass.

Methods:

In this prospective multicenter study, 175 patients who underwent SASJ bypass for morbid obesity between February 2018 and December 2022 in Baghdad were enrolled and followed up for 2 years. The inclusion criteria were body mass index (BMI) 35–39.9 kg/m² with obesity-associated medical problems (OAMPs) or BMI >40 kg/m². A single surgical team ensured consistency and performed preoperative biochemical and radiological assessments.

Results:

Patients were 18–55 years of age; 70.28% were female. Their weight and BMI were 85–190 kg and 37–58 kg/m², respectively. Postoperative average weight loss was 79.2 ± 9.7 kg, and BMI decreased to 28.2 ± 3.9 kg/m² over 2 years. Excess and total weight loss percentages were 70.1% ± 13.1% and 41.9% ± 7.9%, respectively. Remission rates for OAMPs were: diabetes (95.4%), hypertension (91.02%), hyperlipidemia (95.59%), sleep apnea (100%), and gastroesophageal reflux disease (82.61%). Manageable complications included diarrhea, hair loss, and vomiting.

Conclusion:

The significant postoperative weight loss and remission rates for OAMPs highlight the effectiveness and health impacts of SASJ bypass. Personalized care, monitoring, and understanding postoperative complications are vital for positive outcomes.

Introduction

Globally, obesity and obesity-associated medical problems (OAMPs) are major health concerns.¹ In 2008, excess weight was observed in more than 1.4 billion adults ≥20 years of age. More than 200 million men and 300 million women were diagnosed with obesity. Obesity increases vulnerability to a range of medical disorders, notably type 2 diabetes mellitus (T2DM), cardiovascular disorders, stroke, cancers, and metabolic complications; consequently, mortality rates are increased as well.²

Bariatric surgery curbs calorie intake and nutrient absorption, thereby aiding weight loss. It can have restrictive, malabsorptive, and combination approaches. Restrictive surgery (gastric banding) reduces the stomach size to limit food intake, malabsorptive surgery (biliopancreatic diversion with duodenal switch) alters digestion to reduce nutrient absorption, and combination surgery (Roux-en-Y gastric bypass [RYGB]) combines both approaches. Consultation with a clinician is crucial to determine the most suitable surgical approach based on individual health factors and preferences. Restrictive surgeries are simpler, faster, and safer, although with a risk of subsequent weight gain.³ The single-anastomosis sleeve ileal (SASI) bypass includes a one-anastomosis gastric bypass (OAGB), which links the surgically reduced stomach to an ileal segment located ∼250 cm distally.⁴

A 2016 International Federation for the Surgery of Obesity and Metabolic Disorders survey identified Iran as the primary reporting location for SASI bypass procedures.⁵ Mahdy et al. highlighted the efficacy, safety, and straightforwardness of this approach, including its favorable outcomes in weight loss and easing OAMPs; of the 61 patients in their study, only one required reoperation, owing to excessive weight loss.⁶

Complications of SASI bypass, such as excessive weight loss and potential long-term nutritional deficiencies, have been reported.⁷ The Hazrate Rasool Hospital introduced an innovative surgical procedure in which the surgically reduced stomach was anastomosed to the jejunum rather than the ileum. This OAGB technique incorporated a biliopancreatic limb measuring 150 cm.⁸ This limb represents the bypassed segment of the small intestine and contributes to altered absorption and metabolic responses. The surgeon usually adjusts its length based on patient characteristics and surgical considerations. This technique maintains an anatomical structure closer to that of normal gastrointestinal anatomy, delivering positive early results, including satisfactory excess weight loss (EWL) and better management of OAMPs, and promising outcomes in terms of preventing long-term nutritional complications.⁸ Furthermore, the procedure fosters proper micronutrient absorption, thereby reducing the requirement for long-term supplementation.⁹

Other benefits include increased secretion of glucagon-like peptide 1 (GLP-1) and peptide YY, which affects insulin production and other hormonal responses, improves glycemic control, and aids weight loss.¹⁰ Notably, this procedure is reversible, a useful feature in the event of complications.¹¹

Research on single-anastomosis sleeve jejunal (SASJ) bypass are limited, and the results of these studies are inconclusive, especially those on serious postoperative complications that might lead to malnutrition and consequent irreversible neurological complications.¹² Therefore, this study primarily aimed to reveal the results of the first cohort of patients who underwent SASJ bypass at the author's practice. Additionally, the effectiveness and safety of this procedure were assessed based on the author's experience as the sole operating surgeon.

Materials and Methods

Study design, setting, and participants

In this prospective multicenter cohort study, the first cohort of patients (N = 225) who underwent SASJ bypass between February 2018 and December 2022 at the Baghdad Teaching Hospital (Baghdad University College of Medicine), Al Mustansiriya Hospital, and Al-Hayat Hospital were enrolled.

The inclusion criteria were a body mass index (BMI) between 35 and 39.9 kg/m² with OAMPs, or a BMI >40 kg/m². The exclusion criteria were the inability to provide informed consent, loss to follow-up, or not completing 2 years of follow-up. Previous bariatric surgery was not considered an exclusion criterion.

Before a preoperative assessment, every patient was provided comprehensive and individualized details regarding the surgery, including recent advancements, possible risks, and specific nutritional needs. Based on the exclusion criteria, 50 patients were excluded, and a comprehensive database was established for the remaining 175 patients, including demographic data, weight, BMI, EWL, and total weight loss percentages (%EWL and %TWL, respectively), blood test results, and information on OAMPs pre- and postoperatively. All patients underwent a thorough preoperative assessment, which included biochemical evaluations (complete blood count, fasting blood sugar [FBS], glycated hemoglobin [HbA1c], renal, liver, and thyroid function tests, lipid and coagulation profiles, serum albumin, total protein, vitamin D3, vitamin B12, iron, and ferritin levels), virology screening, and radiological investigations (chest radiography and abdominal ultrasound). Patients >50 years of age underwent echocardiography. Patients who exhibited symptoms suggestive of gastroesophageal reflux disease (GERD) underwent preoperative endoscopy to assess the condition of the esophagus and identify potential GERD risks.

All patients were prescribed low-molecular-weight heparin 12 h preoperatively, which was continued postoperatively for 2 weeks (once daily dose), and subsequently, according to patient risk factors.

These extensive assessments and investigations ensured the safety and appropriateness of the surgical procedure for each patient. All surgeries were performed by a single surgical team to ensure consistency in the surgical approaches and its outcomes for all patients.

Operative technique

Laparoscopic SASJ bypass, which involved several stages and required precise positioning of the ports, was performed with the patient in the French position. The instruments included one 11 mm trocar inserted above the navel, two 12 mm trocars for the right and left operational hands, one 5 mm trocar in the left upper quadrant, and one 5 mm trocar, designed for Nathanson liver retraction, at the epigastrium (Fig. 1A).

FIG. 1.

(A) Port positioning with the location of each trocar insertion. (B) Calibration of sleeve gastrectomy. (C) Sleeve jejunal side-to-side anastomosis. (D) Closure suturing of gastrojejunostomy.

The operation commenced with sleeve gastrectomy; a 38F bougie was introduced ∼6 cm from the pylorus and moved upward to the angle of His (Fig. 1B). In this phase, a substantial part of the stomach was excised, leaving a sleeve-like residual pouch. Subsequently, a gastrostomy was created ∼5 cm from the pylorus, at the line where the omentum was detached from the gastric antrum. This facilitated the gastrojejunal anastomosis (Fig. 1C). The side-to-side anastomosis, ∼40 mm in diameter, was completed to allow food to bypass the jejunum.

The jejunal cut was meticulously closed with a double-layered running suture with polydioxanone 2-0 to ensure robust closure (Fig. 1D). No omentopexy was performed. Depending on the patient's BMI, the biliopancreatic limb's length was 150–200 cm. Subsequently, the absence of air leak and hemostasis was verified. A surgical drain was left in situ for ∼3 days to mitigate fluid accumulation.

Postoperative follow-up

Oral gastrografin radiography was performed on the first postoperative day to confirm the absence of any leakage, and patients were initiated on a liquid diet. Patients' tolerance to this diet and their overall wellness were assessed to determine their discharge readiness. A dietary regimen, which comprised 2 weeks of liquid diet, 2 weeks of soft diet, and subsequently, a high-protein low-calorie diet, with other elements introduced gradually and under supervision, was provided to aid recovery. Multivitamin supplements were prescribed for 2 years, and gradually phased out depending on the nutrient levels in the blood samples.

Regular follow-up at outpatient clinics at 1 week, 1 month, and every 3 months for 2 years postoperatively ensured constant monitoring for identifying remission of OAMPs and any possible nutritional deficiencies. Hypertension remission was identified based on the lack of need for antihypertensive medication, while T2DM remission was identified based on FBS and HbA1c levels <100 mg/dL and <6, respectively, and cessation of relevant medications. Weight variations over 24 months were analyzed by examining aspects such as weight, BMI, %EWL, and %TWL, blood parameters such as Hb, HbA1c, and albumin levels, and postoperative complications such as hematemesis, vomiting, diarrhea, hypoalbuminemia, leakage, intraperitoneal bleeding, atelectasis, deep venous thrombosis (DVT), pulmonary embolism, port-site internal hernia, bile reflux, GERD, hair loss, excessive weight loss, and malnutrition. GERD was diagnosed postoperatively by endoscopy and 24 h pH-impedance testing. Blood samples were collected preoperatively and during follow-up visits for a detailed analysis of these variables.

Statistical analysis

IBM^® SPSS^® version 27 for Windows was used for data analysis. Descriptive statistical measures were expressed as mean ± standard deviation (SD) or percentage. The chi-square, Student's t-, and Friedman tests were used to analyze categorical or ordinal, continuous, and multiple interrelated variables, respectively. A p-value <0.05 was considered statistically significant.

Ethics considerations

This study adhered to the Declaration of Helsinki guidelines and study design was approved by the Ethics Committee of the Surgery Department, College of Medicine, University of Baghdad (Approval No.: 149). Verbal informed consent was obtained from the study participants.

Results

The clinicodemographic characteristics of the patients are listed in Table 1. Among the 175 participants, 123 were female (70.28%). Patients were 18–55 years of age (mean: 36.5 ± 6.5). Regarding preoperative anthropometric data, BMI values of 37–58 kg/m² (mean: 47.5) signified morbid obesity in most patients. The most prevalent OAMP was hyperlipidemia (68 patients [38.85%]).

Table 1.

Patients' Clinicodemographic Characteristics

Criteria	Values
Patient numbers and sex, n (%)	Total: 175 Female: 123 (70.28) Male: 52 (29.72)
Age (years)	Range: 18–55 Mean ± SD: 36.5 ± 6.5
Weight (kg)	Range: 85–190 Mean ± SD 137.5 ± 16
Height (cm)	Range: 150–190 Mean ± SD 170 ± 1.02
BMI (kg/m²)	Range: 37–58 Mean ± SD: 47.5 ± 4.9
Obesity-associated medical problems, n (%)	Type 2 diabetes mellitus: 43 (24.57)
	Hypertension: 62 (35.42)
	Hyperlipidemia: 68 (38.85)
	Sleep apnea: 16 (9.14)
	GERD: 23 (13.14)
Type of surgery indications, n (%)	Primary: 153 (87.42)
	Revisional: 22 (12.58)
	Failed sleeve: 18 (10.28)
	Failed gastric plication: 2 (1.14)
	Failed gastric band: 2 (1.14)

BMI, body mass index; GERD, gastroesophageal reflux disease; SD, standard deviation.

Regarding the type of surgery indications, SASJ bypass was the primary procedure and a conversion surgery for failed previous bariatric procedures in 153 (87.42%) and 22 (12.58%) patients, respectively (Table 1). The average duration of the operation was 60 min (SD: 15 min).

A significant decrease in weight and BMI was observed after 3 months, with an average weight loss of 56.4 ± 11.2 kg and a corresponding BMI reduction of 30.4 ± 6.1 kg/m². Progressive improvements were observed for up to 2 years of follow-up. At 2 years, the average weight loss was 79.2 ± 9.7 kg, and the BMI decreased to 28.2 ± 3.9 kg/m². The %EWL and %TWL at 2 years were 70.1% ± 13.1% and 41.9% ± 7.9%, respectively (Table 2). Significant improvements were observed in the remission of OAMPs 2 years postoperatively (Table 3). Notably, sleep apnea, hyperlipidemia, and T2DM decreased to 0%, 1.71%, and 1.14%, respectively, with remission rates of 100%, 95.59%, and 95.4%, respectively (Table 3).

Table 2.

Postoperative Weight Loss After 2 Years of Follow-Up

Variable	Preoperative	3 Months	6 Months	12 Months	18 Months	24 Months	p ^*
Weight (kg)	137.5 ± 16	110.4 ± 15.2	102.3 ± 14.3	92.0 ± 10.8	85.5 ± 9.1	79.2 ± 9.7	<0.0001
BMI (kg/m²)	47.5 ± 4.9	38.5 ± 5.1	34.4 ± 4.8	30.6 ± 4.4	29.1 ± 4.2	28.2 ± 3.9	<0.0001
%EWL	0.0	42.3 ± 8.6	56.4 ± 11.2	65.9 ± 14.8	69.5 ± 12.8	70.1 ± 13.1	—
%TWL	0.0	22.2 ± 4.1	30.4 ± 6.1	37.5 ± 7.3	39.8 ± 7.8	41.9 ± 7.9	—

Data are presented as mean ± SD.

p Value: difference between preoperative and 24-month postoperative values.

EWL, excess weight loss; TWL, total weight loss.

Table 3.

Postoperative Remissions of Obesity-Associated Medical Problems

Variable	Preoperative, n (%)	Postoperative 12 months, n (%)	Postoperative 24 months, n (%)	Postoperative 24 months remission rates (%)	p ^*
Type 2 diabetes mellitus	43 (24.57)	9 (5.14)	2 (1.14)	95.4	<0.0001
Hypertension	62 (35.42)	15 (8.57)	5 (2.58)	91.02	<0.0001
Hyperlipidemia	68 (38.85)	20 (11.42)	3 (1.71)	95.59	<0.0001
Sleep apnea	16 (9.14)	2 (1.14)	0 (0)	100	<0.0001
GERD	23 (13.14)	5 (2.85)	4 (2.28)	82.61	<0.0001

p Value: difference between preoperative and 24-month postoperative values.

Nutritional biochemical parameters evaluated at 6, 12, 18, and 24 months postoperatively are presented in Table 4. Albumin, zinc, and Hb levels exhibited slight fluctuations yet remained relatively stable throughout the postoperative period compared with preoperative levels.

Table 4.

Pre- and Postoperative Nutritional Biochemical Parameters

Variables	Mean preoperative	Mean postoperative 6 months	Mean postoperative 12 months	Mean postoperative 18 months	Mean postoperative 24 months	p ^*
Hb (g/dL)	12.1 ± 1.3	11.9 ± 1.1	12.2 ± 0.9	12.0 ± 1.0	11.9 ± 0.9	0.23
Iron (mcg/dL)	75.2 ± 6.5	70.4 ± 6.9	78.1 ± 7.1	74.3 ± 6.7	73.5 ± 6.8	0.21
Ferritin (ng/mL)	65.1 ± 7.4	60.1 ± 8.0	68.4 ± 8.2	64.2 ± 7.9	64.1 ± 7.8	0.24
Fasting glucose (mg/dL)	96.95 ± 11.68	94.5 ± 9.5	91.2 ± 9.8	87.9 ± 8.5	85.56 ± 8.29	<0.005
HbA1c (mmol/mol, %)	5.9 ± 1	5.7 ± 0.8	5.65 ± 0.9	5.4 ± 0.85	5.2 ± 0.9	<0.005
Calcium (mg/dL)	8.5 ± 1	9.5 ± 0.9	9.4 ± 0.8	9.3 ± 0.9	9.2 ± 1	0.23
Vitamin D (ng/mL)	25.3 ± 9.4	29.3 ± 9.4	30.2 ± 10.2	34.6 ± 8.7	38.3 ± 10.2	<0.005
Albumin (g/dL)	4 ± 0.1	3.9 ± 0.1	4.04 ± 0.1	4.1 ± 0.1	4.08 ± 0.1	0.23
Vitamin B12 (pg/mL)	480.3 ± 228.8	485.2 ± 230.6	499.5 ± 210.5	498.9 ± 250.3	504.2 ± 246.4	<0.005
Zinc (μg/dL)	80.3 ± 9.6	80.2 ± 9.3	85.4 ± 8.4	81.5 ± 9.1	80.8 ± 9.3	0.23

Data are presented as mean ± SD.

p Value: difference between preoperative and 24-month postoperative values.

HbA1c, glycated hemoglobin.

Serum iron and ferritin levels, which initially decreased 6 months postoperatively, gradually increased and became comparable to preoperative levels at >12 months. Notably, HbA1c and FBS levels consistently decreased during the postoperative period, indicating improved glucose control. Vitamin D levels increased postoperatively, indicating potential improvements in the vitamin D status. No clear trend was observed in Vitamin B12 levels, as the values at each time point were relatively similar to those observed preoperatively.

Among the postoperative complications analyzed in this study (Table 5), diarrhea was most frequently reported (20%), followed by hair loss (17.14%) and vomiting (12%). Additional complications included hypoalbuminemia, intraperitoneal bleeding, atelectasis, port-site internal hernia, bile reflux, GERD, excessive weight loss, and malabsorption (1.71–5.7%). No leakages, DVT, or pulmonary embolisms were reported. Twelve patients (6.85%) required conversion to sleeve gastrectomy; among the etiologies for conversion (excessive weight loss, malabsorption, and intractable diarrhea), excessive weight loss was the most prevalent (3.99%).

Table 5.

Postoperative Complications

Complications	No. of patients	Percentage %
Hematemesis	2	1.14
Vomiting	21	12
Diarrhea	35	20
Hypoalbuminemia	3	1.71
Leakage	0	0
Intraperitoneal bleeding	4	2.28
Atelectasis	10	5.7
DVT	0	0
Pulmonary embolism	0	0
Port-site internal hernia	3	1.71
Bile reflux	10	5.7
GERD	4	2.28
Hair loss	30	17.14
Excessive weight loss	10	5.7
Malnutrition	3	1.71
Conversion to sleeve gastrectomy	Total: 12	6.85
	7 (Excessive weight loss)	3.99
	3 (Malabsorption)	1.71
	2 (Intractable diarrhea)	1.14

DVT, deep venous thrombosis.

Discussion

This study aimed to elucidate the clinical outcomes of the first cohort of patients undergoing SASJ bypass and to evaluate the effectiveness and safety of this procedure, based on the author's experience as the sole operating surgeon. The effectiveness of SASJ bypass in promoting weight loss was evident in the patients' progress, with remarkable %EWL achieved over specific time frames. At 3 months postoperatively, the %EWL was 42.3% ± 8.6%, which further improved to 56.4% ± 11.2% at the 6-month follow-up. This positive trend continued as the %EWL reached 65.9% ± 14.8%, 69.5% ± 12.8%, and 70.1% ± 13.1% after 12, 18, and 24 months, respectively. This demonstrates the sustained and substantial impact of the SASJ bypass in facilitating weight loss.

Sayadishahraki et al. and Hosseini et al. reported %EWL at 6 and 12 months of 55% and 77%, respectively,^13,14 while Sewefy and Saleh reported %EWL of 85% at their 2-year follow-up.¹⁵ While the present study's findings closely align with those of the aforementioned studies, minor discrepancies were observed owing to variations in the patients' initial BMI or differences in surgical factors, such as the measurements of the common and biliopancreatic limbs or the gastrojejunal anastomosis size and technique. The rapid and significant weight loss experienced in the first year after SASJ bypass can be attributed to the combined effects of its restrictive and malabsorptive components, such as limited food intake, enhanced excretion of undigested food, and reduction in overall calorie absorption.¹⁴ These physiological changes are regulated by gut hormones such as ghrelin and GLP-1, which influence appetite and satiety.¹⁶

Similar trends of substantial weight loss in the first year have been observed for other combined bariatric procedures. The 1-year %EWL after RYGB, OAGB, and SASI ranges from 56% to 90%, indicating the comparable performance of SASJ bypass in achieving acceptable weight loss during this critical postoperative period.¹⁷ However, the %EWL tends to decrease significantly after the first year, a phenomenon observed in the present study and in similar studies on bariatric surgeries.¹⁵ This decrease in %EWL over time can be attributed to various factors, including the extent of intestinal bypass, size of the anastomosis, and the body's adaptation to the bariatric procedure. Similar trends have been observed for RYGB and OAGB, where weight loss plateaued after the first year.¹⁸

Nevertheless, SASJ bypass can be a viable salvage procedure for patients who experience inadequate weight reduction or rapid weight regain following sleeve gastrectomy, similar to RYGB.¹⁹ This underscores the versatility and potential of SASJ bypass in addressing weight management challenges in certain patients.¹⁹ In this study, 12.58% of 22 patients opted for SASJ bypass as a secondary bariatric procedure after the failure of previous restrictive bariatric surgeries. Notably, the outcomes of these patients were comparable to those of patients who underwent SASJ bypass as the primary bariatric procedure; in particular, there were no significant differences in weight loss between those who underwent SASJ bypass as a primary procedure and those who underwent SASJ bypass as a salvage procedure. This finding is similar to that reported by Sewefy et al.²⁰

In this study, a notable link between weight reduction and the amelioration of OAMPs was observed. The remission rate of T2DM was 95.4%, similar to those at different postoperative periods reported by Sayadishahraki et al.,¹³ Hosseini et al.,¹⁴ and Sewefy and Saleh.¹⁵ Other studies with larger sample sizes and longer follow-up durations that reported marginally lower rates, ∼98%, demonstrated the substantial impact of bariatric procedures on T2DM remission.²¹ The positive results in achieving remission of T2DM can be attributed to the weight loss process, which results in diminished adiposity, decreased insulin resistance, and increased secretion of GLP-1 and peptide YY. These hormones collectively contribute to the increased secretion of insulin by beta cells, decreased glucagon response, improved feeling of fullness, and delayed gastric emptying.²² Similar effects have been observed in experimental studies on different gastrointestinal anastomoses and combined bariatric procedures.²³

Herein, the remission rate of hypertension was 91.02% during the 24-month follow-up, which surpassed the 1-year remission rate reported by Hosseini et al.¹⁴ Differences in the pathomechanisms of hypertension and the presence of confounding cardiovascular risk factors may explain the varying remission rates across studies.²⁴ Further investigations are needed to elucidate the relationship between obesity, blood pressure, and bariatric procedures.

In this study, the remission rate of hyperlipidemia was 95.59%, consistent with that reported by Hosseini et al.¹⁴ Conversely, Sewefy et al. reported higher remission rates at 2 and 6 years,^15,20,21 which could be attributed to differences in defining hyperlipidemia and variations in the use of lipid-lowering medications.

The relationship between obesity and GERD, and its resolution with bariatric procedures, is complex. While previous studies have reported inconsistent effects on GERD after sleeve gastrectomy, combined procedures with gastrointestinal anastomosis may result in an increased risk of bile acid reflux and related complications.²⁵ In the present study, the GERD remission rate was 82.61%, consistent with those reported in other studies with varying postoperative periods.^14,15,20 Collectively, the significant remission rates highlight the significant effect of surgical intervention on postoperative remission of OAMPs and overall patient outcomes.

Potential perioperative complications, such as thromboembolism, leakage, and bleeding, did not exhibit higher rates in SASJ bypass than those in routine procedures. The low risk of SASJ bypass can be attributed to its bipartition characteristics. The gastrojejunal anastomosis acts as a safety valve, efficiently moving acidic stomach contents to the jejunum while preventing the intraluminal pressure from rising. Consequently, complications such as malnutrition and reflux were less common.⁵

In the present study, only a few patients who underwent SASJ bypass had malnutrition-related issues or a decrease in essential blood parameters. This positive result can be attributed to the meticulous configuration of two separate routes for food consumption: the conventional pylorus–antrum–duodenum route and the newly established small intestine submucosa–jejunum pathway. This strategic design guaranteed an optimal length of the common limb, which was crucial for effective nutrient absorption. Improvements in glucose control, vitamin D status, and HbA1c levels were positive indicators of the impact of SASJ bypass on overall metabolic health. Furthermore, patients benefited from frequent postoperative follow-ups, multivitamin supplementation, and awareness of the potential consequences of not adhering to the postoperative protocols.

Conversion to sleeve gastrectomy, performed in 12 cases, was essential for managing complications such as excessive weight loss, malabsorption, and intractable diarrhea. This flexibility allows clinicians to address and resolve these complications, stabilize weight loss, and improve nutritional balance. Reversibility emphasizes the adaptability of modern bariatric care. It enhances patient wellbeing and provides for standardized practice. However, additional research is required to conclusively establish its long-term efficacy.

This study has some limitations. First, this multicenter study was conducted in three different hospitals, which may have introduced variations in patient demographics, surgical practices, and postoperative care, potentially impacting the consistency of the results. Second, the relatively small sample size and 2-year follow-up period might influence the generalizability of our findings and the ability to capture long-term effects or complications. Nevertheless, this study may provide valuable insights into the outcomes of SASJ bypass and serve as a basis for future research.

Conclusions

The SASJ bypass effectively addresses obesity and OAMPs. The substantial and sustained weight loss observed over a 2-year period, and remissions of OAMPs confirm the procedure's impact on patient health. The procedure is relatively safe and has potential benefits for nutritional and metabolic wellbeing. The positive outcomes emphasize the importance of individualized care and diligent monitoring to ensure favorable long-term results.

Author's Contribution

Single-author submission.

Footnotes

Author Disclosure Statement

No competing financial interests exist.

Funding Information

No funding was received for this article.

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