Single Anastomosis Sleeve Ileal Bypass
The Single Anastomosis Sleeve Ileal Bypass, or SASI, is a very effective weight loss tool and reflux prevention technique. The SASI bypass can be employed as a standalone bariatric procedure to help patients lose weight or as a GERD-busting revisional procedure for patients who have had a gastric sleeve but have experienced reflux afterward. In short, the SASI combines restrictive and malabsorptive procedures that utilize the best of the gastric sleeve with the best of the gastric bypass. The SASI is not typically approved by insurance as a primary bariatric procedure, so most patients will have to pay out of pocket for it. However, it is often covered as a secondary or revisional procedure in patients with severe reflux after their sleeve.
How the SASI Bypass Works
The first part of the procedure is a traditional gastric sleeve whereby approximately 75 to 85% of the existing stomach pouch is removed along the greater curvature. This leaves a much thinner stomach resembling a sleeve or banana. The valves at the top and bottom of the stomach are not removed, and therefore, the stomach remains largely the same, just significantly smaller. The cutaway portion of the stomach is removed from the abdomen, and the primary production center of ghrelin, the hunger hormone, goes along with it. As a result, SASI patients will experience the primary hormonal benefit of a gastric sleeve, which is the reduction of hunger pangs, especially in the first two years after surgery.
However, one of the most significant drawbacks of the gastric sleeve is that the stomach pouch remains a high-pressure tube. Because the lower valve, stoma, is stronger, the gastric sleeve can cause upward motion of gastric juices, which irritate the sensitive lining of the esophagus. For some, this is new. They’ve never had reflux before. For others, this represents a worsening of existing reflux. Reflux is a primary reason some patients are steered toward a gastric bypass – because the lower valve or stomal valve that separates the stomach from the small intestine is removed during the gastric bypass; the remaining pouch is no longer a high-pressure system.
The second half of the SASI procedure involves bypassing a significant portion of the small intestine and attaching it using a single anastomosis or connection to the bottom of the suture line of the stomach. Approximately 2/3 of the food consumed passes through this new anastomosis, bypassing a significant part of the small intestine. About 1/3 of the food passes through the stomach and small intestine as before. The result is an excellent compromise between the sleeve and bypass. Patients no longer have the high-pressure system within the stomach that causes reflux, and they also reduce the likelihood of significant malabsorption of critical vitamins and nutrients as with the bypass.
The Ideal Candidate for a SASI Procedure
If your bariatric surgeon of choice is highly skilled in the SASI procedure, you may wish to ask them if you are a candidate. As a standalone procedure, this surgery best suits patients with a higher BMI – over 45. This procedure, however, is also beneficial for gastric sleeve revisions. As a reflux surgery, commercial and government insurance often covers SASI. It can be precisely what a patient needs to combine GERD relief and kickstart a new round of weight loss to hit their goals.
What Results Can I Expect?
While SASI procedures have not been performed for as long as the gastric bypass or even the sleeve, the initial results are compelling. Excess body weight loss is comparable to other combination restrictive and malabsorptive procedures, and some patients may even hit 90% excess body weight loss after a year. Of course, with extra dedication and focus, 100% excess body weight loss is not out of the question.
Risks and Considerations of the SASI
No matter how good the results may be, there are always risks associated with major bariatric surgery, like a SASI bypass. These can include reactions to anesthesia, infection, blood loss, pain, and leakage at the anastomosis. Fortunately, because there is only one attachment or anastomosis, the risk of leakage is significantly lower than in other dual anastomosis bariatric surgeries like the gastric bypass or the duodenal switch. As mentioned above, the dangers of acid reflux and nutritional deficiencies are significantly lower than the gastric sleeve and gastric bypass, respectively.
The Bottom Line
The SASI represents an excellent option for losing excess body weight or improving reflux. Suitability for this and any other major bariatric surgery relies upon several preoperative tests to ensure that patients are healthy enough to undergo a major surgical procedure. Many of the requirements that an insurance company would typically place on a bariatric patient looking to have surgery are not applicable when patients opt to pay cash for their procedure. Speak to a trusted financial advisor to understand the best way to approach the finances of bariatric surgery.
