Bariatric surgery is a medical intervention for individuals with severe obesity and related health conditions. Single Anastomosis Stomach-Ileal (SASI) bariatric surgery modifies established procedures. This method aims to facilitate substantial weight loss and improve metabolic health by altering the digestive tract.
What is SASI Surgery
SASI surgery combines elements of a sleeve gastrectomy and an intestinal bypass. The initial step is a sleeve gastrectomy, which permanently reduces the stomach’s size by removing approximately 75-80%. This creates a banana-shaped pouch, restricting food intake and leading to fullness with smaller portions.
Following the sleeve gastrectomy, an anastomosis is created between the stomach pouch and the ileum, a segment of the small intestine. This bypasses a significant portion of the duodenum and jejunum, the first two segments of the small intestine. Food travels directly from the stomach pouch to the ileum, where nutrient absorption is less efficient. This bypass contributes to weight loss through malabsorption and influences gut hormones, promoting satiety and improving glucose metabolism.
Who Qualifies for SASI
Candidates for SASI bariatric surgery meet specific medical criteria. Individuals with a Body Mass Index (BMI) of 40 or greater are considered. Those with a BMI between 35 and 39.9 may also qualify if they have at least one significant obesity-related health condition, such as type 2 diabetes, severe sleep apnea, or high blood pressure. Unsuccessful attempts at sustained weight loss through diet and exercise are also a common prerequisite.
A thorough pre-operative evaluation determines suitability for surgery, involving a multidisciplinary team. This assessment includes medical evaluations to identify underlying health issues and ensure the individual can safely undergo the procedure. Nutritional counseling prepares patients for post-operative dietary changes, while psychological assessments ensure mental readiness and identify behavioral factors that might impact recovery and long-term success.
Life After SASI Surgery
Immediately following SASI surgery, patients remain in the hospital for one to three days for monitoring and recovery. Pain management is provided, and patients are encouraged to begin light movement to aid circulation and prevent complications. This initial recovery phase focuses on healing and adapting to the body’s altered digestive system.
Dietary progression starts with clear liquids, gradually advancing to full liquids, pureed, soft, and eventually solid foods over several weeks. This slow progression allows the new stomach pouch and intestinal connections to heal properly. Long-term, individuals adopt new eating habits, including smaller portion sizes, slower eating, and thorough chewing. Regular physical activity is also encouraged as a permanent aspect of a healthy lifestyle after surgery.
Expected Results and Nutritional Needs
SASI surgery leads to significant weight loss, with patients often experiencing a reduction of 60-80% of their excess body weight within 12 to 24 months. Beyond weight reduction, the surgery frequently results in the improvement or resolution of obesity-related health conditions. Many patients experience remission of type 2 diabetes, a decrease in high blood pressure, and alleviation of sleep apnea symptoms.
Due to the malabsorptive component of SASI surgery, long-term nutritional considerations are a significant aspect of post-operative care. The bypass of a portion of the small intestine reduces the absorption of certain vitamins and minerals, potentially leading to deficiencies. Patients are advised to take lifelong daily supplements, including multivitamins, vitamin B12, iron, calcium, and vitamin D, to prevent these deficiencies. Regular blood tests, every 6 to 12 months, are necessary to monitor nutritional levels and adjust supplementation.