Laparoscopic Single Anastomosis Sleeve Ileal Bypass Versus Laparoscopic Roux-en-Y Gastric Bypass as Single Stage Procedure for Management of Patients with Class V Obesity (BMI ≥ 60 kg/m2): Short-Term Follow-Up.

Background: Individuals with clinically severe obesity and a BMI ≥ 60 kg/m² (class V obesity) have a higher incidence of both obesity-related comorbidities and anticipated operative difficulty, with a subsequent higher risk of perioperative morbidity and mortality and a longer hospital stay. In patients with class V obesity, the definitive bariatric procedure is still a matter of debate. This study compared surgical procedures (SASI vs. RYGB) in people with class V obesity. The primary objective was to compare weight loss after both procedures over a 1-year follow-up. Secondary outcomes included the evaluation of the incidence of the operative time (skin-to-skin), postoperative complications, duration of hospital stay, rate of conversion to the open technique, and quality of life, as well as amelioration of obesity-related comorbidities.

Methods: From January 2019 to December 2022, the data of 73 consecutive patients with class V obesity was collected, who underwent either standard RYGB (n = 40) or SASI (n = 33) at the General Surgery Department of Alexandria University Hospital and some non-governmental hospitals.

Results: There was no statistically significant difference between both groups as regards mean age (p = 0.012), sex (p = 0.250), preoperative BMI (p = 0.754), or preoperative incidence of obesity-related co-morbidities. The SASI procedure showed a statistically shorter operative time (p < 0.001). There was no significant difference between the two groups as regards the incidence of postoperative surgical complications, either early cmplications (21.1% and 20% in both SASI and RYGB, respectively, p = 0.770) or late (beyond 30 days) complications (15.2% and 15% in SASI and RYGB, respectively, p = 1.000), with neither conversion nor intra-operative mortality in both groups. However, the SASI group showed a significant shorter postoperative hospital stay (p < 0.001). During the follow-up period, both operations demonstrated a significant overall resolution of pre-operative obesity-related comorbidities, a significant increase in postprandial 6 weeks postoperative GLP-1 with statistically more rise in the SASI group in the postprandial GLP-1 compared to the RYGB group (p < 0.001). There was no mortalities in both group during the follow up duration.

Conclusion: In patients with class V obesity, the SASI procedure had a statistically shorter operative time (skin-to-skin) and a shorter hospital stay compared to RYGB. Both procedures resulted in satisfactory weight loss, as well as comparable improvements in obesity-related comorbidities.