Single anastomosis sleeve jejunal bypass versus one anastomosis gastric bypass in treatment of obesity and metabolic diseases: A randomized controlled trial

Introduction: Bariatric surgeries are an effective treatment for morbid obesity and its associated co-morbidities including type 2 diabetes mellitus, hypertension (HTN), and dyslipidemia. Single anastomosis sleeve jejunal (SASJ) has not been well studied in the literature or compared with other bariatric surgeries. We aim to compare one anastomosis gastric bypass (OAGB) to SASJ in terms of reduction in BMI, resolution of co-morbidities, postoperative complications, and nutritional status. Patients and Methods: A randomized clinical trial of patients undergoing either OAGB or SASJ at 1:1 ratio for treatment of morbid obesity. Participants were enrolled since April 2022 and were followed for at least 12 months at bariatric surgery department at Ain Shams University Hospital, a tertiary care center. Inclusion criteria for participant's enrollment were age between 18 and 60 years old and BMI greater than or equal to 40 or BMI 35-40 with obesity-related comorbidities. Patients were excluded if preoperative upper gastrointestinal endoscopy showed GERD class C or Barrett's esophagus, previous upper gastrointestinal tract surgery or liver cirrhosis, on oral steroid therapy, previous bariatric surgery, contraindications for abdominal insufflation as those with severe cardiovascular or severe restrictive respiratory diseases, Not fit for general anesthesia, significant abdominal ventral hernia, major psychiatric illness, and pregnant. Primary outcome involves weight loss, BMI loss, total weight loss %, and excess weight loss (EWL%). Secondary outcomes include resolution of comorbidities, biliary reflux, postoperative complications, readmissions, reoperations, and nutritional status. Results: Since April 2022, 68 patients have been enrolled into the study. The mean age, weight, and BMI of the entire cohort are 38.32 +/- 10.08 years old, 124.72 +/- 18.75 kg, and 43.97 +/- 5.47 kg/m2. A higher number of patients had DM and/or HTN in SASJ (38.2% DM, 47.1% HTN) compared with OAGB. Comparison between both groups showed no significant reflux (P=0.09). Both SASJ and OAGB groups had comparable postoperative weight loss, BMI, EWL % at 6 and 12 months of follow-up, however, OAGB had significantly higher total weight loss % at 6 months only. SASJ patients had a significantly higher rate of resolution from DM compared with OAGB patients (P=0.012). No significant difference between both groups in the resolution of HTN (P=0.07) and dyslipidemia (P=0.03). Patients who had OAGB had a higher rate of gallstones postoperatively compared with SASJ patients (P=0.001). None of the patients had anemia, hypoalbuminemia, or iron deficiency. Regarding vitamin D and calcium, no significant differences between both surgeries (SASJ and OAGB) were noted. Conclusion: Remission rates of DM are higher in SASJ in comparison to OAGB. SASJ had similar weight loss, BMI loss, and EWL to OAGB. Both procedures have comparable results as regards postoperative complications, readmissions, and re-operations except development of gallstones which is significantly higher in OAGB group.