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Single Anastomosis Jejuno-ileal (SAJI): a New Model of Malabsorptive Revisional Procedure for Insufficient Weight Loss or Weight Regain After Roux-en-Y Gastric Bypass

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Abstract

Background

In case of insufficient weight loss or weight regain or relapse of weight-related comorbidities after Roux-en-Y gastric bypass (RYGB), other procedures such as reduction of a large gastric pouch and stoma, lengthening of the Roux limb, conversion to sleeve gastrectomy and/or bilio-pancreatic diversion with duodenal switch have been advocated. Single anastomosis jejuno-ileal (SAJI) is a new revisional simple operation performed after RYGB failure which adds malabsorption to the previous gastric bypass.

Methods

SAJI includes a single jejuno-ileal anastomosis specifically joining the ileum 250–300 cm proximal to the ileo-caecal valve and the jejunum 30 cm below the gastro-jejunal anastomosis on the Roux limb of the previous RYGB. Thirty-one patients underwent SAJI for insufficient weight loss and/or weight regain after RYGB. The percent total weight loss (%TWL) after RYGB and before SAJI was 21.8 ± 7.8. All SAJI operations were performed laparoscopically. The SAJI mean operating time was 145 min.

Results

Regarding weight loss after SAJI, %TWL is 27.2 ± 7.4, 31.2 ± 6.4, 33.7 ± 5.9 and 32.9 ± 5.2 at 12, 24, 36 and 48 months, respectively. Our series recorded a low rate of peri-operative and medium-term complications with a low grade of severity (Clavien-Dindo classification grade). One patient required reoperation 36 days after SAJI for epigastrium incarcerated incisional hernia at the previous RYGB laparotomy site. Mortality was 0. Comorbidity reduction/resolution after SAJI is 83.2% for type 2 diabetes mellitus, 42.8% for arterial hypertension, 72.8% for dyslipidemia and 45.3% for OSA.

Conclusions

Treatment of failed RYGB is challenging. SAJI is a less complicated, purely low invasive malabsorptive operation that should reach satisfactory %TWL and comorbidity reduction/resolution.

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Authors and Affiliations

  1. Chief Department of General and Metabolic Surgery, Rovigo Hospital, Rovigo, Italy

    Maurizio De Luca

  2. Department of Surgery, San Valentino Montebelluna Hospital, Treviso, Italy

    Giacomo Piatto, Alberto Sartori & Cesare Lunardi

  3. Department of General and Metabolic Surgery, Rovigo Hospital, Rovigo, Italy

    Monica Zese

  4. Department of Surgery, Adria Hospital, Rovigo, Italy

    Simone Targa

  5. Department of Emergency and Metabolic Surgery, Pineta Grande Hospital, Caserta, Italy

    Cristiano Giardiello

  6. Department of Bariatric and Metabolic Surgery, San Carlo Nancy Hospital, Rome, Italy

    Paolo Gentileschi

  7. Metabolic & Obesity Unit, Chirec Delta Hospital, Brussels, Belgium

    Jacques Himpens

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  1. Maurizio De Luca
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Correspondence to Maurizio De Luca.

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Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of Verona and Rovigo (Prot n. 69311—prog 3559CESC).

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Author 1 reports a consultancy fee from Novo Nordisk. It was outside the submitted study. The rest of the authors declare no competing interests.

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Key Points

Single anastomosis jejuno-ileal (SAJI) is a new revisional simple operation performed after RYGB failure.Single anastomosis jejuno-ileal adds malabsorption to the previous gastric bypass.Single anastomosis jejuno-ileal reaches satisfactory %total weight loss and comorbidity reduction/resolution.

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De Luca, M., Piatto, G., Sartori, A. et al. Single Anastomosis Jejuno-ileal (SAJI): a New Model of Malabsorptive Revisional Procedure for Insufficient Weight Loss or Weight Regain After Roux-en-Y Gastric Bypass. OBES SURG 32, 3194–3204 (2022). https://doi.org/10.1007/s11695-022-06174-x

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