Long-term outcomes of the single-anastomosis sleeve jejunal bypass (SASJ): a single-center experience

Single-Anastomosis Sleeve Jejunal Bypass (SASJ) is an innovative metabolic bariatric surgery (MBS) designed to achieve meaningful weight loss with minimal nutritional risks. As a modification of the Single-Anastomosis Sleeve Bypass (SASI), SASJ combines sleeve gastrectomy with a single gastrojejunal anastomosis (GJA). This study reports the long-term outcomes of SASJ. We retrospectively analyzed 64 patients who underwent SASJ with a follow-up of up to 5 years. Body mass index (BMI), excess weight loss percentage (%EWL), total weight loss percentage (%TWL), and remission of type 2 diabetes (T2D), hypertension (HTN), hyperlipidemia (HLP), and gastroesophageal reflux disease (GERD) were assessed in each post-operative visits. Recurrent weight gain (RWG) was defined as gaining more than 30% of the initial weight loss or worsening of an obesity complication. Over five years, among 44 females and 20 males with a mean age of 37.5 ± 10.3 years, mean BMI decreased from 45.1 ± 6.1 to 30.3 ± 4.6 kg/m², with %EWL reaching 75.2 ± 21.4%. Disease remission rates after 5 years were 78.6% (T2D), 69.2% (HTN), and 85.7% (HLP), while GERD improved in 11.1% of affected patients. RWG occurred in 25.0% of patients. No malnutrition, BMI < 18.5 kg/m², or major surgical complications were observed. Only one patient developed a marginal ulcer at the anastomotic site. SASJ was associated with sustained long-term weight loss and improvement in obesity-related comorbidities. Recurrent weight gain occurred in approximately one-fourth of patients, highlighting the importance of long-term follow-up and continued multidisciplinary support. These findings support further prospective comparative evaluation of SASJ as a metabolic bariatric procedure.