Two-year outcomes of single anastomosis sleeve jejunal bypass (SASJ) vs sleeve gastrectomy: a Taiwanese multi-center study

Introduction: Sleeve gastrectomy (SG) has been a widely performed metabolic and bariatric surgery (MBS) procedure. However, complications and suboptimal long-term outcomes have prompted the exploration of alternatives. Single anastomosis sleeve jejunal bypass (SASJ), a variation of SASI, was systemically developed in Taiwan for its surgical advantages and promising clinical performance. This study aimed to report the 2-year outcomes of SASJ compared to SG. Patients and methods: A retrospective multicenter study was conducted across five MBS centers between 2022 and 2023. Adults undergoing primary SASJ or SG were included; revision surgeries were excluded. SG was performed using a 36Fr bougie. SASJ was done with the following details: total bowel length (TBL) measured, the bilio-pancreatic (B-P) limb was set to 40% of TBL, and a common channel (CC) length of 350 cm. Anthropometric data, serum biochemistry, and perioperative outcomes were collected and analyzed. Results: A total of 1479 patients were included (SASJ, n = 770; SG, n = 709). SASJ achieved significantly greater % total weight loss (%TWL) at 2 years compared to SG (34.0% vs 30.1%, P < 0.001). Both procedures effectively reduced fasting glucose, while SASJ more significantly improved HbA1c and cholesterol levels. Triglyceride improvements were similar between groups. Hemoglobin and albumin levels were slightly lower in the SASJ group at 2 years yet remained within normal limits. Re-admission and re-operation rates were comparably low in both groups. Conclusion: SASJ – with appropriate CC length – delivers superior 2-year weight loss and metabolic outcomes than SG, with a minor nutritional and hemoglobin trade-off. Its favorable profile warrants long-term evaluation and broader clinical consideration.