الفهرس 
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Abstract
Obesity and its related morbidities have become a significant concern all over the world. with the annual allocation of healthcare resources for the disease and related comorbidities projected to exceed 150 billion dollars in the United States. The incidence of obesity has risen in the United States over the past 30 years; 60% of adults are currently either obese or overweight. Obesity is associated with a higher incidence of several diseases, including diabetes, cardiovascular disease, and cancer.
Bariatric surgery, regardless of its type, is the most effective approach for treating morbid obesity. Mechanical obstacles to food ingestion, nutrient-excluded segments, and malabsorption are common strategies of bariatric surgery, which are a potential cause for complications and should be better avoided from a strictly physiological point of view.
One of the most familiar techniques used commonly in bariatric surgery is the Roux-en-Y gastric bypass (RYGB). It is the second most common bariatric procedure done today. The laparoscopic Roux-en-Y gastric bypass (LRYGB) is the gold standard bariatric procedure to which all others are compared. There are early postoperative complications following LRYGB that require immediate recognition include anastomotic or staple line leak, postoperative hemorrhage, bowel obstruction, and incorrect Roux limb reconstructions. Later complications may be challenging to differentiate from other gastrointestinal disorders and include anastomotic stricture, marginal ulceration, fistula formation, weight gain, and nutritional deficiencies.
The single anastomosis sleeve ileal (SASI) bypass is a novel Metabolic/Bariatric Surgery operation based on mini gastric bypass operation and Santoro’s operation in which a sleeve gastrectomy is followed by a side to side gastro-ileal anastomosis. SASI bypass is a promising operation, with very good results as a duodenal switch (DS) operation without malabsorption morbidity. The elimination of two ways for the passage of food decreases nutritional deficiency.
Aim of the work: 1-To compare the outcome of SASI bypass with that of RYGB in regard to weight loss, improvement in comorbidities, malnutrition, and postoperative complications early complications as anastomotic or staple line leak, postoperative hemorrhage.
2-To compare late complications as anastomotic stricture, marginal ulceration, fistula formation ..etc.) at 12 months of follow-up.
Patient and methods: The current study was a prospective, case-matched study on patients with morbid obesity after 12 months of follow-up after RYGB or SASI bypass. Consecutive patients who underwent SASI bypass from May 2020 through May 2021 were matched with a similar number of patients who underwent RYGB within the same study period. Patients who underwent SASI bypass (cases) were matched with patients who underwent RYGB (controls) in a 1:1 ratio. Matching of cases and controls were based on baseline characteristics including age, sex, weight, height, BMI, and medical comorbidities to reduce the effect of these confounding factors on the outcome of the procedures. A number of 30 patients with morbid obesity were selected for SASI bypass and 31 patients with morbid obesity were selected for RYGB. The primary endpoint of the study was weight loss estimated by TWL% one-year post-operative. Secondary outcomes were improvement in comorbidities (diabetes and hypertension resolution) at 6 and 12 months postoperatively, and postoperative. The primary outcomes were the percent of excess weight loss (%EWL), resolution of diabetes and improvement of comorbidity.
Results: The mean age of the studied cases in Roux en y cases was 39.4± 9.7 and the mean age of those who underwent SASI operation was 40.0± 10.2. Regarding the gender, the Roux en Y cases were 11 males and 20 females while the SASI cases were 6 males and 24 females. The preoperative measurement Roux en Y group 1 were as following; height 1.66± 0.09, weight 127± 27and BMI 45.87 ±7.45 and in the SASI group; height 1.64± 0.07; weight 142 ± 23 and BMI 52.62 ±7.20. There was no significant difference in the baseline characteristics in both groups. there was no significant difference between two groups regarding weight loss at 6 months and 12 months and regarding excess weight loss at 6 months and at 12 months.
There was a significant loss in the 12 months postoperative compared to 6 months in both groups for both weight and excess weight. there was no significant difference in the percent of the mean weight loss pre and post operatively in both groups. The mean operative time in the Roux en Y (1.43±0.24) was lower than in SASI (1.77±0.29) and P-value was statistically significant at (0.001). Similarly, the mean hospital stay in Roux en Y (1.07 ±0.365) was lower than in SASI (1.53±0.730) and the p value was statistically significant at 0.003. there were no significant differences in the remission of comorbidities between two groups. There was significant improve in diabetic, hypertensive and dyslipidemia cases in each group individually and p-value was statistically significant.