SASI procedure

SASI procedure

The SASI bypass surgery has recently been introduced to reflect the massive progress achieved in bariatric surgery. It now goes beyond just a weight reduction procedure!

Distinguished results were delivered, whether by a full remission or a significant improvement in diabetes (type 2), hypertension, hypercholesterolemia…etc., in a percentage that could sometimes reach 100% of people who had surgeries such as sleeve gastrectomy or gastric bypass. Therefore, this type of surgery has come to be called ‘metabolic surgery’ and not only weight loss surgery. The SASI bypass represents a novel metabolic/bariatric surgery, whose results declare a great step towards the treatment of chronic diseases as well as excess weight loss. So, what is the SASI bypass in detail?!


What is SASI bypass surgery?

The SASI (Single Anastomosis Sleeve Ileal) bypass is an innovative procedure that combines the advantages of sleeve gastrectomy and gastric bypass. It’s also termed SASI-S (Single Anastomosis Stomach Ileal bypass with Sleeve gastrectomy).
Since its introduction in 2010, several trials and studies are being conducted in light of the success and promising results achieved, to ensure long-term continuity and safety of the surgery.

The SASI bypass surgery is performed laparoscopically in two stages:

  • Stage One: Sleeve gastrectomy, where the surgeon cuts about 80% of the stomach creating a small stomach tube or ‘sleeve’. Accordingly, the feeling of hunger decreases, and the patient quickly becomes satiated.
  • Stage Two: The surgeon creates an additional food pathway, as the lower part of the stomach (antrum) is connected to the last part of the small intestine (ileum), bypassing the top and the middle parts of the small intestine. This reduces the absorption of fat, sugars, and calories found in food; Thus, stimulating weight loss and controlling blood sugar levels.

➤ You can return home within a day of the surgery, and return to work and daily activities after about a week.


The SASI bypass results in two food pathways:

  1. The normal pathway (stomach → duodenum → jejunum → ileum); About 30% of food passes through it. Which means that vitamins and minerals are absorbed naturally.
  2. The additional pathway (from the stomach directly to the last part of the small intestine); Almost 70% of food passes through it. Thus, a lot of food and sugars are not absorbed; Leading to weight loss and type 2 diabetes treatment.


Advantages of SASI bypass surgery

  • Up to 90% of excess weight loss in a year of the SASI bypass, especially with adherence to the medical team’s instructions.
  • Studies indicate that there’s a rapid secretion of satiety stimulating hormones upon eating, and a decreased secretion of the hunger hormone directly after the SASI bypass surgery.
  • Further SASI bypass health benefits include:
  • Complete remission of type 2 diabetes or a significant improvement in up to 99% of patients within a few weeks! This means reduced or permanently stopped medications.This happens due to several reasons, the most important of which is the stimulation of some hormones secretion; Which in turn increases the rate of insulin secretion from the pancreas, and reduces insulin resistance, besides reducing food intake and absorption of calories.


  • Hypertension remission in 36% to 86% of patients.
  • Maintaining normal blood levels of cholesterol and triglycerides in 65% to 97% of patients.
  • Improvement in GERD treatment in approximately 90% of patients.
  • Ease of movement and treatment of joint diseases.
  • Improvement of the physical and mental state.
  • Avoiding malnutrition problems such as anemia after the surgery, without the need to take vitamins for long periods upon adhering to the healthy food recommended by the dietitian at the center.
  • The intactness of the gastrointestinal tract after the SASI bypass allows full endoscopic access to the duodenum and biliary system when needed for diagnostic or therapeutic purposes.
  • No excluded segments of the digestive system, which maintains its functionality and vitality.
  • The ‘bypass part’ of the SASI-S procedure is easily reversible.
  • SASI bypass can be performed as a revisional or redo surgery after an unsuccessful sleeve gastrectomy.


Is SASI bypass the best choice for all patients with obesity?

After medical examination & some tests, and identifying your exact situation, the doctor can determine whether or not you are eligible for the SASI bypass .. depending on your weight, health status, and other criteria.

In general, people can benefit from the SASI bypass when:

  • BMI exceeds 40 kg/m2.
  • Presence of diabetes, hypertension, or another obesity-related disease, for whom with a BMI over 30 kg/m2.➠Find out your BMI through this link, or by dividing the weight (kg) by the square of height (m2).
  • SASI bypass is typically performed for people between18 and 65 years old.
    It could be performed for those under 18 or over 65 years old in particular cases under specific precautions.
  • The patient must have no previous abdominal surgery.


Complications of the SASI bypass surgery

After the SASI bypass, there could be symptoms that are less likely to occur, such as vomiting, diarrhea, ulcers, or bile reflux; The doctor will then prescribe effective medications and take appropriate action until the patient’s situation improves and symptoms disappear.

As with all bariatric surgeries, there is a slight possibility of complications in rare cases, such as leakage, intestinal obstruction, bleeding, or infection.
A well-qualified and experienced surgeon can avoid such rare risks efficiently.


Is a SASI-S the same surgery as a SADI-S?!

The SASI-S and SADI-S procedures set an example of the impressive evolution of bariatric surgery.

The origin of the SADI-S is a bit different… In 1986, the Biliopancreatic Diversion with Duodenal Switch (BPD/DS) surgery was introduced. It involved a sleeve gastrectomy with preservation of the part connecting the stomach to the duodenum (pylorus) and bypassing a part of the small intestine.

It showed effectiveness in maintaining weight loss and long-term treatment of obesity complications compared to the Roux-en-Y gastric bypass. However, to counteract complications (such as chronic diarrhea, bloating, and malnutrition); SADI-S was introduced as a newer variant of BPD/DS.

Single Anastomosis Duodenoileal bypass with Sleeve gastrectomy (SADI-S) involved sleeve gastrectomy using a smaller size bougie, resulting in a smaller stomach while preserving the pylorus; Then approximately 250 cm of the ileum is connected to the duodenum through a single anastomosis or connection. Thus, SADI-S retained the benefits of BPD/DS in terms of maintaining weight loss, treating type 2 diabetes, hypertension…etc., as well as avoiding complications of gastric bypass such as dumping syndrome, ulcers, and malnutrition.

In 2015, The Stomach Intestinal Pylorus-Sparing (SIPS) variant emerged as the latest modification of the SADI-S.
SIPS involved the use of a much smaller bougie (to improve weight loss results by further stomach size reduction) while preserving the pylorus; Then connecting nearly 300 cm of the ileum to the duodenum through a single anastomosis. This makes the procedure safer and reduces the possibility of complications.

In 2018, the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) approved the SADI-S (and its SIPS variant) as an established bariatric operation.

Our medical team at Dr Tarek Abouzeid Center provides careful follow-up at all stages… before, during, and after the SASI bypass surgery; To help you attain weight loss and better health safely and smoothly. Here comes your vital role to adhere to our advice and the post-surgical therapeutic and nutritional systems for the sake of the best result.