Outcomes of Laparoscopic Single Anastomosis Sleeve Ileum Bypass (SASI Bypass) Versus Mini-Gastric Bypass in Low Body Mass Index Obese Patients with Metabolic Syndrome

Background: Obesity is a growing global issue with rising health and economic impacts. Bariatric surgery has shown better outcomes than other treatments. Aim: To compare the results of mini gastric bypass (MGB) and single anastomosis sleeve ileal bypass (SASI) in low BMI obese cases, focusing on improvement of diabetes, hypertension, hyperlipidemia, weight loss, nutritional and metabolic effects, and early and late complications. Patients and methods: This prospective research compared MGB and SASI in 80 low BMI obese patients at Al-Azhar University Hospitals, divided equally into two groups. It evaluated weight loss, improvement in diabetes, hypertension, hyperlipidemia, metabolic and nutritional effects, and early and late complications over a two-year follow-up. Results: By 24 months, both groups showed marked improvement in comorbidities. In the SASI group, 94.1% of diabetic patients achieved complete remission, compared to 97.2% in the MGB group. Hypertension was controlled without medication in 87.5% of SASI and 82.1% of MGB patients. Both groups also showed significant improvement in hyperlipidemia (p < 0.001), with insignificant variance among them. Weight loss outcomes (%EWL and %TWL) were comparable across groups. No visceral or vascular injuries occurred. Complications were minimal and similar between groups, including single cases of leakage, low rates of bleeding, vomiting, port site hernia, anemia, and hypoalbuminemia, all of which were managed appropriately. Conclusion: Both SASI and MGB are effective and safe for weight loss and comorbidity resolution, with insignificant variances in outcomes or complications among both groups.