The effectiveness of the Braun anastomosis in the management of severe hypoalbuminaemia occurring after a single anastomosis sleeve ileal bypass

INTRODUCTION: The global escalation of morbid obesity has expanded the scope of bariatric and metabolic surgery in addressing obesity and its associated comorbidities. This pilot study retrospectively evaluates the efficacy of Braun anastomosis in the management of nausea, vomiting and hypoalbuminaemia following single anastomosis sleeve ileal (SASI) bypass surgery. PATIENTS AND METHODS: Nineteen patients who underwent SASI bypass for obesity and Type 2 diabetes mellitus between June 2020 and June 2023 and subsequently developed nausea, vomiting and hypoalbuminaemia were included. Braun anastomosis was performed as a revision procedure. Pre-operative and post-operative assessments at 1, 6 and 12 months included serum albumin, haemoglobin A1c and body mass index (BMI). RESULTS: Pre-operative mean serum albumin levels of 1.86 ± 0.24 g/dL increased significantly to 3.38 ± 0.15 g/dL by the 6th post-operative month (P < 0.001). BMI decreased from a pre-operative mean of 32.58 ± 2.26 kg/m2 to 27.60 ± 1.53 kg/m2 at 6 months postoperatively (P < 0.001). Haemoglobin A1c showed a non-significant reduction from 6.40% ±0.60% preoperatively to 6.20% ±0.37% at 6 months postoperatively (P = 0.250). Bile reflux, present preoperatively, resolved by the 6th post-operative month. A marked reduction in nausea and vomiting was also noted following the revision surgery. CONCLUSIONS: Braun anastomosis was effective in managing the complications following SASI bypass, leading to significant improvements in serum albumin and BMI. Further studies are required to assess the long-term safety of SASI and the role of Braun anastomosis in the management of post-SASI complications. These results suggest that Braun anastomosis may play a valuable role in optimising the outcomes following SASI bypass.