Single Anastomosis Jejuno-ileal (SAJI): a New Model of Malabsorptive Revisional Procedure for Insufficient Weight Loss or Weight Regain After Roux-en-Y Gastric Bypass

background In case of insufficient weight loss or weight regain or relapse of weight-related comorbidities after roux-en-Y gastric bypass (RYGB), other procedures such as reduction of a large gastric pouch and stoma, lengthening of the roux limb, conversion to sleeve gastrectomy and/or bilio-pancreatic diversion with duodenal switch have been advocated. Single anastomosis jejuno-ileal (SAJI) is a new revisional simple operation performed after RYGB failure which adds malabsorption to the previous gastric bypass. methods SAJI includes a single jejuno-ileal anastomosis specifically joining the ileum 250-300 cm proximal to the ileo-caecal valve and the jejunum 30 cm below the gastro-jejunal anastomosis on the roux limb of the previous RYGB. thirty-one patients underwent SAJI for insufficient weight loss and/or weight regain after RYGB. the percent total weight loss (%TWL) after RYGB and before SAJI was 21.8 +/- 7.8. All SAJI operations were performed laparoscopically. the SAJI mean operating time was 145 min. results regarding weight loss after SAJI, %TWL is 27.2 +/- 7.4, 31.2 +/- 6.4, 33.7 +/- 5.9 and 32.9 +/- 5.2 at 12, 24, 36 and 48 months, respectively. our series recorded a low rate of peri-operative and medium-term complications with a low grade of severity (clavien-dindo classification grade). one patient required reoperation 36 days after SAJI for epigastrium incarcerated incisional hernia at the previous RYGB laparotomy site. mortality was 0. comorbidity reduction/resolution after SAJI is 83.2% for type 2 diabetes mellitus, 42.8% for arterial hypertension, 72.8% for dyslipidemia and 45.3% for OSA. conclusions treatment of failed RYGB is challenging. SAJI is a less complicated, purely low invasive malabsorptive operation that should reach satisfactory %TWL and comorbidity reduction/resolution.