Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
Obes Surg. 2024 Aug;34(8):3124-3126. doi: 10.1007/s11695-024-07387-y. Epub 2024 Jul 11.
The authors raise concerns regarding the study by Wafa et al. on the high rates of malnutrition and revisional surgery after single anastomosis sleeve ileal (SASI) bypass. The small sample size (30 patients), single-center design, and lack of multicenter data limit the generalizability of the findings. The authors question the learning curve of the surgeon and whether the high complication rates are due to the surgeon's experience or inherent to the SASI technique. The involvement and contribution of co-authors from different institutions are unclear, potentially introducing bias. The study lacks preoperative nutritional assessment data, making it difficult to determine if postoperative deficiencies are due to SASI or preexisting issues. The nutritional management and supplementation protocols are not detailed, and the mechanisms behind the high incidence of malnutrition are not discussed. A comparison with well-established bariatric procedures is missing, making it challenging to assess the relative risks and benefits of SASI. The authors conclude that more extensive, multicenter studies with comprehensive preoperative nutritional assessments, detailed management protocols, and long-term follow-up are needed to fully evaluate SASI. Until such data are available, SASI should be considered experimental and performed only in well-designed clinical trials with rigorous patient selection and monitoring.
作者对 Wafa 等人关于单吻合口袖状空肠旁路（SASI）术后高营养不良率和翻修手术的研究提出了担忧。该研究的样本量小（30 例）、单中心设计以及缺乏多中心数据，限制了研究结果的普遍性。作者质疑外科医生的学习曲线以及高并发症发生率是否是由于外科医生的经验还是 SASI 技术本身所致。来自不同机构的合著者的参与和贡献不明确，可能会引入偏倚。该研究缺乏术前营养评估数据，难以确定术后的缺乏是否是由于 SASI 还是术前存在的问题所致。营养管理和补充方案不详细，也没有讨论营养不良高发的机制。与成熟的减重手术相比，该研究缺失了对照，因此难以评估 SASI 的相对风险和获益。作者得出结论，需要进行更广泛、多中心的研究，包括全面的术前营养评估、详细的管理方案以及长期随访，以充分评估 SASI。在这些数据可用之前，应将 SASI 视为实验性的，并仅在经过严格患者选择和监测的精心设计的临床试验中进行。
