Purpose Many revisional procedures are available for unsuccessful laparoscopic sleeve gastrectomy (LSG) in patients with complications or weight recidivism. Single anastomosis duodeno-ileal bypass (SADI-S) and one anastomosis gastric bypass (OAGB-MGB) are two revisional procedures to address the problem of weight recidivism. We aimed to evaluate the efficacy and outcomes of the 2 revisional approaches (SADI-S vs. OAGB-MGB). Materials and Methods A retrospective analysis of prospectively collected database of patients who underwent SADI-S or OAGB-MGB as a revisional procedure for weight recidivism after primary LSG with a minimum 1-year follow-up. Weight loss, comorbidities, nutritional deficiencies, complications, and outcomes were compared in the 2 procedures. Results Ninety-one patients were included in the study (42 SADI-S and 49 OAGB-MGB). There was a significant weight loss (total weight loss percentage, TWL%) at 1-year follow-up observed for SADI-S when compared to OAGB-MGB (23.7 ± 5.7 vs. 18.7 ± 8.5, p = 0.02). However, this difference was not statistically significant at 18 months (26.4 ± 7.3 vs. 21.2 ± 11.0, p = 0.25). Remission of comorbidities (diabetes mellitus and hypertension) was comparable. Although OAGB-MGB had higher complication rate than SADI-S, the difference was not statistically significant (p = 0.39). No mortality was reported in the study groups. Conclusion Both SADI-S and OAGB-MGB are effective and safe revisional procedures for weight regain after LSG. The shortterm outcomes are comparable; however, SADI-S is associated with less upper gastrointestinal complications and could be a better option for patients suffering from GERD post-LSG. Moreover, the underlying bile reflux may get worse with OAGB-MGB. However, further prospective larger studies are needed. Keywords Revisional surgery. Sleeve gastrectomy. Single anastomosis duodeno-ileostomy. One anastomosis gastric bypass Abbreviations BMI Body mass index LSG Laparoscopic sleeve gastrectomy SADI-S Single anastomosis duodeno-ileostomy OAGB-MGB One anastomosis gastric bypass/mini gastric bypass EWL% Excess weight loss percentage TWL% Total weight loss percentage GERD Gastroesophageal reflux disease T2D Type 2 diabetes mellitus A1C Glycated hemoglobin A1C Electronic supplementary material The online version of this article (

Background It is imperative to assess the results of revisional procedures following Sleeve Gastrectomy (SG), given the substantially growing population of patients who experience weight regain within a few years after undergoing this procedure. Objective Examine the comparative effectiveness of the Single Anastomosis Duodeno-Ileal Bypass (SADI-S) and the One Anastomosis Gastric Bypass (OAGB-MGB) as revisional procedures, with respect to their impact on weight loss, resolution of comorbidities, incidence of complications, and rates of reoperation in patients who had weight regain after SG with up to or more than 5 years of follow-up. Setting Hamad General Hospital, Academic tertiary referral center, Qatar. Methods This study retrospectively analyzed a database of patients who underwent the Single Anastomosis Duodeno-Ileal Switch (SADI-S) or the One Anastomosis Gastric Bypass - Mini Gastric Bypass- (OAGB-MGB) as revisional procedures for weight recidivism after a primary Laparoscopic Sleeve Gastrectomy (LSG). The follow-up period was at least 5 years, during which the impact of both procedures on weight loss, comorbidities, nutritional deficiencies, complications, and outcomes were compared. Results The study comprised 91 patients, with 42 and 49 in the SADI-S and OAGB-MGB groups, respectively. Significant weight loss (measured by total weight loss percentage, TWL%) was observed at the 5-year follow-up for the SADI-S group compared to the OAGB-MGB group (30.0 ± 18.4 vs. 19.4 ± 16.3, p = 0.008). Remission of comorbidities, specifically diabetes mellitus and hypertension, was more prevalent in the SADI-S group. Notably, the OAGB-MGB group had a higher incidence of complications (28.6% vs. 21.42%) and reoperations (5 patients vs. 1 in the SADI-S group). No mortality events were reported in either group. Conclusion While both the OAGB-MGB and SADI-S have demonstrated efficacy as revisional procedures for weight regain following SG, the SADI-S exhibits superior outcomes compared to the OAGB-MGB with regard to weight loss, resolution of comorbidities, complication rates, and reoperation rates.

There is considerable controversy about the treatment of patients with malignant advanced pancreatic neuroendocrine tumors (PNETs). Aggressive surgery remains a potentially efficacious anti-tumor therapy but is rarely performed because of its possible morbidity and mortality. The purpose of this work is to describe a case of PNETs who underwent aggressive multivisceral pancreatic resection and the literature's review. Case report: A 52-year old man with no medical history, who presented for abdominal pain, recent constipation and intermittent rectal bleeding. Clinically, we found a tender mass of 10x7 cm in the left upper quadrant. Colonoscopy revealed an irregular lesion of 2 cm in the splenic flexure with histological diagnosis at biopsies suggesting a pancreatic neoplastic origin. Computed tomography (CT) of the abdomen demonstrated a large mass in the left pancreas invading the spleen and its vessels, the adjacent left transverse colon with sign of segmental extrahepatic portal hypertension. There were no liver metastases or suspected adenopathies. He underwent laparotomy with extended resection of the left pancreas, the spleen and the left colon. Histological examination confirmed a well differentiated PNET with Ki67 < 2%. The post operative course was uneventful. After 16 months of follow, the patient remains well. There is no sign of recurrence at CT. Conclusion: Many retrospective studies and the European neuroendocrine Tumors' (ENETs) guidelines claim that debulking and aggressive surgical resection in locally advanced PNETs should be considered in selected patients because it is technically feasible with encouraging disease-specific survival.