Sadi-S With Right Gastric Artery Ligation: Technical Systematization and Early Results

Abstract

Background: Bariatric surgery is performed all over the world with close to 500.000 procedures per year. The most performed techniques are Roux-en-Y gastric bypass and sleeve gastrectomy. Despite this data, the most effective procedure, biliopancreatic diversion with or without duodenal switch, represents only no more than 1.5% of the procedures. Technical complexity, morbidity, mortality, and severe nutritional adverse effects related to the procedure are the main fears that prevent most universal acceptance.Aim: To explain the technical aspects and the benefits of the SADI-S with right gastric artery ligation as an effective simplification from the original duodenal switch.Methods: Were included all patients undergoing this procedure from the November 2014 to May 2016, describing and analysing aspects of this technique, the systematization and early complications associated with the procedure.Results:A series of 67 patients were operated; 46 were women (68.7%); mean age of the group was 44 years old (33-56); and an average BMI of 53.5 kg/m2 (50-63.5). Surgical time was 115 min (80-180). A total of five patients (7.5%) had any complication and two (2.9%) had to be reoperated. There were two patients with leak, one at the duodenal stump and other at the esophagogastric angle. There was no mortality. Patients stayed at the hospital a median of 2.5 days (1-25).Conclusions:SADI-S with right gastric artery ligation is a safe procedure with few preliminary complications. The technical variations introduced to the classical duodenal switch are reproducible and may allow this procedure to be more popular. All the complications in this series were not related to the ligation of the right gastric artery.

Single Anastomosis Duodeno-ileostomy (SADI-S) Versus One Anastomosis Gastric Bypass (OAGB-MGB) as Revisional Procedures for Patients with Weight Recidivism After Sleeve Gastrectomy: a Comparative Analysis of Efficacy and Outcomes

“…Our study demonstrated an equivalent positive effect on improving the comorbidities (T2D, hypertension, or lipid profile) over 1 year. Prior studies showed that SADI-S had a significant potential improvement of comorbidities when compared to other revisional surgeries [8,[23][24][25].…”

Safety and feasibility of laparoscopic sleeve gastrectomy with loop duodenojejunal bypass for obesity

“…In SG-LDJB surgery, the loop duodenojejunal anastomosis is anatomical from end-to-side. Dallegrave Marchesini [ 19 ] has proposed the division of the right gastric artery while performing loop DS surgeries, while Gebelli et al [ 20 ] has shown that SADI-S surgery with right gastric artery ligation can be performed safely.…”

Safety and Feasibility of Laparoscopic Sleeve Gastrectomy with Loop Duodenal Switch Surgery for Obesity in Indian Patients

“…Gebelli et al showed that LDS surgeries with RGA ligation can be performed safely. 9 Preservation of the pylorus reduces the risk of acid exposure to the anastomosis, thereby reducing the risk of marginal ulcers. In their pooled analysis, Surve et al showed that the anastomotic leak, ulcer, and bile reflux occurred in 0.6% (9/1328), 0.1% (2/1328), and 0.1% (2/1328), respectively.…”

“…This step was a modification compared to the classical SADI-S described by Sánchez-Pernaute et al 7,8 This step ensured free mobility of gastric sleeve, pylorus, and the first part of the duodenum as a single unit after the duodenal transection. 9 A lax sleeve gastrectomy (SG) was performed around a 38 French calibration tube starting 4 cm proximal to the pylorus. After completion of SG, the duodenum was transected using staplers (Fig.…”