Efficacy and Drawbacks of Single-Anastomosis Duodeno-Ileal Bypass After Sleeve Gastrectomy in a Tertiary Referral Bariatric Center

Abstract

Background The need for revisional procedures after sleeve gastrectomy (SG) for insufficient weight loss or weight regain, gastroesophageal reflux, or other complications is reported to be 18–36% in studies with 10-year follow-up. Single-anastomosis duodeno-ileal bypass (SADI) may be performed as a revisional procedure after SG. This study aims to evaluate the short- and mid-term outcomes of SADI after SG in a referral center for bariatric surgery. Materials and Methods Data of patients who underwent SADI between March 2015 and March 2020 were collected prospectively and analyzed retrospectively. Follow-up comprised clinical and biochemical assessment at 1, 3, 6, 12, 18, and 24 months postoperatively, and once a year thereafter. Results Overall, 106 patients underwent SADI after a previous SG. The timeframe between SG and SADI was 50 ± 31.3 months. Postoperative mortality was observed in two cases (1.8%) and morbidity in 15.1% of patients. At 24 months, %total weight loss was 37.6 ± 12.3 and %excess weight loss 76.9 ± 25.2 (64 patients). Three patients were treated for malnutrition during follow-up, two with medical treatment and one with SADI reversal. Conclusion SADI after SG provides effective weight loss results in the short-term, even if in the present series the postoperative complication rate was non-negligible. Further trials are needed to establish the more advantageous revisional bariatric procedure after failed SG.

Single Anastomosis Duodeno-Ileal Bypass (SADI) as a Second Step After Failed Sleeve Gastrectomy: Systematic Review and Meta-analysis

“…To our knowledge, this is the first metanalysis conducted to delineate the outcomes of single anastomosis duodeno-ileal bypass as a prospective alternative for weight reduction following SG [ 6 ]. One trend in bariatric surgery is to simplify procedures, leading to the creation of one-anastomosis surgery options such as one anastomosis gastric bypass (OAGB) as an alternative to Roux en Y gastric bypass (RYGB) and SADI as an alternative to DS [ 1 ].…”

“…The Newcastle-Ottawa Quality Assessment Scale ( Table 1 ) was used as an evaluation tool to assess non-randomized controlled trials (non-RCTs) [ 1 2 4 5 6 7 8 9 10 11 12 13 14 ]. The scale’s range varies from 0 to 9 stars.…”

“…Sleeve gastrectomy (SG) is the most commonly performed bariatric procedure globally, with a staggering 340,550 surgeries recorded in 2016, according to the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) [ 1 ]. It has been found to be a highly effective intervention for obesity for a considerable number of patients.…”

“…This single-anastomosis duodeno-ileal (SADI) bypass has been suggested as a viable substitute to the traditional DS technique. It offers the benefit of a less complicated procedure from a technical perspective, and the possibility of decreased morbidity [ 1 ].…”

One Anastomosis Gastric Bypass: Weight Loss Results Are Not a Function of the Biliary Limb Length!

“…It has been demonstrated that the increase of the biliary loop dangerously increases the risk of malnutrition by decreasing the total alimentary limb length (TALL) [3,4]. Our experience with 106 patients who underwent single anastomosis duodeno-ileal bypass (SADI) showed, on the one hand, the systematic manipulation of the whole intestine starting from the cecum can be responsible for iatrogenic perforation and, on the other hand, despite a short common intestinal loop, the results on weight loss can be disappointing [5]. A nonstandard OAGB with variable biliary limb length and/or an OAGB with a biliary limb > 200 cm does not facilitate re-operations for reflux resistant to medical treatment, nor does it facilitate re-operations for malnutrition or those in an emergency by a surgeon, sometimes from another center, who must adapt the intervention after a calculation of the biliary limb length with risk of injury to the gastro-jejunal anastomosis or to carry out a complex operation.…”