Long-Term Results of Single-Anastomosis Duodeno-ileal Bypass with Sleeve Gastrectomy (SADI-S)

Abstract

Background Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a simplification of the duodenal switch (DS) in which the alimentary limb is eliminated, and the common channel is lengthened from 200 to 300 cm. Short-term results have demonstrated that SADI-S is safe and reproducible and that weight loss and comorbidities resolution are comparable to biliopancreatic diversion or DS. Objective To analyze the long-term outcomes of SADI-S. Methods From May 2007 to December 2015, 164 patients were consecutively submitted to a one-step SADI-S. The mean age was 47 years, and the mean body mass index (BMI) was 45.8 kg/m2. A total of 101 patients had type 2 diabetes, 91 arterial hypertension, 81 obstructive apnea, and 118 dyslipidemia. Limb length was 200 cm in 50 cases, 250 cm in 99, and 300 cm in 15. Results There was no mortality. One patient had a gastric leak, and 2 patients had an anastomotic leak. A total of 25% of the patients were lost to follow-up at 10 years. Excess weight loss and total weight loss were 87% and 38% at 5 years and 80% and 34% at 10 years. A total of 12 patients were submitted to revisional surgery for hypoproteinemia. Preoperatively 41 diabetics were under insulin treatment; at 5 years, 7 remained with insulin and 12 at 10 years. Mean glycemia was 104 mg/dL at 5 years and 118 mg/dL at 10 years. Mean HbA1c was 5.51% at 5 years and 5.86 at 10 years. Conclusion In the long term, SADI-S offers satisfactory weight loss and comorbidities resolution. Graphical Abstract

Surgical Treatment of Obesity. Special Mention to Roux-en-Y Gastric Bypass and Vertical Gastrectomy

“…SADI-S has been demonstrated to be a safe and reproducible technique and offers good weight loss results in the short term (66,67). Results on diabetes are comparable to those obtained with the duodenal switch (68), and some studies have even found a better metabolic effect thanks to the longer common channel (69,70).…”

“…Mean HbA1c was 5.51% at 5 years and 5.86% at 10 years. This allows concluding that in the long term, SADI-S seems to offer satisfactory weight loss and comorbidities resolution but there is insufficient data to comment on the long-term safety and efficacy of SADI-S (70). However, more studies should be done.…”

Four-Year Nutritional Outcomes in Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy Patients: an Australian Experience

“…Surve et al, in their long-term outcome article, reported an average BMI of 30.1 kg/m 2 at 48 months [ 2 ]. Sánchez-Pernaute et al reported an average BMI of 27.5 kg/m 2 ; however, a majority of patients in their cohort received a 250-cm (60%) or 200-cm (30%) common channel [ 6 ]. Only 9% of the cohort received a 300-cm common channel.…”

“…Following surgery, patients were categorized into seven groups (3,6,12,18,24,36, and 48 months), based on months elapsed since surgery. The pre-surgery cohort readings for nutritional markers were grouped and labelled as group 0 to compare with group 3 (3 months), group 6 (6 months), group 12 (12 months), group 18 (18 months), group 24 (24 months), group 36 (36 months), and group 48 (48 months).…”

Single Versus Double Anastomosis Duodenal Switch in the Management of Obesity: A Meta-analysis and Systematic Review

“…In addition, Finno et al 22 hypothesized that this reduction in the common channel is the primary cause of other micronutrient deficiencies, such as calcium, iron, copper, zinc, and folic acid. Thus, Sanchez-Pernaute et al 45 have proposed that patients must strictly adhere to 3 rules to counterbalance this high rate of nutritional deficiencies which are as follows: follow-up, dietary compliance, and supplementation. Furthermore, they recommended the consumption of at least 100 g of proteins and no more than 30% of fat per day for those who underwent the duodenal switch.…”