Medium-Term Nutritional and Metabolic Outcome of Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S)

Abstract

Introduction: Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy (SADI-S), like other hypoabsorptive procedures, could be burdened by long-term nutritional deficiencies such as malnutrition, anemia, hypocalcemia, and hyperparathyroidism. Objectives: We aimed to report our experience in terms of mid-term (2 years) bariatric, nutritional, and metabolic results in patients who underwent SADI-S both as a primary or revisional procedure. Methods: One hundred twenty-one patients were scheduled for SADI-S as a primary or revisional procedure from July 2016 to February 2020 and completed at least 2 years of follow-up. Demographic features, bariatric, nutritional, and metabolic results were analyzed during a stepped follow-up at 3 months, 6 months, 1 year and 2 years. Results: Sixty-six patients (47 female and 19 male) were included. The median preoperative BMI was 53 (48–58) kg/m2. Comorbidities were reported in 48 (72.7%) patients. At 2 years, patients had a median BMI of 27 (27–31) kg/m2 (p < 0.001) with a median %EWL of 85.3% (72.1–96.1), a TWL of 75 (49–100) kg, and a %TWL of 50.9% (40.7–56.9). The complete remission rate was 87.5% for type 2 diabetes mellitus, 83.3% for obstructive sleep apnea syndrome and 64.5% for hypertension. The main nutritional deficiencies post SADI-S were vitamin D (31.82%) and folic acid deficiencies (9.09%). Conclusion: SADI-S could be considered as an efficient and safe procedure with regard to nutritional status, at least in mid-term (2 years) results. It represents a promising bariatric procedure because of the excellent metabolic and bariatric outcomes with acceptable nutritional deficiency rates. Nevertheless, larger studies with longer follow-ups are necessary to draw definitive conclusions.

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

“…This was managed by extending the common limb to 250–300 cm. A two-year follow up study by Marincola et al [ 22 ] reported Vitamin D and folate nutritional deficiency post-SADI in 31.82% and 9.09% of patients, respectively. These findings underscore the importance of regular nutritional checkups on patients who undergo these revisional bariatric procedures, especially since many obese patients suffer from micronutrient deficiencies even prior to undergoing bariatric surgery.…”

Barbed vs. Conventional Sutures in Bariatric Surgery: Early and Late Outcomes

“…Nevertheless, we ascribed the shortening of hospital stay observed in BS-G as probably due to the application of enhanced recovery after surgery protocols through the years. In fact, our clinical practice has shifted from a discharge on postoperative days 3-4 to the current discharge between postoperative days 1 and 2 [12,[16][17][18].…”

“…The Clavien-Dindo classification was utilised to assess the severity of postoperative complications [15]. The discharge and follow-up protocols have been previously described [12,[16][17][18]. Demographic and clinical data, as well as perioperative results, were obtained by a comprehensive evaluation of patient documents and electronic databases.…”

Robot-assisted vs laparoscopic bariatric procedures in super-obese patients: clinical and economic outcomes

“…The post-operative protocol has been elucidated in extenso in prior scientific studies [ 19 , 20 , 25 , 30 , 31 ]. All RYGB patients received FitForMe WLS Forte ® as vitamins and minerals supplementation customized for this bariatric procedure (see https://fitforme.it/product/wls-forte/?_gl=1*12cjjqc*_up*MQ..&gclid=CjwKCAjw1t2pBhAFEiwA_-A-NHqOIVB1CPEiVIzNVJysVEaQrxrCjX_OPjpszcp0CfFu7NwCs0mZlBoCJ20QAvD_BwE#product-tabs for details of composition).…”