Single Anastomosis Duodenal Switch: 1-Year Outcomes

Abstract

Introduction Single-anastomosis duodenal switch has been suggested to be an effective bariatric procedure that offers excellent weight loss and by lengthening the common channel the potential to reduce micronutrient deficiencies. Purpose To evaluate the weight loss, comorbidity resolution and the 1-year nutritional outcomes of the single-anastomosis duodenal switch (SADS) procedure. Setting Multiple US Hospitals. Methods From October 2014 to January 2017, 120 patients were enrolled at six sites across the USA and underwent the SADS procedure. Weight loss, comorbidities, quality of life, and adverse events were followed post-procedure for 12 months. Results At 1, 6, and 12 months, 98.3%, 85.5%, and 77.1% of the patients were available for assessment, respectively. At 12 months, patients showed significantly reduced body mass index when compared to baseline (46.8 ± 5.8 vs 29.8 ± 4.4, P < 0.001 respectively). Sixty-five patients had type 2 diabetes at baseline; however, 11 patients lost to follow-up. Of the available data (54 patients), 96.3% of the patients had a resolution of type 2 diabetes by 12 months with a mean A1C reduction from 7.8 ± 1.6 to 5.3 ± 0.7. Additionally, there were reductions in hyperlipidemia, sleep apnea, and hypertension at 12 months. Patient gastroesophageal reflux disease satisfaction and quality of life (SF-36) scores were significantly higher at 12 months postprocedure (P < 0.001 in all cases) while 12-month protein levels remained at normal values. There were abnormalities of parathyroid hormone and vitamin D at 1 year with all other nutritional markers being not significantly different at 1 year from baseline. There were 10, IIIb, or greater complications according to the Clavien-Dindo scoring system during the study period, not all of which were related to the surgery. Conclusions SADS is a highly efficacious weight loss procedure with significant comorbidity reduction at 1 year. At 1 year, complications and vitamin and mineral deficits appear to be consistent with other malabsorption operations. Long-term follow-up is needed, especially around complications and vitamin deficiencies.

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

“…24 Cottam et al showed that there was a significant reduction of BMI from baseline 46.8 ± 5.8 to 29.8 ± 4.4 kg/m 2 at 1 year follow-up after LDS surgeries. 25 Weight-loss response in our patients was similar to the results shown in these studies. Studies have shown similar %TWL after LDS surgeries and BPD-DS.…”

“…Cottam et al showed diabetes remission of 96.3% at a 1 year follow-up after the single anastomosis duodenal switch (SADS). 25 Independent samples t test c Significance when the common channel length was taken as an independent variable similar in the common channel subgroups in our study indicating that the common channel length can be increased from 2.5 to ≥3 m in LDS surgeries, without altering metabolic efficacy. The anastomosis is placed distally in the ileum in LDS surgeries, and this probably correlates with a potent ileal brake mediated by an enhanced secretion of Peptide YY and GLP1 which stimulate early satiety.…”

Side-to-side magnet anastomosis system duodeno-ileostomy with sleeve gastrectomy: early multi-center results

“…The Verhoeff et al meta-analysis weighted mean remission rate for T2D of 87.4% following SADI-S (measured at longest follow-up, 28.8 months) [ 27 ] was similar to that of the current study at 1-year follow-up notwithstanding its small sample size. In a prospective multicenter study of primary SADI-S by Cottam et al (2020) at 1-year follow-up, in SADI-S patients, T2D in 54/57 of patients (96.0%) was either resolved or improved with continued medications [ 29 ]. In relation to recent studies of SADI-S (and SADI-S vs DS), side-to-side MS DI + SG appeared to achieve a comparable rate of T2D resolution.…”

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

“…Among the previous series, Sanchez-Pernaute et al [ 19 ] demonstrated the efficacy of SADI in a population of 97 diabetic patients, achieving control of the disease in 70–84% of patients long-term, and %EWL of 98 at 5-year follow-up. SADI was effective also in improving the patients’ quality of life [ 20 ]. A large series by Finno et al [ 21 ] compared 259 patients undergoing DS with 181 who had SADI-S (single-anastomosis duodeno-ileal bypass with sleeve gastrectomy).…”