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

Andrés Sánchez-Pernaute,Elia Pérez-Aguirre,Miguel Ángel Rubio Herrera,Antonio Torres,Clara Pañella,Clara Marcuello,Leyre Lopez Antoñanzas,Carlos Sáez Rodríguez,Natalia Pérez Ferré

doi:10.1007/s11695-021-05879-9

Andrés Sánchez-Pernaute, Elia Pérez-Aguirre + Show 7 more

Open Access

https://doi.org/10.1007/s11695-021-05879-9

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Journal: Obesity Surgery	Publication Date: Jan 15, 2022
Citations: 29	License type: open-access

Affiliation: Hospital Clínico San Carlos

Abstract

BackgroundSingle-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.ObjectiveTo analyze the long-term outcomes of SADI-S.MethodsFrom 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.ResultsThere 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.ConclusionIn the long term, SADI-S offers satisfactory weight loss and comorbidities resolution.Graphical

Highlights

The Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) (Fig. 1) was introduced in 2007 in our institution [1] with the intention of simplifying a difficult but very effective surgical technique to treat morbid obesity, the duodenal switch (DS) [2,3,4,5]
The operation differed substantially from the previous one-anastomosis technique, the one-anastomosis gastric bypass (OAGB) [6], first because of the pylorus preservation, which warranted the absence of pathologic bile reflux, and second because the common channel length was always measured, as it was in the Scopinaro procedure [7, 8] and the duodenal switch [2], the operations known as biliopancreatic diversions
SADI-S is a simplification of the DS

Summary

Introduction

The SADI-S (Fig. 1) was introduced in 2007 in our institution [1] with the intention of simplifying a difficult but very effective surgical technique to treat morbid obesity, the DS [2,3,4,5]. SADI-S has been demonstrated to be a safe and reproducible technique [9] and offers good weight loss results in the short term [10, 11]. It results effective as a second-step or revisional operation after sleeve gastrectomy [12,13,14]. After 2–3 weeks, a pureed/soft food was initiated, and a solid diet with a high protein intake (> 80 g/day) was introduced by the second postoperative month. The present manuscript reviews the experience with the SADI-S in a series of patients operated consecutively in our department and followed for at least 5 years. Weight loss is expressed as final BMI, excess weight loss (EWL), and total weight loss (TWL)

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