Abstract
ABSTRACTBackground: Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) was introduced into bariatric surgery by Sanchez-Pernaute et al. as an advancement of the biliopancreatic diversion with duodenal switch. Aim:To evaluate the SADI-S procedure with regard to weight loss, comorbidity resolution, and complication rate in the super obese population. Methods: A retrospective chart review was performed on initial 72 patients who underwent laparoscopic or robot-assisted laparoscopic SADI-S between December 17th, 2013 and July 29th, 2015. Results: A total of 48 female and 21 male patients were included with a mean age of 42.4±10.0 years (range, 22-67). The mean body mass index (BMI) at the time of procedure was 58.4±8.3 kg/m2 (range, 42.3-91.8). Mean length of hospital stay was 4.3±2.6 days (range, 3-24). Thirty-day readmission rate was 4.3% (n=3), due to tachycardia (n=1), deep venous thrombosis (n=1), and viral gastroenteritis (n=1). Thirty-day reoperation rate was 5.8% (n=4) for perforation of the small bowel (n=1), leakage (n=1), duodenal stump leakage (n=1), and diagnostic laparoscopy (n=1). Percentage of excess weight loss (%EWL) was 28.5±8.8 % (range, 13.3-45.0) at three months (n=28), 41.7±11.1 % (range, 19.6-69.6) at six months (n=50), and 61.6±12.0 % (range, 40.1-91.2) at 12 months (n=23) after the procedure. A total of 18 patients (26.1%) presented with type II diabetes mellitus at the time of surgery. Of these patients, 9 (50.0%) had their diabetes resolved, and six (33.3%) had it improved by 6-12 months after SADI-S. Conclusions: SADI-S is a feasible operation with a promising weight loss and diabetes resolution in the super-obese population.
Highlights
The first bariatric procedure was the jejunocolic bypass followed by the jejunoileal bypass, which resulted in substantial weight loss but unacceptable life threatening complication rates
This study aims to evaluate the single anastomosis (SADI-S) procedure with regard to weight loss, comorbidity resolution, and complication rate in the super obese population, and will be the first report of the technique in the United States
Comorbidities Hypertension Diabetes mellitus Sleep apnea a At the time of procedure
Summary
The first bariatric procedure was the jejunocolic bypass followed by the jejunoileal bypass, which resulted in substantial weight loss but unacceptable life threatening complication rates. These procedures along with several others have fallen out of favor over the years, due to failure rates, health risks, and severe deficiencies[3,4]. Laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are most commonly performed for surgical treatment of morbid obesity[1]. Surgery for the super obese (body mass index >50 kg/m2) carries higher readmission and reoperation rates[19]. The classic construction is a laparoscopic or robotic technique combining sleeve gastrectomy
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