Abstract
BackgroundAlthough the sleeve gastrectomy (SG) has good short-term results, it comes with a significant number of patients requiring revisional surgery because of insufficient weight loss or functional complications.ObjectiveTo investigate the effectiveness of the single anastomosis duodenoileal bypass (SADI-S) versus the Roux-en-Y gastric bypass (RYGB) on health outcomes in (morbidly) obese patients who had previously undergone SG, with up to 5 years of follow-up.MethodsData from patients who underwent revisional SADI-S or RYGB after SG were retrospectively compared on indication of surgery, weight loss, quality of life, micronutrient deficiencies, and complications.ResultsFrom 2007 to 2017, 141 patients received revisional laparoscopic surgery after SG in three specialized Dutch bariatric hospitals (SADI-S n=63, RYGB n=78). Percentage total weight loss following revisional surgery at 1, 2, 3, 4, and 5 years was 22%, 24%, 22%, 18%, and 15% for SADI-S and 10%, 9%, 7%, 8%, and 2% for RYGB (P<.05 for 1–4 years). Patients who underwent RYGB surgery for functional complications experienced no persistent symptoms of GERD or dysphagia in 88% of cases. No statistical difference was found in longitudinal analysis of change in quality of life scores or cross-sectional analysis of complication rates and micronutrient deficiencies.ConclusionConversion of SG to SADI-S leads to significantly more total weight loss compared to RYGB surgery with no difference in quality of life scores, complication rates, or micronutrient deficiencies. When GERD in sleeve patients has to be resolved, RYGB provides adequate outcomes.Graphical abstract
Highlights
The sleeve gastrectomy (SG) is the most frequently performed bariatric procedure to treat obesity, accounting for 55.4% of all bariatric procedures worldwide according to the latest IFSO global registry report of 2018 [1]
This comes as no surprise as the SG is a relatively easy to perform surgical procedure when for example compared to the Roux-en-Y gastric bypass (RYGB), with nearly as good results for weight loss and slightly lower complication rates [2]
We found that single anastomosis duodenoileal bypass (SADI-S) after SG led to significantly more weight loss, while complication rates and micronutrient deficiencies were similar for SADI-S and RYGB
Summary
The sleeve gastrectomy (SG) is the most frequently performed bariatric procedure to treat (morbid) obesity, accounting for 55.4% of all bariatric procedures worldwide according to the latest IFSO global registry report of 2018 [1] This comes as no surprise as the SG is a relatively easy to perform surgical procedure when for example compared to the Roux-en-Y gastric bypass (RYGB), with nearly as good results for weight loss and slightly lower complication rates [2]. In cases where GERD is the main complaint and additional weight loss is not the primary goal, it is generally advised to perform a RYGB as this has proven to be the most effective treatment for the resolution of GERD symptoms [6,7,8] This effect can be explained by surgical “removal” of the pylorus from the equation, resulting in a lower pressure system and thereby promoting gastric (pouch) emptying. The sleeve gastrectomy (SG) has good short-term results, it comes with a significant number of patients requiring revisional surgery because of insufficient weight loss or functional complications
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