Laparoscopic Single Anastomosis Research Articles

Early results of laparoscopic single-anastomosis duodeno-ileal bypass with sleeve gastrectomy: case series from a single Polish bariatric center

Early results of laparoscopic single-anastomosis duodeno-ileal bypass with sleeve gastrectomy: case series from a single Polish bariatric center

Short and intermediate-term effects of laparoscopic single anastomosis sleeve-jejunal bypass on type 2 diabetic morbidly obese patients.

Short and intermediate-term effects of laparoscopic single anastomosis sleeve-jejunal bypass on type 2 diabetic morbidly obese patients.

A Comparative Study between Laparoscopic One Anastomosis Gastric Bypass and Laparoscopic Roux-en-Y Gastric Bypass in Morbidly Obese Patients with Pre-Existing Gastroesophageal Reflux Disease, A Retrospective Study

Abstract Background Obesity is a significant problem worldwide, and it is a leading cause of several serious diseases that decrease patient quality of life and increase mortality as well as it is significant risk factor for GERD. Objective To compare between RYGB and OAGB regarding improvement of the symptoms of GERD post operative considering the comparison between the two techniques and the complications post operative of the two types of surgeries. Patients and Methods This is a retrospective comparative study that will be conducted on Morbidly obese patients with pre-existing GERD. Data of patients will be collected retrospectively starting from march 2017 till the end of February 2021. Approval of the Ethical Committee and written informed consent from all participants will be obtained. 40 morbidly obese patients divided into two groups; group A underwent laparoscopic single anastomosis gastric bypass and group B underwent laparoscopic Roux-en-Y gastric bypass. Results This study clarified that OAGB had favorable comparable results with RYGB in patients with obesity having GERD with easier technique, less operative time, and fewer complications. Both procedures have reduced the BMI and PAGI SYM significantly 6 months postoperative. Further larger scale studies for more severe cases of GERD and longer periods of follow-up should be conducted to obtain full picture of the most suitable procedure for weight loss in patients with obesity suffering from GERD. Conclusion This study clarified that OAGB had favorable comparable results with RYGB in patients with obesity having GERD with easier technique, less operative time, and fewer complications. Both procedures have reduced the BMI and PAGI SYM significantly 6 months postoperative. Further larger scale studies for more severe cases of GERD and longer periods of follow-up should be conducted to obtain full picture of the most suitable procedure for weight loss in patients with obesity suffering from GERD.

ThP3.10 - Initial experience with laparoscopic single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) in Class IV (BMI 50-60kg/m2) and Class V (BMI > 60 kg/m2) Obesity

Abstract Aims Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a simplification of the duodenal switch (DS) in which alimentary limb is eliminated, and common channel is lengthened from 200 to 300 cm is gaining recognition as effective procedure in Class IV (BMI 50-60 kg/m2) and Class V (BMI >60 kg/m2) obesity. The aim of study is to discuss the surgical technique and analyse initial outcomes after introduction of SADI-S in our department for management of Class IV and Class V Obesity. Methods This is a retrospective cohort study of consecutive patients who underwent SADI-S at a tertiary level teaching hospital in NHS. Only patients who underwent single stage SADI-S procedure with minimal follow-up of 30 days were included in study. Patients who underwent Sleeve gastrectomy first, followed by duodenal switch in second stage as part of two-stage strategy were excluded. Results Total 14 patients, 2 (14.2%) males and 12 (85.8%) females were included in study. The median pre-op BMI was 56.1 (51.95-69) kg/M2 and median Pre-op weight was 149.2 (121.8 – 163.2) kg. 9 pts had diabetes, 11 pts OSA on CPAP, 8 pts HTN, 6 pts fibromyalgia etc. 1 patient had sleeve staple-line bleed which was managed conservatively with fluids and blood transfusion. No re-operations, mortality or re-admissions were recorded. Median length of stay was 2 days. Conclusion SADI-S is a promising surgery in Class IV and Class V obesity patients with low postoperative morbidity. The postoperative recovery and protocol is similar to standard procedure like sleeve gastrectomy and Roux-Y-gastric bypass.

Comparative study of outcomes between Laparoscopic single anastomosis sleeve ileum bypass (SASI bypass) Versus Laparoscopic Sleeve Gastrectomy for Management of Type II Diabetes and Hypertension in Obese Patients

Comparative study of outcomes between Laparoscopic single anastomosis sleeve ileum bypass (SASI bypass) Versus Laparoscopic Sleeve Gastrectomy for Management of Type II Diabetes and Hypertension in Obese Patients

Comparative study of Laparoscopic Sleeve Gastrectomy versus Laparoscopic Single Anastomosis Sleeve Ileal Bypass (SASI) as a Treatment Modality for Morbidly Obese Patients with Type 2 Diabetes Mellitus

Abstract Background Bariatric surgery has been shown to be the most successful approach in managing morbid obesity that can achieve and sustain great weight loss for a long period. Furthermore, bariatric surgery can achieve better resolution of type 2 diabetes mellitus (T2DM) than intensive medical therapy alone. The present study aimed to compare the effect of Sleeve Gastrectomy (SG) against Single Anastomosis Sleeve Ileal Bypass (SASI) regarding the control of Diabetes Mellitus and weight loss. Patients and Methods This is a prospective comparative study conducted on 60 obese patients (BMI of 30 kg/m2 associated with obesity-related comorbidities including T2DM) to evaluate the effect of SG Versus SASI on obese patients with type II DM. it was carried out in Misr University Hospital from January 2022 to June 2022. This study included 60 patients which are divided randomly into two groups; one group consisted of 30 patients underwent SASI, the other group consisted of 30 patients underwent SG. The main outcome measures were excess weight loss (EWL) and resolution of T2DM at 6 after surgery. Results The results of this study showed that there was no statistically significant difference between both groups regarding EWL (the mean EWL % was 47.39±8.07 & 48.09 ±1.4 for SASI & SG respectively). Improvement in T2DM after SASI was better than SG (80% vs 66.7%, respectively) with no statistically difference between them. SASI required longer operative time than SG (116.83±19.23 versus 60.5 ±9.77, respectively). Complications occurred in 2 (6.7%) patients after SASI and 5 (16.7%) patients after SASI. Conclusion There was a statistically significant effect of SASI and SG on morbidly obese patients with T2DM; improving both obesity and obesity related co- morbidities with no statically significant difference between both groups regarding EWL and Improvement in T2DM after 6 months. So, large sample size with long-term follow-up period should be performed to better evaluate these technical surgeries and their efficacy regarding postoperative weight loss, metabolic changes, and nutritional status of patients.

Effect of laparoscopic mini gastric bypass versus laparoscopic single anastomosis sleeve ileal bypass on serum iron and calcium levels

Background Although bariatric surgery techniques are very effective in the treatment of obesity, they are usually associated with evident nutritional deficiencies. Such operations require ongoing medical care along with vitamin (Vit) and nutrition supplements. Aim Is to determine and compare the effect of Laparoscopic mini gastric bypass (MGB) versus laparoscopic single anastomosis sleeve ileal bypass (SASI) on serum iron and calcium levels. Methodology The current prospective Randomized controlled study included 62 patients who were randomly allocated into one of two equal groups. Group A (n=31) underwent MGB while group B (n=31) underwent SASI. Follow-up was designed for 6 and 12 months in both groups for the serum iron profile, serum folate, Vit B12, Vit D, parathyroid hormone, and calcium level. Results There was a statistically significant decrease in Excess weight loss (EWL)% in both groups after 1, 6, and 12 months and a significant EWL % in group A more than group B (P=0.045*). There was a statistically significant drop in the Iron profile components’ levels in both groups after 1, 6, and 12 months in comparison with the corresponding baseline levels. There was a statistically significant decrease in the calcium level as well as Vit D3 within both groups at 1, 6, and 12 months follow-up with a significant increase in Parathyroid hormone in both groups at the same interval of follow-up. Conclusion Both MGB and SASI are effective methods for the treatment of morbid obesity. However, adherent follow-up for the Iron profile, Vit B12, Vit D3, parathyroid hormone, and calcium levels are mandatory.

Comparative Study between Laparoscopic One Anastomosis Gastric Bypass and Laparoscopic Single Anastomosis Sleeve Ileum Bypass

Comparative Study between Laparoscopic One Anastomosis Gastric Bypass and Laparoscopic Single Anastomosis Sleeve Ileum Bypass

Laparoscopic single anastomosis sleeve ileal bypass in the surgical management of morbid obesity: A single‐centre experience

AbstractBackgroundSingle anastomosis sleeve ileal (SASI) bypass is a recently developed two‐step bariatric operation that involves a sleeve gastrectomy followed by a side‐to‐side sleeve‐ileal anastomosis. While the primary outcomes are promising, more evidence is required before SASI can be considered a standard bariatric procedure.ObjectiveThis study aims to evaluate short‐term outcomes of SASI bypass regarding safety, efficacy and complications.MethodsThis retrospective study involved the analysis of 75 patients who underwent SASI between January 2019 and January 2022. The study examined patients’ characteristics, comorbidities, surgical technique, operative details, post‐operative weight loss and complications.ResultsOf the 88 patients who underwent SASI, 13 were excluded, leaving 75 participants for analysis. The mean age was 36.9 ± 8.3 years, and the mean body mass index was 49.23 ± 5.5 kg/m2. Among the participants, 19 patients (25.3%) had diabetes and 8 patients (10.6%) had hypertension. The mean operative time was 78.42 ± 13.18 min. The mean excess weight loss percentage was 25.53 ± 3.63, 43.33 ± 8.78, 63.51 ± 10.85, 82.11 ± 11.42 and 88.95 ± 8.69 at 1, 3, 6, 12 and 24 months, respectively. The diabetic remission rate was 100%, and the hypertension remission rate was 75%. Post‐operative complications were observed in 12 patients (16%), with most being minor. Notably, two patients underwent SASI reversal to sleeve gastrectomy due to excessive weight loss, and one patient experienced weight regain in the second post‐operative year.ConclusionSASI bypass emerges as a straightforward and highly effective bariatric procedure, with an acceptable complication rate. It is easy to perform and revise, offering not only excellent and sustained weight loss outcomes during short‐term follow‐up but also the resolution or improvement of obesity‐associated comorbidities.

IBC-Oxford University2023_BJSOral_22Long Term Results of Conversion of Failed Laparoscopic Sleeve Gastrectomy into Four Different Bariatric Procedures, with a Follow-up of up to 14 Years

Abstract Background Laparoscopic sleeve gastrectomy (LSG) is the most popular bariatric operation. Its main downside is the high long term weight loss failure, necessitating re-operation and conversion. The optimal conversion technique is yet unknown, and reported long term data after conversion is lacking. Here we report the long-term results of our experience with conversion of failed LSG to four different bariatric procedures, laparoscopic Roux-Y Gastric Bypass (RYGB), laparoscopic Duodenal Switch (LDS), laparoscopic One Anastomosis Gastric Bypass (OAGB), and laparoscopic Single Anastomosis Duodeno-Ileal Bypass (SADIS), with a follow up of up to 14 years. Methods We analyzed data from 160 conversion procedures done for failed LSG, between the years 2007 to 2023. The procedure selection has changed over time, but the indication for conversion for weight related reasons was the same (BMI ≥34 kg/m²). Most patients were operated for weight loss failure. Patients operated for early strictures, stenosis and early dysfunction were excluded from the weight analysis. In almost all cases where sleeve dilatation was encountered, re-sleeve or pouch trimming were performed. The subgroup of patients with a follow up longer than 5 years was analyzed separately, to produce the long-term data. Results All operations were done laparoscopically, 6 patients suffered postoperative complications, no perioperative deaths were reported. Three patients required a corrective procedure due to severe malabsorption, from the LDS group. RYGB: 58 patients underwent conversion to RYGB, of those, 31 patients had pre-conversion BMI of ≥34kg/m², with a mean BMI of 40.4±5.5kg/m² and mean excess weight before conversion was 40.6kg. After a mean follow up of 7.7 years, mean BMI, excess weight loss and mean total weight loss were 32.8±5.3kg/m², 50.35%, and 18.1%, respectively. Long-term follow up (mean 9.2 years) of 23 patients, revealed mean BMI, excess weight loss and mean total weight loss were of 33±5.6kg/m², 52.1% and 19.24%, respectively. LDS: 20 patients underwent conversion to DS, all had pre-conversion BMI of ≥34kg/m², with a mean BMI of46.48±6.8kg/m², their mean excess weight before conversion was 59.22kg. After a mean follow up of 8 years, mean BMI, excess weight loss and mean total weight loss were 31.4±5.6kg/m², 71.6% and 31.9%, respectively. Long-term follow up (9.3 years) of 15 patients showed a mean BMI, excess weight loss and mean total weight loss were BMI of 30.9±5.1kg/m², 73.9%, 33.8%, respectively. Mean bowel movements per day was 3.2. OAGB: 45 patients underwent conversion to OAGB, of those, 39 patients had pre-conversion BMI of ≥34kg/m², with a mean BMI of 40±3.2kg/m², their mean excess weight before conversion was 42.2kg. After a mean follow-up of 2.4 years, mean BMI, excess weight loss and mean total weight loss were 30.4±5.5kg/m², 65.18%, 23.9%, respectively. Long-term follow up (6 years) of 9 patients showed mean BMI, excess weight loss and mean total weight loss of 27.1±4.3kg/m, 84.5% and 30%, respectively. Mean bowel movements per day was 3.2. SADI-S: 37 patients underwent conversion to SADI-S, all patients had pre-conversion BMI of ≥34kg/m², with a mean BMI of 43.2±7kg/m², their mean excess weight before conversion was 52.6kg. After a mean follow up of 1.2 years, mean BMI, excess weight loss and mean total weight loss were 28.7±5.5kg/m², 78.5%, and 32.2%, respectively. The mean bowel movements per day was 4. Long-term follow up for these patients is underway. Conclusion Conversion of failed LSG to either RYGB, DS, MGB or SADI-S, are all safe and feasible options without significant perioperative complications. Even with different preoperative characteristics of the groups (intrinsic to all non-randomized studies) our long-term results suggest for weight loss failure or weight regain stronger malabsorptive procedures produce a better long term weight loss, comparatively to RYGB. Long-term results after conversion to SADI are still pending and may seem as a very effective conversion technique.

Evaluation of Single Anastomosis Gastric Bypass

Abstract Objective The study was performed to evaluate the technique of laproscopic single anastomosis gastric bypass for treatment of morbidly obese patient. Study design The patients were enrolled in a Prospective observational study, from May 2013 till May 2015, including 100 patients set for laparoscopic Single anastomosis gastric bypass. Surgical procedures and follow up were performed at Ain Shams University hospitals. Patient and methods The study includes one hundred patients; 33 males and 67 females with a mean age of 33±10 years (range, 20–59), who fulfilled the criteria for bariatric surgery with BMI >35 with associated co-morbidities, all patients underwent laparoscopic single anastomosis gastric bypass. Results The average operative time was 90 minutes, and the median length of hospital stay was 2 day. No mortality reported within 30 days postoperatively. early postoperative complication within 30 day, no cases of leak reported, endo luminal hemorrhage (2%)treated conservatively. long-term complications were bile reflux(1%), with failed medical treatment which Laparoscopically converted to RYGBP. iron deficiency anemia (1%.). Average weight loss at 1 year was 46 kg (70.08% of excess body weight). (88.8%) of the obesity-associated co morbidities are resolved within 1 year. Conclusion Laparoscopic single anastomosis gastric bypass offers major benefits with great satisfactory results over most alternative procedures, is a successful procedure for weight loss and maintaining the weight reduction in morbid obesity, it has highly safe with good technical feasibility, short hospital stay, a low rate of major postoperative complications and growing learning curve

Comparative Study between Laparoscopic Single Anastomosis Sleeve Ileal Bypass (SASI Bypass) versus Laparoscopic Mini-Gastric Bypass (MGB/OAGB) in Controlling Type 2 Diabetes in Morbidly Obese Patients

Abstract Background In our opinion, the most important criteria in the selection of a bariatric procedure remain the safety and efficacy in achieving both weight loss and remission of the metabolic consequences of obesity. Despite the intrinsic limitation imposed by a retrospective study, our results seem to confirm that LMGB is both safe and effective for the treatment of morbidly obese diabetic patients. Laparoscopic SASI bypass has been shown to be an effective, safe, and simple procedure for the treatment of morbid obesity and its associated metabolic consequences. Moreover, it results in minimal postoperative nutritional complications in comparison to other bariatric procedures. However, long-term follow-up period should be performed to evaluate postoperative weight loss, metabolic changes, and nutritional status of patients. Objective To compare Laparoscopic Single Anastomosis Sleeve Ileal (SASI) Bypass with Minigastric bypass (MGB/OAGB) in controlling type 2 Diabetes Mellitus in morbidly obese patients. Patients and Methods This study is a retrospective comparative study in which morbidly obese Patients with type 2 DM who underwent either Mini-gastric bypass or Single Anastomosis Sleeve Ileal (SASI) bypass with available preoperative Fasting blood Glucose, Hemoglobin A1c& serum cpeptide (As predictive measures for remission of diabetes after surgery) was collected & their data and results was compared to this1,3, 6 & 12 months postoperatively. Results As regard glycemic and lipid profile pre and postoperative mean values in MGB group, the present study showed that there were significant differences between before and after surgery as regard FBG, HbA1C, triglyceride, cholesterol, HDL and LDL. Laparoscopic mini-gastric bypass (MGB) is a technically simple and safe procedure in SSO patients. LMGB has the advantages of being a single stage procedure, being easily reversible and revisable in a laparoscopic procedure and does not sacrifice portions of the stomach or implant foreign materials. SASI bypass is a promising operation that offers excellent weight loss and metabolic result. The elimination of two ways for passage of food and one anastomosis decrease nutritional deficiency and the possibility of surgically related complications. Conclusion Metabolic surgery is a safe option for carefully selected patients with metabolic syndrome. The increased risk for type 2 diabetes and cardiovascular disease demands therapeutic attention for those at high risk. Our study suggests that both SASI and MGB are highly effective in controlling Diabetes mellitus, Hypertension and Hyperlipidemia.

Comparative study between Laparoscopic mini-gastric bypass versus laparoscopic single anastomosis sleeve jejunal bypass for treatment of morbidly obese patients

Comparative study between Laparoscopic mini-gastric bypass versus laparoscopic single anastomosis sleeve jejunal bypass for treatment of morbidly obese patients

One Year Follow-up of Laparoscopic Single Anastomosis Sleeve Ileal Bypass in Super-morbidly Obese Patients

One Year Follow-up of Laparoscopic Single Anastomosis Sleeve Ileal Bypass in Super-morbidly Obese Patients

Laparoscopic single anastomosis sleeve–jejunal bypass for the treatment of morbidly obese patients: 1-year follow-up

Laparoscopic single anastomosis sleeve–jejunal bypass for the treatment of morbidly obese patients: 1-year follow-up

Surgical Technique of Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S).

Laparoscopic Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) is a bariatric/metabolic procedure that has been gaining popularity in recent years. SADI-S strongly affects the secretion of various gut hormones, adipocytokines and incretins. From a mechanistic point of view, the operation combines malabsorption and restriction, and has been shown to have a long-lasting and significant impact on weight loss and remission of comorbidities. With regard to the technique, first, a Sleeve is created and then the duodenum is tran-sected approximately 3-4cm after the pylorus at the level of the gastroduodenal artery (GDA). Next, 250-300cm of small bowel is measured from the caecum and a hand-sewn duo-deno-ileal anastomosis is performed. The length of the biliopancreatic limb is variable in this procedure. Because of the standardized common limb length in all patients, weight loss is very precise within a low range. Nevertheless, due to the complex hand-sewn anastomosis and the delicacy necessary when handling the duodenum, this procedure should be reserved for experienced bariatric surgeons in specialized centers. This article provides an overview of the standard surgical technique at the Department of Visceral Surgery at the Medical University of Vienna, as well as information about patient selection and pre- and postoperative care.

Laparoscopic Single Anastomosis Sleeve Ileal Bypass with Follow-up of Weight Loss and Metabolic Impact

Background: Bariatric surgery has been an effective safe management for severe obesity. The newly developed single-anastomosis sleeve ileal (SASI) bypass has shown efficacy as a functional as well as mechanical restrictive bariatric procedure, with a neuroendocrine modulation effect. SASI bypass is still an investigational procedure, hence, more evidence is needed till it is declared as a standard bariatric procedure by the IFSO. Aim of the study: The current work aimed to describe our experience regarding the technical steps, the efficacy and the short-term outcome of SASI bypass procedure in patients with severe obesity. Patients and methods: Forty seven patients with severe obesity underwent SASI bypass procedure. They were followed till 1 year postoperatively. The weight loss, comorbidities and laboratory changes were assessed. Results: Patients evaluation at the 1-year postoperative follow up revealed a mean %TWL of 37.55 ± 6.17 and a mean %EBWL of 76.21 ± 9.8. The remission rates of T2DM, hyperlipidemia and hypertension were 85.7%, 94.7% and 89.66%, respectively, with statistically high significant differences between the preoperative and 1-year postoperative comorbidities rate. Stepwise regression analysis demonstrated that only the preoperative HbA1C remained in the model predicting the %TWL, and the preoperative BMI was the remaining factor in the model predicting the %EBWL in the study patients. Conclusion: The present study adds a new evidence to the promising outcome of the newly introduced SASI bypass procedure. After one year, the study patients showed excellent weight loss and comorbidities remission together with acceptable major complication rates.

One-year outcomes of laparoscopic single-anastomosis duodenal-ileal bypass with sleeve gastrectomy versus laparoscopic sleeve gastrectomy for the treatment of obesity and obesity-related metabolic diseases

Objective: To compare the efficacy and safety of laparoscopic single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) and laparoscopic sleeve gastrectomy (SG) in the treatment of obesity and obesity-related metabolic diseases. Methods: A retrospective cohort study method was used to analyze the clinical data of 22 patients with obesity who underwent laparoscopic SADI-S in the China-Japan Union Hospital of Jilin university from May 2018 to December 2019 (SADI-S group). Meanwhile, 22 patients with obesity undergoing laparoscopic SG at the same period were selected in this study whose preoperative demographics, including sex, age, body weight, body mass index, metabolic diseases and blood index, were comparable to those of SADI-S group. All the patients were followed up at 3 months, 6 months and 12 months after operation to compare the weight loss [body weight, body mass index, percent of excess weight loss (%EWL) and percent of total weight loss (%TWL), etc.], remission of obesity-related metabolic diseases (hypertension, hyperuricemia, and type 2 diabetes mellitus, etc.) and nutritional deficiency (albumin, retinal-binding-protein, vitamin B12, vitamin D and iron protein, etc.) between the two groups. Results: All the patients successfully underwent laparoscopic bariatric surgery without conversion to laparotomy or death. Compared with SG group, SADI-S group had longer operative time [(204.8±38.3) minutes vs. (109.2±22.4) minutes, t=10.107, P<0.001], higher rate of intraoperative drainage tube [100.0% (22/22) vs. 50.0% (11/22), P<0.001], longer duration of indwelling drainage tube [4 (2-7) days vs. 1 (0-7) days, U=131.000, P=0.008], and the differences were statistically significant (all P<0.05). There was no significant difference between the SG group and the SADI-S group in terms of postoperative hospital stay and complication rate. The weight loss efficacy of SADI-S group and SG group was compared at 3, 6 and 12 months after operation. The results showed that with the increase of follow-up time, the patient's body weight and body mass index gradually decreased, %EWL and %TWL gradually increased (all P<0.05). There were no statistically significant differences in body weight, body mass index and %EWL between the SADI-S group and the SG group at 3, 6 and 12 months after operation (all P>0.05). There was no statistically significant difference of %TWL between two groups at 3 months after operation (F=0.846, P=0.368), but SADI-S group had higher %TWL at 6 and 12 months after operation and the differences were statistically significant (6-month: 34.0±5.1 vs. 30.2±4.3, F=5.813, P=0.025; 12-month: 42.9±6.8 vs. 34.8±7.6, F=14.262, P=0.001). Except for that the remission rate of total cholesterol of SADI-S group was higher than that of SG group, remission rates of metabolic diseases were not significantly different at different follow-up points (all P>0.05). As for the nutrient deficiency (albumin, retinal-binding-protein, iron protein, vitamin B12, vitamin D and folic acid) and the incidence of gallstones, no significant differences were found between two groups (all P>0.05). Conclusion: Both SADI-S and SG are safe and effective for the treatment of obesity and obesity-related metabolic diseases, but the former is more effective.

A safety study of laparoscopic single-anastomosis duodeno-ileal bypass with gastric plication (SADI-GP) in the management of morbid obesity

BackgroundBariatric surgery is more effective in the management of morbid obesity and related comorbidities than is conservative therapy. Pylorus-preserving single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-SG) is a modified duodenal switch technique. Gastric plication (GP) is an alternate to SG.MethodsMorbidly obese (BMI of > 40, or > 35 in the presence of diabetes or prediabetes) patients were recruited and operated on to perform SADI with GP. Complications related to surgery were recorded to assess the feasibility of the procedure. Weight-loss outcomes were analysed to determine efficacy. Minnesota Multiphasic Personality Inventory 2 (MMPI-2) was recorded after 1 year of follow-up, and test scales were used to describe physiological phenomena.ResultsSeventeen middle-aged (mean: 40 years) patients were involved in our study; 15 of them were females. The mean duration of surgery was 205 min. There were no complications of conversion, death, bleeding, VTE or 30-day readmission to hospital. We did experience CD4a (pulmonary insufficiency due to chronic lung disease) and a CD3b (anastomosis leakage treated laparoscopically) complications. Vomiting occurred in three cases (CD1). Obesity-related comorbidities showed favourable resolution rates (77.8% for hypertension, 81.2% for dyslipidaemia, 100% for diabetes at the 1-year follow-up). Weight-loss outcomes were favourable (53.20 EWL%, and 35.58 TWL% at 1-year follow-up). Greater weight loss caused significantly higher levels of Depression (t(13.958) = − 2.373; p = 0.00; p < 0.05) and Low Positive Emotions (t(13.301) = − 2.954; p = 0.00; p < 0.05) and Introversion/Low Positive Emotionality (t(13.408) = − 1.914; p = 0.02; p < 0.05) in MMPI-2 data.ConclusionAccording to our safety study, SADI-GP is a promising malabsorptive procedure, but a long-term high-volume case series or a randomised controlled trial is necessary to evaluate complication rates and weight-loss outcomes. Emotional dysregulation is common among bariatric surgery patients according to personality inventory data; therefore, psychological follow-up and psychotherapeutic support are necessary for weight-loss maintenance.

Is duodeno-jejunal bypass liner superior to pylorus preserving bariatric surgery in terms of complications and efficacy?

PurposeBased on recent scientific evidence, bariatric surgery is more effective in the management of morbid obesity and related comorbidities than conservative therapy. Pylorus preserving surgical procedures (PPBS) such as laparoscopic single-anastomosis duodeno-jejunal or duodeno-ileal bypass with sleeve gastrectomy are modified duodenal switch (DS) surgical techniques. The duodeno-jejunal bypass liner (DJBL) is a novel surgical method in the inventory of metabolism focused manual interventions that excludes duodeno-jejunal mucosa from digestion, mimicking DS procedures without the risk of surgical intervention. The aim of this article is to summarize and compare differences between safety-related features and weight loss outcomes of DJBL and PPBS.MethodsA literature search was conducted in the PubMed database. Records of DJBL-related adverse events (AEs), occurrence of PPBS-related complications and reintervention rates were collected. Mean weight, mean body mass index (BMI), percent of excess of weight loss (EWL%), percent of total weight loss (TWL%) and BMI value alterations were recorded for weight loss outcomes.ResultsA total of 11 publications on DJBL and 6 publications on PPBS were included, involving 800 and 1462 patients, respectively. The baseline characteristics of the patients were matched. Comparison of DJBL-related AEs and PPBS-related severe complications showed an almost equal risk (risk difference (RD): −0.03 and confidence interval (CI): −0.27 to 0.21), despite higher rates among patients having received endoscopic treatment. Overall AE and complication rates classified by Clavien-Dindo showed that PPBS was superior to DJBL due to an excess risk level of 25% (RD: 0.25, CI: 0.01–0.49). Reintervention rates were more favourable in the PPBS group, without significant differences in risk (RD: −0.03, CI: −0.27 to 0.20). However, PPBS seemed more efficient regarding weight loss outcomes at 1-year follow-up according to raw data, while meta-analysis did not reveal any significant difference (odds ratio (OR): 1.08, CI: 0.74–1.59 for BMI changes).ConclusionOnly limited conclusions can be made based on our findings. PPBS was superior to DJBL with regard to safety outcomes (GRADE IIB), which failed to support the authors’ hypothesis. Surgical procedures showed lower complication rates than the incidence of DJBL-related AEs, although it should be emphasized that the low number of PPBS-related mild to moderate complications reported could be the result of incomplete data recording from the analysed publications. Weight loss outcomes favoured bariatric surgery (GRADE IIB). As the DJBL is implanted into the upper gastrointestinal tract for 6 to 12 months, it seems a promising additional method in the inventory of metabolic interventions.