Single Anastomosis Duodenal Switch Research Articles

Trends in Bariatric Surgery: a 5-Year Analysis of the Israel National Bariatric Surgery Registry.

The worldwide prevalence of obesity nearly tripled between 1975 and 2016. There are limited data quantifying national trends. The aim of this study is to evaluate and summarize current trends in bariatric surgery in Israel. Data for all bariatric surgeries (BS)performed between January 2014 and December 2018 was collected from the Israel National Bariatric Surgery Registry(INBSR) and analyzed. During the study period, 42,296 BS were included in the INBSR. Females accounted for 68% and the mean age and body mass index were 41.6 ± 12.6years and 42.0 ± 5.4kg/m2, respectively. Most of the patients were Jewish, but there was a significant rise in number of Arabs undergoing BS during the study period. There was a gradual decline in the annual numbers of BS, except for a small rise in 2015. There was a significant rise in the rate of One Anastomosis-Mini Gastric Bypass (OAGB-MGB), from 0.1% in 2014 to 46.1% in 2018, making it the most prevalent BS in that year. Laparoscopic sleeve gastrectomy (SG) surgeries decreased steadily, from 80% in 2014 to 37% in 2018. The annual rate of Roux-en-Y gastric bypass (RYGB) remained essentially constant at 10%. The annual rates of gastric banding decreased sharply and the annual rates of duodenal switch, single anastomosis duodenal switch and biliopancreatic diversion were negligible. Bariatric surgery was distributed evenly between private (50.4%) and public (49.6%) hospitals. The numbers of BS are decreasing in Israel. There is a gradual but noticeable shift from SG to OAGB-MGB.

A244 Management of bile reflux after Single-Anastomosis Duodenal Switch (SADS): Conversion to RYGB

Single-anastomosis duodenal switch (SADS) procedures offer a powerful metabolic surgery option with potentially technical advantages during surgery. While uncommon, significant bile reflux symptoms can develop in the post operative period. This can lead to symptomatic bile reflux gastritis and esophagitis. Management of these symptoms can be accomplished with a variety of of non operative and operative interventions. Should conservative or medical therapy be insufficient, surgical options can be considered. This video case report highlights a potential management option: the laparoscopic conversion of a SADS to RYGB anatomy. We describe the technical aspects of the procedure and the initial post operative follow up.

A633 Conversion of Laparoscopic Gastric Band to Single Anastomosis Duodenal Switch

Patients with recidivism following Laparoscopic adjustable gastric band (LAGB) is a challenging and ever-increasing issue. Conversion to Single anastomosis duodenal switch (SADSP maybe the answer.) 59 years old Male with CAD, Type 2 DM, HTN, who underwent LAGB in 2015, weight 145Kg BMI 46, Current weight 136Kg, BMI 43. Elected to undergo LAGB conversion to SADS.

A199 Retrospective Analysis of Laparoscopic Single Anastomosis Duodenal Switch (LOOP DS) at 6 Months and 1 Year

Data on Laparoscopic Single Anastomosis Duodenal Switch (LOOP DS) in the literature is limited compared to sleeve gastrectomy and gastric bypass. Purpose: Analyze the 6 month and 1 year data outcomes of patients who underwent LOOP DS as primary procedure.

Outcomes After Laparoscopic Conversion of Failed Adjustable Gastric Banding (LAGB) to Laparoscopic Sleeve Gastrectomy (LSG) or Single Anastomosis Duodenal Switch (SADS).

Inadequate weight loss following LAGB (laparoscopic adjusted gastric banding) requiring band removal and conversion to another bariatric procedure is common. There is a paucity of objective data to guide procedure selection. Single anastomosis modifications (SIPS, SADI, SADS) of the duodenal switch biliopancreatic division (DS-BPD) are being investigated. Laparoscopic sleeve gastrectomy (LSG) has become the most prevalent primary bariatric procedure and has been used for revision following LAGB. The purpose is to investigate single-stage LAGB removal to LSG SADS (single anastomosis duodenal switch). A matched cohort analysis compared each revision to a similar patient having a primary procedure. This was performed to understand the impact of prior banding on outcomes with each procedure. This is a retrospective study to investigate the outcomes of revision of LAGB for inadequate weight loss to LSG or SADS. To determine whether prior banding impairs results, a matched cohort was done comparing each revision to a patient that had a primary procedure. As expected, patients who had SADS had greater weight loss than LSG. There was no difference in peri-operative and early complications. Both procedures resulted in weight loss. Importantly, with matched cohort, prior LAGB decreased weight loss outcomes in LSG, but not SADS. Conversion of LAGB to LSG or SADS results in weight loss. The presence of LAGB decreases weight loss in LSG, but not in SADS. This can have important implications for long-term outcomes.

A519 - Single Anastomosis Duodenal Switch: Effects on Weight Loss and Reduction of Weight Related Comorbidities

Background: Single Anastomosis Duodenal Switch (SADS) is a novel bariatric procedure where a single loop anastomosis is made between the first portion of the duodenum and the jejunum. Our study is an investigational study to determine if SADS results in weight loss and reduction of associated comorbidities compared with traditional bariatric procedures. We also compare the risks of nutritional and vitamin deficiencies.

A302 - Changes in HOMA-IR Index After Bariatric Surgery: Comparison of SADS-p and MGB-OAGB

Background: Bariatric surgery plays a major role to ameliorate metabolic abnormalities of type 2 diabetes. The aim of study was to evaluate the early effects of “Single Anastomosis Duodenal Switch- proximal approach” (SADS-p) and “Mini Gastric Bypass” (MGB-OAGB) on the “homeostasis model assessment of insulin resistance” (HOMA-IR) index levels in morbidly obese patients with type 2 diabetes mellitus (T2DM).

A234 - Laparoscopic Single Anastomosis Duodenal Switch by Linear Triple Staple Technique Peter C. Ng, MD, Lindsey S. Sharp, MD, Dustin M Bermudez, MD, Erica M. McKearney, PA-C, Jillian M. Vari, PA-C, RD, John D. Ambrose, Sophia E. Menozzi

Background: Single anastomosis duodenal switch continues to gain greater acceptance. The predominant technique focuses on a total greater curve moblization as well as hand sewn duodenoileostomy. We present a totally stapled linear technique that offers speed, reproducible results, and widely patent afferent and efferent limbs. We demonstrate the technique, touching base on the critical aspects of duodenal anastomotic stapling, important to consistent results.

History, Recent Advancements, and Prospects in Bariatric/Metabolic Surgery

Bariatric/metabolic surgery is the most effective method to treat morbid obesity and its complications. Tracing its origin back to jejunoileal bypass in 1950s, bariatric/metabolic surgery has been continuously improved after more than 60 years of development. At present, the mainstream surgical procedures include sleeve gastrectomy, Roux-en-Y gastric bypass, biliopancreatic diversion/duodenal switch, and mini gastric bypass. In addition, new procedures such as single-anastomosis duodenal switch, duodenal-jejunal bypass with sleeve gastrectomy, laparoscopic greater curvature plication and endoscopic surgeries have been developed. This article reviews the history, status quo, and prospects of bariatric/metabolic surgery.

Is There a Better Design for a Bariatric Procedure? The Case for a Single Anastomosis Duodenal Switch

The majority of bariatric surgical stapling procedure concepts were developed prior to the understanding of obesity as an energy storage disease. Conventional treatments did not consider the impact of macronutrients on hormones and glucose variability. Current recommendations suggest diets low in glycemic load, with moderate protein and unsaturated fat. Roux-en-Y gastric bypass promotes glucose variability which can be harmful for health and encourage weight regain. Classic duodenal switch with short common channels may prevent absorption of measurable fat-soluble vitamins and frequently untested essential fatty acids. The purpose of this review is to discuss these factors and explain why single anastomosis duodenal switch reduces glucose variability, allows for absorption of critical fats and fat-soluble vitamins, and has potential to offer better weight loss and metabolic outcomes.

Conversions After Sleeve Gastrectomy for Weight Regain: to Single and Double Anastomosis Duodenal Switch and Gastric Bypass at a Single Institution.

With the increase in popularity of laparoscopic sleeve gastrectomy (LSG), the number of patients experiencing weight regain has increased as well. This study aims to demonstrate the outcomes of LSG conversions to Roux-en-Y gastric bypass (RYGB), double anastomosis duodenal switch (DS), and single anastomosis duodeno-ileal sleeve (SADI-S) due to weight regain. A retrospective chart review was performed on 21 patients who underwent a conversion of LSG due to weight regain between March 1, 2013, and April 30, 2017. A longitudinal analysis was performed for the body mass index (BMI) measures, using multilevel model for change. Of 21 patients, 6 underwent a conversion to RYGB, 9 underwent a conversion to SADI-S, and 6 underwent a conversion to double anastomosis DS. Mean percentage of total weight loss was 16.0% at 6months, 20.1% at 12months, 18.8% at 24months, and 21.8% at 36months after the procedure. The final model suggests that preoperative BMI is the most significant indicator for initial status and the rate of change in BMI. Adjusting for preoperative BMI, type of procedure significantly affected the rate of change in BMI. The rate of decrease was fastest in RYGB patients, adjusting for preoperative BMI. One patient was readmitted 26days after the conversion for pulmonary embolism and intraabdominal hematoma, and no patient required a reoperation within 30days after the conversion. Conversions of LSG to RYGB, double anastomosis DS, and SADI-S are safe and can provide significant additional weight loss.

Metabolic comparison of one-anastomosis gastric bypass, single-anastomosis duodenal-switch, Roux-en-Y gastric bypass, and vertical sleeve gastrectomy in rat

BackgroundOne-anastomosis gastric bypass (OAGB) and single-anastomosis duodenal switch (SADS) have become increasingly popular weight loss strategies. However, data directly comparing the effectiveness of these procedures with Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (SG) are limited. ObjectivesTo examine the metabolic outcomes of OAGB, SADS, RYGB, and SG in a controlled rodent model. SettingAcademic research laboratory, United States. MethodsSurgeries were performed in diet-induced obese Long-Evans rats, and metabolic outcomes were monitored before and for 15 weeks after surgery. ResultsAll bariatric procedures induced weight loss compared with sham that lasted throughout the course of the study. The highest percent fat loss occurred after OAGB and RYGB. All bariatric procedures had improved glucose dynamics associated with an increase in insulin (notably OAGB and SADS) and/or glucagon-like protein-1 secretion. Circulating cholesterol was reduced in OAGB, SG, and RYGB. OAGB and SG additionally decreased circulating triglycerides. Liver triglycerides were most profoundly reduced after OAGB and RYGB. Circulating iron levels were decreased in all surgical groups, associated with a decreased hematocrit value and increased reticulocyte count. The fecal microbiome communities of OAGB, SADS, and RYGB were significantly altered; however, SG exhibited no change in microbiome diversity or composition. ConclusionsThese data support the use of the rat for modeling bariatric surgical procedures and highlight the ability of the OAGB to meet or exceed the metabolic improvements of RYGB. These data point to the likelihood that each surgery accomplishes metabolic improvements through both overlapping and distinct mechanisms and warrants further research.

An Analysis of Mid-Term Complications, Weight Loss, and Type 2 Diabetes Resolution of Stomach Intestinal Pylorus-Sparing Surgery (SIPS) Versus Roux-En-Y Gastric Bypass (RYGB) with Three-Year Follow-Up.

For many years, the Roux-en-Y Gastric Bypass (RYGB) was considered a good balance of complications and weight loss. According to several short-term studies, single anastomosis duodenal switch or stomach intestinal pylorus sparing surgery (SIPS) offers similar weight loss to RYGB with fewer complications and better diabetes resolution. No one has substantiated mid-term complication and nutritional differences between these two procedures. This paper seeks to compare complication and nutritional outcomes between RYGB and SIPS. A retrospective analysis of 798 patients who either had SIPS or RYGB from 2010 to 2016. Complications were gathered for each patient. Nutritional outcomes were measured for each group at 1, 2, and 3years. Regression analysis was applied to interpolate each patient's weight at 3, 6, 9, 12, 18, 24, and 36months. These were then compared with t tests, Fisher's exact tests, and chi-squared tests. RYGB and SIPS have statistically similar weight loss at 3, 6, 9, 12, and 36months. They statistically differ at 18 and 24months. At 36months, there is a trend for weight loss difference. There were only statistical differences in nutritional outcomes between the two procedures with calcium at 1 and 3years and vitamin D at 1year. There were statistically significantly more long-term class IIIb-V complications, class I-IIIacomplications, reoperations, ulcers, small bowel obstructions, nausea, and vomiting with the RYGB than the SIPS. With comparable weight loss and nutritional outcomes, SIPS has fewer short- and long-term complications than RYGB and better type 2 diabetes resolution rates.

The incidence of complications associated with loop duodeno-ileostomy after single-anastomosis duodenal switch procedures among 1328 patients: a multicenter experience

BackgroundThe single-anastomosis duodenal switch procedure is a type of duodenal switch that involves a loop anastomosis rather than traditional Roux-en-Y reconstruction. To date, there have been no multicenter studies looking at the complications associated with post-pyloric loop reconstruction. ObjectivesThe aim of the study was to report the incidence of complications associated with loop duodeno-ileostomy (DI) following single-anastomosis duodenal switch (SADS) procedures. SettingMixed of private and teaching facilities. MethodsThe medical records of 1328 patients who underwent primary SADS procedure (single-anastomosis duodeno–ileal bypass with sleeve gastrectomy or stomach intestinal pylorus-sparing surgery) by 17 surgeons from 3 countries (United States, Spain, and Australia) at 9 centers over a 6-year period were retrospectively reviewed, and their results were compared with articles in the literature. ResultsMean preoperative body mass index was 51.6 kg/m2. Of 1328 patients, 123 patients received a linear stapled duodeno-ileostomy (DI) and 1205 patients a hand-sewn DI. In the overall series, the anastomotic leak, ulcer, and bile reflux occurred in .6% (9/1328), .1% (2/1328), and .1% (2/1328), respectively. None of our patients experienced volvulus at the DI or an internal hernia. Overall, 5 patients (.3%) (3/123 [2.4%] with linear stapled DI versus 2/1205 [.1%] with hand-sewn DI [P<.05]) experienced stricture at the DI in this series. ConclusionsThe overall incidence of complications associated with loop DI was lower than the reported incidence of anastomotic complications after Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch. SADS procedures may cause much fewer anastomotic complications compared with Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch.

Safety and Effectiveness of Single-Anastomosis Duodenal Switch Procedure: 2-Year Result from a Single US Institution.

Single-anastomosis duodenal switch (DS) was introduced by Sanchez-Pernaute et al. as a modification of the biliopancreatic diversion with duodenal switch. We have published preliminary results of the loop DS as the first report of the procedure in the USA. This study aims to evaluate the loop DS procedures again, in terms of weight loss, comorbidity resolution, complication rate, and address the nutritional concerns. A retrospective chart review was performed on initial 128 patients who underwent laparoscopic or robot-assisted laparoscopic single-stage loop DS between December 17, 2013 and September 23, 2016. Sixteen additional patients were prospectively enrolled from September 24, 2016 to May 4, 2017. A total of 102 female and 38 male patients were included in this study with a mean age of 41.2 ± 9.6years. The mean body mass index (BMI) at the time of procedure was 57.3 ± 9.2kg/m2. Percentage of total weight loss was 23.1, 37.1, 42.9, and 44.7% at 6, 12, 18, and 24months, respectively. Percentage of excess BMI loss was 41.9, 68.1, 76.6, and 80.8% at 6, 12, 18, and 24months, respectively. Mean levels of HbA1c, triglyceride, and LDL-cholesterol decreased significantly after the loop DS. Regarding the fat-soluble vitamins, majority of patients had vitamin A and E levels in the normal range. However, 42 to 56% of the patients had low levels of vitamin D at 6, 12, and 24months following the procedure. Mean length of hospital stay was 4.1 ± 2.7days. Thirty-day readmission rate was 7.6% (n = 11), and 30-day reoperation rate was 6.9% (n = 10). Loop DS seems to be effective in weight loss and is a feasible operation in the super-obese population. However, close monitoring of liver enzymes is warranted in addition to nutritional follow-up.

A5137 - Conversions after Sleeve Gastrectomy for Weight Regain: To Single and Double Anastomosis Duodenal Switch, and Gastric Bypass at a Single Institution

A5137 - Conversions after Sleeve Gastrectomy for Weight Regain: To Single and Double Anastomosis Duodenal Switch, and Gastric Bypass at a Single Institution

A114 - Comparative analysis of the Single Anastomosis Duodenal Switch to established bariatric procedures: an assessment of two-year postoperative data illustrating weight loss, diabetes resolution, and nutritional status Authors: Paul Enochs, MD, David Pilati, MD Co-authors: Jon Bruce, MD, Michael Tyner, MD, Scott Bovard, MD, Jaime Bull, CRC

A114 - Comparative analysis of the Single Anastomosis Duodenal Switch to established bariatric procedures: an assessment of two-year postoperative data illustrating weight loss, diabetes resolution, and nutritional status Authors: Paul Enochs, MD, David Pilati, MD Co-authors: Jon Bruce, MD, Michael Tyner, MD, Scott Bovard, MD, Jaime Bull, CRC

A5278 - Safety and Efficacy of Single Anastomosis Duodenal Switch: A Single US

A5278 - Safety and Efficacy of Single Anastomosis Duodenal Switch: A Single US

A508 - Complications associated with the Two-stage Approach to Single Anastomosis Duodenal Switch Procedure: Is it really safer?

A508 - Complications associated with the Two-stage Approach to Single Anastomosis Duodenal Switch Procedure: Is it really safer?

The single anastomosis duodenal switch modifications: a review of the current literature on outcomes

BackgroundThe single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) was designed in 2007 to reduce the side effects of biliopancreatic diversion with duodenal switch (BPD-DS) by replacing the Roux-en-Y construction with a single duodeno-ileal anastomosis and combining the common channel with the alimentary limb. Several variants using different channel lengths were published. The objective of this study was to identify the published cases of SADI-S and variants and assess the results regarding potential benefits on side effects and revisions. MethodsPubMed, ClinicalTrials.gov, and the databases of 3 relevant surgical journals were searched for any publication from 2007 to date. ResultsIn all, 19 studies were analyzed. After identifying overlaps, 1,041 patients among 9 institutions were identified: 304 with SADI-S, 667 with stomach intestinal pylorus sparing surgery, and 70 with single anastomosis duodenojejunal bypass with sleeve gastrectomy. There were no postoperative deaths and the early complication rate was 7.3% (range 1.6–14%). The mean operative time was 100.8 minutes (range 69.9–181.7 min). The mean 1-year percentage of excess weight loss (%EWL) was 78.7% (range 61.6–87%) and percentage of total weight loss (%TWL) was 36.8% (range 32.7–41.1%). Two studies reported a 2-year %TWL of 38.7% and a single study reported a 5-year %TWL of 37%. A total of 50% of patients had biological data at 1 year. One retrospective study found no difference between BPD-DS and SIPS for vitamin deficiency at 2 years, but there was less severe diarrhea and malnutrition after SIPS. The revision rate increased from 2% to 7% after SADI-S between 2- and 5-year follow-up. ConclusionThere are still limited long-term data available for single anastomosis duodenal switch. In the absence of published prospective randomized trials, no evidence exists in favor of this variant of the BPD-DS despite a possible trend in less malabsorption side effects.