Single Anastomosis Duodeno-ileal Bypass Research Articles

The Effectiveness and Feasibility of Laparoscopic Re-sleeve Gastrectomy.

Weight regain following laparoscopic sleeve gastrectomy (LSG) may be due to dilation of the gastric reservoir. Laparoscopic re-sleeve gastrectomy (LrSG) is among the revisional surgery options. We aimed to investigate the effectiveness of LrSG for weight loss after a 12- and 24-month follow-up period. Bariatric surgery center in Baku/Azerbaijan. From June 2016 to June 2019, a total of 34 LSG patients with weight regain, underwent LrSG. We prospectively followed outcomes data were BMI changes, excessive weight loss, changes in laboratory values, and the presence of complications. The mean age at revision surgery was 36 ± 7.09 (range, 22-51)years, and the mean body mass index (BMI) before LrSG was 40 ± 5.2kg/m2. The mean time between the primary and revision surgery was 50 ± 7.8months. The main reasons for the revisions were weight regain and inadequate weight loss. The mean BMI value decrease at the 12th and 24th months were 27.7 ± 2 and 24.3 ± 1.02, which were statistically significant (p< 0.05). Analyses of hemoglobin A1C (A1C) values showed that the differences at the baseline, 12th and 24th months were statistically significant (95% 1.96 to 3.39, p< 0.001 and 95% CI 0.34 to 2.08, p= 0.005, respectively). In patients with weight regain or inadequate weight loss after LSG, LrSG may be a feasible and safe revisional procedure in a selected group of patients. Larger studies that compare other revisional surgery options (LRYGB, OAGB, duodenal switch, single anastomosis duodeno-ileal bypass) with LrSG are required.

Prospective multicentre randomised trial comparing the efficacy and safety of single-anastomosis duodeno–ileal bypass with sleeve gastrectomy (SADI-S) versus Roux-en-Y gastric bypass (RYGB): SADISLEEVE study protocol

IntroductionDespite the non-negligible weight loss failure rate at midterm, Roux-en-Y gastric bypass (RYGB) remains the reference procedure in the treatment of morbid obesity with metabolic comorbidities. A recently emerged procedure,...

Long-term outcomes of primary single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S).

The long-term outcomes of primary single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) have never been reported in the literature. The study aimed to evaluate the long-term outcomes after primary laparoscopic SADI-S (LSADI-S). Single, private institute, United States. Data from 750 patients who underwent a primary LSADI-S from June 2013 through November 2019 by 3 surgeons were retrospectively analyzed. Seven hundred fifty patients were included in the study. The mean age and preoperative body mass index were 49.3 ± 13.1 years and 50 ± 12.6 kg/m2, respectively. Follow-up was available on 109 patients (61%) at 5 years and on 87 patients (53%) at 6 years. Six patients did not have any follow-up. The average operative time and length of stay were 67.6 ± 27.4 minutes and 1.5 ± .8 days, respectively. The intraoperative, short-term, and long-term complication rates were 0%, 7.8%, 11.7%, respectively. The 30-day emergency room visit, readmission, and reoperation rates were .4%, 1.1%, and 1.1%, respectively. In total, there were 15 (2%) grade IIIb long-term complications unique to LSADI-S. Complete remission of type 2 diabetes was seen in 77% of the diabetic population. At 5 and 6 years, the mean change in body mass index was 17.5 ± 6.9 and 17.6 ± 6.4 kg/m2, respectively. The mortality rate was .5%. LSADI-S is effective in this retrospective review in achieving good initial weight loss and weight maintenance. Although our data show acceptable nutritional complications, questions still remain because of the retrospective nature of the study.

SADI (Single-Anastomosis Duodeno-Ileal Bypass): Current Evidence

Single-anastomosis duodeno-ileal bypass was first described in 2007 as a simplified version of the biliopancreatic diversion with duodenal switch. The aim of the following study is to describe the characteristics of this bariatric technique including its results and complications, based on an extensive review of the literature. SADI has achieved satisfactory short- and long-term results for the treatment of both morbid obesity and its metabolic comorbidities. Despite being reported as postoperative long-term complications and nutritional deficiencies, these are tolerable and comparable to BPD-DS. SADI is a safe and effective bariatric procedure that offers excellent weight loss and metabolic outcomes as a malabsorptive technique, with acceptable side effects when compared to other bariatric techniques.

Different Malabsorptive Obesity Surgery Interventions Result in Distinct Postprandial Amino Acid Metabolomic Signatures.

Biliopancreatic diversion with duodenal switch (BPD-DS) is an effective weight loss surgical procedure. Yet, BPD-DS is technically difficult to perform and carries a higher risk of nutrient deficiencies as compared with other surgical interventions. Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a modified BPD-DS procedure conceived with the aim of decreasing the technical complexity, while retaining the weight loss efficiency. Whether the two surgical procedures diverge in nutrient absorption rates and malnutrition risk is still matter of debate. Our aim was to determine if postprandial nutrient absorption rates are different in patients subjected to BPD-DS or SADI-S for weight loss. Plasma amino acid metabolomic profiling during mixed-meal tolerance test (MMTT) was performed in subjects (N = 18) submitted to BPD-DS (n = 9) or SADI-S (n = 9) 1.6 ± 0.1years earlier. Patients submitted to SADI-S or BPD-DS presented distinct postprandial metabolomic profiles. Postprandial excursions of total and essential amino acids-leucine, isoleucine, and valine-were higher after SADI-S as compared with BPD-DS. Our study demonstrates that a simplified malabsorptive bariatric surgery procedure SADI-S results in greater essential branched-chain amino acid absorption when compared with the classical BPD-DS intervention. These findings suggest that SADI-S can potentially lower lifetime risk of postoperative protein malnutrition, as well as have a positive impact on systemic metabolism and glucose homeostasis.

Single-anastomosis duodenoileal bypass as a revisional or second-step operation after sleeve gastrectomy.

One-loop duodenal switch leads to weight loss and improvement or resolution of co-morbidities similar to standard duodenal switch, and it is technically less demanding. To analyze the weight loss and metabolic improvement after conversion of sleeve gastrectomy to single-anastomosis duodenoileal bypass. University Hospital, Madrid, Spain. This was a retrospective cohort study. Patients submitted to sleeve gastrectomy with insufficient weight loss or programmed for a 2-step surgical approach were included. Single-anastomosis duodenoileostomy was completed if there was no stricture in the stomach and no severe symptoms of gastroesophageal reflux. Fifty-one patients with a mean initial body mass index of 52 kg/m2 were included. Maximum excess weight loss after the sleeve procedure was 63%. Mean time to the second operation was 36 months. The common channel was 250 cm in 41 patients and 300 cm in 10 patients. The follow-up rate was 77% at 5 years. Excess weight loss and total weight loss were 79% and 39%, respectively, at 1 year from the second surgery and 79% and 41%, respectively, at 5 years. Furthermore, 47% of the patients with diabetes achieved complete remission after sleeve gastrectomy, and 94% achieved remission after conversion to single-anastomosis duodenoileal bypass. Final weight loss was significantly higher in those patients who achieved better weight loss after the sleeve gastrectomy than those who did not. Single-anastomosis duodenoileal bypass is a beneficial procedure after sleeve gastrectomy for those who fail to lose weight or those with co-morbidities or as a planned second step.

Five-year results after resleeve gastrectomy.

Laparoscopic sleeve gastrectomy (LSG) has become increasingly popular in bariatric surgery. However, in the long-term follow-up, weight loss failure and intractable severe acid reflux after primary LSG can necessitate further interventions. The aim of our study was to evaluate long-term results 5 years after resleeve gastrectomy (ReSG). Private hospital, France. The study included all patients with failure after LSG who underwent ReSG between October 2008 and January 2014. The patients underwent radiologic evaluation, and an algorithm of treatment was proposed. We analyzed the 5-year outcomes concerning weight loss and long-term complications after ReSG. A total of 52 patients (46 women; mean age 40.2 yr) with a mean body mass index (BMI) of 39.4 kg/m2 underwent ReSG. The mean interval time from the primary LSG to ReSG was of 27.8 months (11-72 mo). The indication for ReSG was inadequate weight loss (28 patients; 53.8%), weight regain (22 patients; 42.3%), and gastroesophageal reflux disease (2 patients; 3.8%). In 35 cases the contrast agent (diatrizoate meglumine/diatrizoate sodium solution [Gastrografin]) swallow results were interpreted as primary dilation and in the remaining 17 cases as secondary dilation. One patient died from gynecologic cancer. Of the remainder, 3 patients underwent single-anastomosis duodenoileal bypass, 5 patients underwent Roux-en-Y gastric bypass, and 1 patient underwent a second ReSG for reflux. A total of 39 of 42 patients with ReSG as definitive procedure had available data at 5-year follow-up. The mean percentage of excess BMI loss was 63.7%. Of the 39 patients, 28 (71.8%) had >50% excess BMI loss at 5 years. Eight of the 11 patients with weight loss failure (<50% excess BMI loss) after ReSG were diagnosed with secondary or diffuse dilation on preoperative imaging; the remaining 3 patients had been operated in our early initial experience with the resleeve procedure. All cases were completed by laparoscopy with no intraoperative incidents. In terms of complications, we recorded 1 leak, 2 stenoses, and 2 cases of bleeding with no mortality. At 5 years postoperative, the ReSG as a definitive bariatric procedure remained effective for 53.8%. The results appear to be more favorable especially for the non-super-obese patients and for those with primary dilation. ReSG is a well-tolerated bariatric procedure with a low long-term complication rate. Further prospective clinical trials are required to compare the outcomes of ReSG with those of Roux-en-Y gastric bypass or single-anastomosis duodenoileal bypass for weight loss failure after LSG.

Short- to medium-term results of single-anastomosis duodeno-ileal bypass compared with one-anastomosis gastric bypass for weight recidivism after laparoscopic sleeve gastrectomy.

Single-anastomosis duodeno-ileal bypass (SADI) and the one-anastomosis gastric bypass (OAGB) are 2 revisional procedures to address the problem of weight recidivism after laparoscopic sleeve gastrectomy (LSG). To evaluate the efficacy and safety of SADI and OAGB as revisional bariatric surgery (RBS) in initially super-obese patients (body mass index [BMI] >50 kg/m2). Academic hospital, bariatric center of excellence, Germany. Observational study of outcomes in 84 initially super-obese patients who had undergone RBS after LSG (SADI n = 42, OAGB n = 42) between July 2013 and April 2018. Follow-up examinations were performed at 1, 6, 12, 24, and 36 months after RBS. The variables analyzed included time between LSG and RBS, BMI, excess weight loss, total weight loss, operation time, and complications. The time interval between LSG and RBS was 45.5 ± 22.8 and 43.5 ± 24.2 months for SADI and OAGB, respectively. At the time of RBS, the mean BMI was 42.8 ± 7.9 kg/m2 for SADI and 43.4 ± 9.2 kg/m2 for OAGB. The follow-up examinations rates (%) after SADI were 97.6, 92.8, 90.5, 78.6, 57.1, and 100, 97.6, 95.2, 85.7, and 59.5 after OAGB. The BMI at the follow-up examinations were 39.1 ± 7.2, 34.2 ± 6.9, 31.2 ± 5.8, 30.2 ± 5.3, 29.3 ± 5.1 for SADI, and 39.5 ± 8.1, 36.6 ± 7.4, 34.7 ± 7.9, 32.9 ± 6.3, and 31.6 ± 5.9 for OAGB. The mean operating times for SADI and OAGB were 138 ± 40 and 123 ± 39 minutes, respectively. Three patients in the SADI group and 1 patient in the OAGB group developed a major complication within the first 30 postoperative days. SADI and OAGB were effective second-step procedures for further weight reduction after LSG in initially super-obese patients after short to medium follow-up. There was a trend toward higher weight loss for SADI though this did not reach statistical significance. Substantial differences concerning surgery time and complications between the 2 procedures were not observed.

Effect of Single Anastomosis Duodeno-ileal Bypass (SADI) on Type 2 Diabetes Mellitus: A Meta-analysis

Abstract Background Among the competition between the various surgical school, each to prove the superiority of its surgical method to treat obesity &amp; metabolic syndromes, here comes our meta-analysis to search through &amp; collect the various trials to avoid bias concerning the effect of single anastomosis duodeno-ileal bypass with sleeve gastrostomy on the rapidly growing type 2 diabetes mellitus population. Objective To assess the effect of single anastomosis duodeno-ileal bypass (SADI) on type 2 diabetes mellitus patients and the magnitude of their metabolic benefit from undergoing surgery, to help both surgeons and patients make their decisions through giving them a realistic and neutral clearer picture of the expected postoperative outcome. Patients and Methods 10 papers included, our total number of assessed diabetic patients in this meta-analysis reached approximately 257 patients (excluding one study which did not specify the number of its diabetic participants). Results Concerning the need for post-operative medication (whether insulin or oral hypoglycemic: In 5 studies there was no more need for medication post-operatively and in the other five the overall remission rate exceeded 90%. Concerning C-peptide results: C-peptide was mentioned as a quantitative post-operative result in only 3 studies. Fortunately it was within normal ranges post-operatively in the 3 studies. However the other studies pointed to it indirectly when mentioning their complete remission rates. Concerning HbA1c: 7 studies revealed the outcome of their patients’ Hba1c postoperatively and it reached the normal in all. In fact; neither fasting nor post-prandial blood sugar data were provided by any of the studies. Conclusion Single anastomosis duodeno-ileal bypass proved to be very convenient and competitive surgical option for the treatment of resistant diabetes mellitus cases associated with mild to severe obesity.

Early Outcomes of Primary SADI-S: an Australian Experience.

Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) surgery is a modification of the traditional duodenal switch (DS) surgery. SADI-S is relatively a new bariatric surgical procedure and has gone by many names depending on the length of the common channel. In this study, we report our initial experience with this novel technique in the Australian population. The medical records of 91 patients who underwent laparoscopic primary SADI-S surgery by one surgeon at a single Australian center from January 2017 through May 2019 were retrospectively studied. Ninety-one patients were identified for analysis. The mean age and preoperative body mass index (BMI) was 46.2 ± 9years and 43.2 ± 5.7kg/m2, respectively. The mean operative time and length of stay were 121.8+/- 25 minutes and 1.4 ± 0.8days, respectively. At 12 and 24months, the patients lost an average BMI of 15.2 ± 5.2kg/m2 and 17.2 ± 5.9kg/m2, respectively. The short-term and long-term complication rates were 4.3% and 0%, respectively. The mortality rate was 0%. Postoperatively, the obstructive sleep apnea, type 2 diabetes, hyperlipidemia, hypertension, and gastroesophageal reflux disease resolution rates were 94, 94, 75, 68, and 13%, respectively. There was no statistically significant difference between most of the preoperative and postoperative nutritional data. SADI-S appears to be a safe bariatric surgical procedure with favorable outcomes at 2years in the Australian population.

Metabolic Efficacy and Diabetes Remission Predictors Following 'Sleeve Gastrectomy with Loop Duodenojejunal Bypass' Surgery.

Laparoscopic sleeve gastrectomy with loop duodenojejunal bypass (SLDJB) is a novel metabolic surgery that is a modification of the single anastomosis duodenoileal bypass with sleeve. Compared to conventional surgeries, SLDJB is highly effective in inducing diabetes remission. This study analyzed the metabolic efficacy of SLDJB. Seventy-eight patients with obesity and diabetes who underwent SLDJB between May 2013 and October 2017 were retrospectively analyzed to investigate the efficacy of their surgery and diabetes remission predictors. Complete diabetes remission was defined as an HbA1c level <6% with cessation of insulin and oral hypoglycemic agents. Complete diabetes remission occurred in 80.52% and 76.71% of patients at 1- and 3-year follow-ups, respectively. There was no significant difference in the rates of complete diabetes remission between the groups based on gender, preoperative body mass index (BMI), diabetes duration or preoperative insulin use. There was a significantly higher rate of complete remission in patients <50 years of age at the 1-year follow-up. Additionally, the rate of complete remission was significantly less when preoperative glycemic control was poor. Preoperative HbA1c levels negatively predicted complete remission, but was significant only at the 3-year follow-up. SLDJB is highly effective in treating obesity with type 2 diabetes, and preoperative glycemic control was found to predict complete remission. Patients under 50 years of age had a better short-term response rate; however, the surgery was effective regardless of gender, preoperative BMI, duration of diabetes or preoperative insulin use.

Unsolved issues related to multivitamin and multimineral support for patients following bariatric surgery

In the review article the authors discuss unsolved issues regarding vitamin and mineral support of patients undergoing bariatric/metabolic operations. Many patients refer for the surgery already having deficiencies of macro- and micronutrients and need preoperative preparation for improving of vitamin-mineral status. Vitamin-mineral support is indicated after each bariatric operation, however the volume of nutritive support and the choice and doses of vitamins and minerals can be varied depending on type of surgery. Hypoabsorptive procedures such as duodenal switch or SADI-S (Single anastomosis duodenoileal bypass with sleeve gastrectomy) usually demand more significant protein, calcium and iron supplementations together with administration of multivitamin complexes containing fat-soluble vitamins. Existing standard vitamin-mineral complexes may not contain necessary doses of iron, calcium, fat-soluble and other vitamins as well as some microelements like cooper, zink, selenium etc. Thus, sufficient vitamin-mineral support may need up to 10 tablets or pills daily depending on kind of surgery. That can influence on patients compliance, lead to refusal of supplementations and thus to undesirable metabolic consequences after surgery. The authors have concluded about necessity of working out of cost-effective domestic series of vitamin-mineral combinations with high bio-availability specially adapted to every class of bariatric/metabolic operation. To authors opinion this can lead to better patients compliance and can prevent undesirable side effects after metabolic surgery.

Conversions of Roux-en-Y gastric bypass to duodenal switch (SADI-S and BPD-DS) for weight regain.

Duodenal switch is a choice of conversion when patients fail to lose or regain weight after Roux-en-Y gastric bypass (RYGB). This study aims to evaluate the effectiveness and safety of duodenal switch as a secondary operation for patients who presented with insufficient weight loss or weight regain after a RYGB. A retrospective chart review was performed on 15 patients who underwent a conversion of RYGB to single anastomosis duodeno-ileal bypass with sleeve (SADI-S) or biliopancreatic diversion with duodenal switch (BPD-DS) due to weight regain between December 31, 2013 and October 31, 2018. For the body mass index (BMI) analysis, the multilevel model for change was used. Of 15 patients, 10 underwent a conversion to SADI-S, and 5 underwent a conversion to BPD-DS. Also, 7 patients underwent the conversion in two-stages, while 8 did as single-stage. One patient had a duodenal stump leak after SADI-S, and another patient had a sleeve leak after BPD-DS. One patient underwent a reoperation to increase the common channel 20months after the conversion to BPD-DS due to malnutrition. There was no mortality. Mean percentage of total weight loss (TWL) was 18.4% at 6months, 25.0% at 12months, 26.4% at 18months, and 25.7% at 24months after the conversion. The rate of decrease in BMI was slower in SADI-S patients than in BPD-DS patients (p < 0.01), adjusting for preoperative BMI. Conversions of RYGB to SADI-S and BPD-DS can provide significant additional weight loss. However, complications and malnutrition can develop after the conversion, and further research is needed for evaluating safety.

A648 A Novel Over-Under Technique for Managing Acute Sleeve Strictures Associated with Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy

A648 A Novel Over-Under Technique for Managing Acute Sleeve Strictures Associated with Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy

A232 A Video of an Iatrogenic Portal Vein Injury during Duodenal Dissection for Single Anastomosis Duodeno-Ileal Bypass

The single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) surgery is technically demanding because of duodenal dissection over the head of the pancreas. However, there have not been any reports of extra-hepatic portal triad injury during duodenal dissection. Herein we report the first case of a portal vein injury during duodenal dissection. Additionally, we attempt to demonstrate the root cause of this intra-operative complication, and how to avoid this type of injury in the future.

A621 Robotic Conversion of Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) to Mini Gastric Bypass due to Malnutrition

41-year-old male with a history of single-anastomosis duodeno-ileal bypass with sleeve gastrectomy(SADI-S) in 2014 presented in 3 years later with liver cirrhosis related to protein malnutrition. At the time, reversal was discussed but the patient did not follow-up. Patient re-presented to the clinic 2 years later with continued weight loss, severe malnutrition with liver cirrhosis, and renal failure requiring dialysis. He was taken back to the operating room(OR) for conversion of SADI-S to mini gastric bypass.

A548 Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S): long term results and complications. A single institution experience

A548 Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S): long term results and complications. A single institution experience

A Multi-institutional Study on the Mid-Term Outcomes of Single Anastomosis Duodeno-Ileal Bypass as a Surgical Revision Option After Sleeve Gastrectomy

Recently, a single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) has become increasingly popular for patients with BMI > 50 as a primary or staged surgery. Staging allows surgeons to do the sleeve gastrectomy (SG) first with the conversion only happening when a failure or technical challenge is identified. We present the mid-term outcomes of SADI bypass surgery after SG. A retrospective analysis was performed on a prospective database from four institutions. Ninety-six patients were identified from 2013 to 2018. Patients were divided into two groups: one had two-stage SADI because of insufficient weight loss, the second had planned two-stage SADI because of super obesity (BMI > 50kg/m2). Incidence of complications was divided into < 30days and > 30days. Of 96 patients, 3 patients were completely lost to follow-up. The mean age was 44.8 ± 11.3years. There were no deaths or conversion to open surgery. The postoperative early complication and late complication rate was 5.3% and 6.4% respectively. At 24months, group 2 had higher %weight loss (WL) and change in BMI units compared to group 1 with statistically significant difference. The average WL and change in BMI for entire patient's population at 24months after 2nd stage SADI was 20.5% and 9.4 units respectively. The remission rate for DM was 93.7% with or without the use of medication. The two-stage approach to SADI-S appears technically simpler than a single compromised operation. However, this approach needs more patients to understand its limitations.

Laparoscopic Conversion from Single Anastomosis Duodeno-Jejunal Bypass with Sleeve Gastrectomy (SADJ-S) to Roux-en-Y Gastric Bypass (GBP): Improving Unsatisfactory Outcomes

Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) can be considered as either a primary procedure or second stage procedure. Malnutrition is rare but could lead to a reversal of the SADI-S. The aim of this manuscript is to present the management and technique of weight regain after proximalization of a SADI-S by converting it to a gastric bypass.

Metabolische Chirurgie

In recent years the surgical treatment of metabolic diseases has become established as an effective alternative to conservative treatment. The new S3 guidelines address these changes and give clear indications for obesity surgery. One of the core points of the new guidelines is the differentiation between obesity surgery and metabolic surgery. In obesity surgery the primary aim of treatment is weight loss whereas for metabolic indications the aim is an improvement of comorbidities independent of the body mass index (BMI). With respect to the selection of procedures sleeve gastrectomy (SG) and the traditional Roux-en-Y gastric bypass (RYGB) can be used as safe and evidence-based operative procedures. The RYGB has better metabolic effects but higher complication and reintervention rates. More recent procedures, such as the one anastomosis gastric bypass (OAGB) and single anastomosis duodeno-ileal (SADI) bypass possibly have slightly stronger metabolic effects, however, the risk of malnutrition and vitamin deficiency is higher.