Single Anastomosis Duodeno-ileal Bypass Research Articles

Revisional surgery for malnutrition after SADI-S: prevalence, indications, techniques and outcomes.

SADIS with short common limb (< 250cm) is a malabsorptive operation. Reoperation is advised in patients requiring admission for severe malnutrition. Elongation of the common channel is the preferred revisional technique Introduction: Single-Anastomosis Duodeno-Ileal bypass with Sleeve gastrectomy (SADI-S) is a modification of the duodenal switch. Initial common channel's length was 200, and after malnutrition was detected in some patients, it was elongated to 250 or 300cm. The present study analyzes presentation and treatment of malnutrition after SADI-S. Three hundred and thirty-three consecutive patients undergoing SADI-S between May 2007 and February 2019 were included. The common limb length was 200cm in 50 cases, 250cm in 211, 300 in 71 and 350 in 1. Thirty-one patients were admitted for severe hypoalbuminemia and 17 patients were submitted to revisional surgery, and constitute the series of our study. Mean weight before reoperation was 57kg and mean body mass index (BMI) was 21kg/m2. Mean number of daily bowel movements was 5,6. Mean time to reoperation was 56months. The limb was found shorter than expected in 6 cases. Revisional surgery was conversion into a Roux en Y duodenal switch in 3 cases, elongation of the common limb in 11 patients, duodeno-duodenostomy in 1 and duodeno-jejunostomy to the first jejunal loop in 2. Mean weight regain was 14kg, and mean final BMI 26kg/m2. Daily bowel movements were reduced to 1,3. Factors related to hypoalbuminemia were hypertension, poor-controlled diabetes, shorter common limb and liver-test alterations. SADI-S is expected to be less malabsorptive than previous biliopancreatic diversions. However, caution must be taken with certain patients to avoid postoperative malnutrition. Adequate follow up with long-term supplementation is required.

Conversion of One Anastomosis Gastric Bypass to Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy.

Conversion of One Anastomosis Gastric Bypass to Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy.

Telementoring Experience for Complex Bariatric Operation-Laparoscopic Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S).

In a groundbreaking surgical collaboration, a team of surgeons in Lithuania successfully performed the first single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) operation under the remote telemonitoring guidance of a highly experienced surgeon from Spain.The Lithuanian surgical team, comprising skilled bariatric surgeons, meticulously prepared for the SADI-S operation under the remote guidance of their Spanish proctor. Utilizing video conferencing and real-time communication, the mentor provided step-by-step instructions, shared insights, and addressed any concerns during the procedure. The mentor's extensive experience and guidance ensured a safe and successful surgical outcome.This innovative approach not only demonstrates the potential of telemedicine in the field of complex bariatric surgeries but also highlights the power of international cooperation in advancing surgical techniques and patient care by using modern methods of telemedicine and proctorship.

Single-Anastomosis Duodeno-ileal Bypass with Sleeve Gastrectomy as an Ultimate Option for Diabetics with Severe Obesity: A Scoping Review

Single-Anastomosis Duodeno-ileal Bypass with Sleeve Gastrectomy as an Ultimate Option for Diabetics with Severe Obesity: A Scoping Review

Single Anastomosis Duodeno-Ileal bypass (SADI-S) as Primary or Two-Stage Surgery: Mid-Term Outcomes of a Single Canadian Bariatric Center.

Compare primary single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) and two-stage SADI after sleeve gastrectomy (SG) in terms of weight loss, reduction/remission of comorbidities, and morbidity. Retrospective study including 179 patients treated laparoscopically between 2016 and 2020. A 50Fr bougie was used for the SG in the primary SADI-S (group 1) and 36/40Fr for the two-stage procedure (group 2). The duodeno-ileal anastomosis was performed at 250cm from the ileocecal valve and at least 2cm after the pylorus. Mean age was 44.1years old, and there were 148 women and 31 men. There were 67 (37.4%) patients in group 1 and 112 (62.6%) in group 2, with 67% completing the 4-year follow-up. Mean preoperative body mass index (BMI) was 51.1kg/m2 and 44.6kg/m2 for groups 1 and 2, respectively. Preoperative comorbidities were obstructive sleep apnea, hypertension, type 2 diabetes, and dyslipidemia in 103 (57.5%), 93 (52%), 65 (36.3%), and 58 (32.4%) of cases. At 4years postoperatively, excess weight loss (EWL) was 67.5% in group 1 and 67% in group 2 (p = 0.1005). Both groups had good comorbidity remission rates. Early postoperative morbidity rate was 10.4% in group 1 and 3.6% in group 2. In group1, there were mostly postoperative intra-abdominal hematomas managed conservatively (n = 4). Two revisional surgeries were needed for duodeno-ileal anastomosis leaks. Postoperative gastroesophageal reflux disease (GERD), daily diarrhea, vitamin, and protein levels were similar in both groups. Both types of strategies are efficient at short and mid-term outcomes. Preoperative criteria will inform surgeon decision between a primary and a two-stage strategy.

Robot-assisted vs laparoscopic bariatric procedures in super-obese patients: clinical and economic outcomes

The increased operative time and costs represent the main limitations of robotic technology application to bariatric surgery. Robotic platforms may help the surgeon to overcome the technical difficulties in super-obese (SO, BMI ≥ 50 kg/m2) patients, in which multi-quadrant operations could be challenging. We aimed to evaluate the effect of robot-assisted (R) versus laparoscopic (L) approaches in Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) and Roux-en-Y Gastric Bypass (RYGB) in SO and Super-Super Obese (SSO, BMI ≥ 60 kg/m2) patients in terms of outcomes and cost-effectiveness. Bariatric procedures performed from 2012 to 2023 were retrospectively reviewed. The inclusion criteria were BMI ≥ 50 kg/m2, primary SADI-S or RYGB. Operative time (OT), early complications, post-operative stay (POS), overall costs and follow-up data were analyzed. A subgroup analysis for surgical procedures and SSO patients was also performed. Among 4596 patients, 174 RYGB and 91 SADI-S in BMI ≥ 50 kg/m2 patients were selected. After Propensity Score Matching analysis, two groups of patients were identified (laparoscopic and robot-assisted), each one composed of 18 RYGB and 26 SADI-S. Intraoperative and post-operative complication rates and POS were comparable. Mean OT was longer in robotic procedures compared with laparoscopy (199.1 ± 65.7 and 109.5 ± 39.1 min, respectively, p < 0.001). The difference in OT was eliminated after only SSO patients were included in the analysis (172.7 ± 24.1 vs 152.6 ± 26.2 min for R-SADI-S and L-SADI-S, respectively, p = 0.107). Robotic surgeries were associated with higher costs (8134.6 ± 1886.7 and 2386.7 ± 388.2 € in R-RYGB and L-RYGB, respectively; 7996.6 ± 873.1 and 3954.6 ± 631.1 € in R-SADI-S and L-SADI-S). Despite increased costs, robotic approach may represent an added value in more complex cases such as SSO patients.

Single Anastomosis Duodenoileostomy with Sleeve: A Comprehensive Review of Anatomy, Surgical Technique, and Outcomes.

Single anastomosis duodenoileal bypass with sleeve (SADI-S) is a recently endorsed metabolic and bariatric surgery (MBS) procedure in the US. Despite its favorable characteristics, the utilization of SADI-S remains limited, accounting for a mere 0.25% of all MBS procedures performed. This review aims to offer an updated examination of the technique, while also presenting the safety and outcomes associated with SADI-S on both the short and long term. The safety of SADI-S is well-established, with short-term complication rates as low as 2.6%. A common channel length of 300cm has consistently shown a lower incidence of malabsorption complications compared to shorter lengths. Bile reflux after SADI-S is relatively rare with an incidence of only 1.23%. SADI-S demonstrated sustained total weight loss (%TWL) at 5years (37%) and 10years (34%) postoperatively. Resolution of weight-related medical conditions was also significant after SADI-S, with remission rates of diabetes mellitus as high as 86.6% with over 5years of follow-up. SADI-S is a safe and effective MBS procedure that has shown impressive and sustainable results in terms of weight loss and improvement in obesity-related medical conditions. Careful limb length selection is essential in minimizing the risk of nutritional deficiencies. SADI-S holds great promise as a valuable option for individuals seeking effective weight loss and improvement in associated health conditions.

The Role of Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy in Treatment of Type-2-Diabetes Mellitus with Morbid Obesity in Comparison with Mini-Gastric-Bypass

The Role of Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy in Treatment of Type-2-Diabetes Mellitus with Morbid Obesity in Comparison with Mini-Gastric-Bypass

IBC-Oxford University2023_BJSPoster_5In The Era of “Sleeve Revision”, What is The Perfect Algorithm?: Suggested Algorithm with Review of the literature

Abstract Background Laparoscopic sleeve gastrectomy (LSG) is the mainstream treatment option for patients with morbid obesity due to restrictive and endocrine mechanisms, however it requires modifications for a subset of patients because of weight regain and tough complications, such as gastroesophageal reflux, strictures, gastric leak, and persistent metabolic syndrome. Revision surgeries have become more and more indispensable in bariatric surgery, accounting for 7.4% in 2016. Methods A systematic literature search was performed in PubMed, Embase and Cochrane library. Data were collected and analysed. Results Revisional bariatric surgeries after LSG include Roux-en-Y gastric bypass, repeated sleeve gastrectomy, biliopancreatic diversion, duodenal switch, duodenal-jejunal bypass, one-anastomosis gastric bypass (MGB), single anastomosis duodeno-ileal bypass (SADI) and transit bipartition. The overall revision rate was 10.4%, but for patients with ≥ 10-year follow-up, the rate was 22.6%. European studies had a higher revision rate (14.4%) than other studies. The most common reason for revision was failure in weight loss, and the most frequent revisional procedure was gastric bypass. Conclusion Reaching a clear algorithm for revisional bariatric surgery is still debated. However, we assume that it depends mainly on pre-revisional BMI and presence of GERD symptoms as follows: patients with BMI&amp;gt; 40 kg/m2 should receive Standard R-Y gastric bypass, those with BMI &amp;lt; 40 kg/m2 with GERD should have R-Y gastric bypass with long biliopancreatic limb or MGB with RY configuration. Patients with BMI &amp;lt; 40 kg/m2 without GERD may benefit from MGB or SADI

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.

Single anastomosis duodeno-ileal bypass with sleeve gastrectomy generates sustained improvement of glycemic control compared with sleeve gastrectomy in the diet-induced obese rat model.

Bariatric surgery has become a recognized and effective procedure for treating obesity and type 2 diabetes (T2D). Our objective was to directly compare the caloric intake-independent effects of sleeve gastrectomy (SG) and single anastomosis duodenoileal bypass with SG (SADI-S) on glucose tolerance in rats with diet-induced obesity (DIO) and to elucidate the differences between bariatric surgery and caloric restriction.A total of 120 adult male Wistar rats with DIO and insulin resistance were randomly assigned to surgical (sham operation, SG, and SADI-S) and dietary (pair-feeding the amount of food eaten by animals undergoing the SG or SADI-S surgeries) interventions. Body weight and food intake were weekly monitored, and 6weeks after interventions, fasting plasma glucose, oral glucose and insulin tolerance tests, plasma insulin, adiponectin, GIP, GLP-1, and ghrelin levels were determined.The body weight of SADI-S rats was significantly (p < 0.001) lower as compared to the sham-operated, SG, and pair-fed groups. Furthermore, SADI-S rats exhibited decreased whole body fat mass (p < 0.001), lower food efficiency rates (p < 0.001), and increased insulin sensitivity, as well as improved glucose and lipid metabolism compared to that of the SG and pair-fed rats.SADI-S was more effective than SG, or caloric restriction, in improving glycemic control and metabolic profile, with a higher remission of insulin resistance as well as long-term weight loss.

Current status of metabolic and bariatric surgery in Beijing: results of an initial survey

Objectives: To investigate the current status of metabolic and bariatric surgery (MBS) in Beijing's hospitals and to provide evidence to promote homogenization of medical development, standardizing clinical behavior, and continuously improving medical quality. Methods: This survey was conducted in September 2022 to investigate 27 hospitals in Beijing that had conducted MBS through a questionnaire survey. The questionnaire includes basic information from medical institutions, departmental information and MBS implementation, and statistical description of the results was performed. Results: At present, 27 hospitals in Beijing had carried out MBS and participated in quality control, among which 4 hospitals had established independent departments for MBS. The total number of beds for MBS was 234, and the number of doctors engaged in the specialty of MBS was 126. Among the 27 hospitals, 22 hospitals had weight-reduction and metabolic specialty clinics or multidisciplinary teams. Eleven hospitals had established 14 positions of case manager. In 2021, 1 hospital had ≥500 surgical cases, 3 hospitals had 200 to <500, 2 hospitals had 100 to <200, 3 hospitals had 50 to <100, 6 hospitals had 20 to <50, and 12 hospitals had less than 20. Twenty-six hospitals performed sleeve gastrectomy, 16 hospitals performed Roux-en-Y gastric bypass, 3 hospitals performed one anastomosis gastric bypass, 1 hospital performed biliopancreatic diversion with duodenal switch, 1 hospital performed single anastomosis duodeno-ileal bypass with sleeve gastrectomy. Six hospitals performed revisional surgery after MBS and 4 hospitals performed robotic-assisted MBS. Additionally, 15 hospitals had joined the Greater China Metabolic and Bariatric Database. Conclusions: MBS in Beijing is in the process of development. It is still necessary to clarify the position and role of surgery in the treatment of obesity and metabolic diseases, determine the concept and goal of surgical treatment of related diseases, and establish the corresponding surgical standards.

Revisional Procedures after Sleeve Gastrectomy for Weight Recurrence or Inadequate Weight Loss: An Analysis of the MBSAQIP Database.

The safety of conversional bariatric procedures after sleeve gastrectomy (SG) for weight recurrence (WR) or inadequate weight loss (IWL) is debated due to limited evidence. Conversion options include Roux-en-Y gastric bypass (RYGB), single anastomosis duodeno-ileal bypass (SADI), and biliopancreatic diversion with duodenal switch (BPD-DS). We aimed to compare serious complications and mortality rates between these procedures within 30 days. Using the 2020 and 2021 MBSAQIP databases, we identified patients who underwent a conversion from SG to RYGB, SADI, or BPD-DS. We performed a multivariable logistic regression to assess predictors of 30-day complications and mortality. Among 7388 patients (77.6% RYGB, 8.7% SADI, 13.7% BPD-DS), those undergoing SADI and BPD-DS had higher preoperative body mass index. Conversion reasons included WR (63.0%) and IWL (37.0%). SADI and BPD-DS patients had longer operative times (p < 0.001) and higher leak rates (p = 0.001). Serious complications, reoperations, readmissions, and 30-day mortality were similar across groups. Conversion procedure type was not an independent predictor of complications. RYGB was the most performed conversional procedure after SG. The study indicated a similar safety profile for revisional RYGB, SADI, and BPD-DS, with comparable 30-day complications and mortality rates. However, SADI and BPD-DS patients had longer operative time and higher leak rates.

Comparative analysis of sleeve conversions of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program 2020 Database

BackgroundAlthough the sleeve gastrectomy (SG) is the dominant bariatric procedure, studies have shown conversion rates of up to 30%. These conversions are generally for weight regain (WR), insufficient weight loss (IWL) or gastroesophageal reflux disease (GERD). Before 2020, details on why conversions were being performed were not collected in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Participant Use Data File (PUF). Now, the indication for sleeve conversion is noted in the PUF, allowing identification and reporting sleeve conversion reasons. ObjectiveWe aimed to examine the reasons for SG conversions nationwide. SettingThe 2020 MBSAQIP PUF. MethodsThe 2020 MBSAQIP PUF was examined to determine the reasons why SG were converted to other operations. The data field of “Revision/Conversion Final Indication” was used along with “Procedure type.” Primary bariatric operations were excluded. Descriptive statistics were applied. Different reasons for conversion and operations were compared by preoperative characteristics and operative outcomes. ResultsThere were 103,782 primary SG reported in the 2020 PUF. There were 7181 SG that were converted to other operations. The most common conversion (86.2%) was to Roux-en-Y gastric bypass (RYGB). The main reason for SG conversion was GERD at 48.4%, followed by WR/IWL (41.9%). Biliopancreatic diversion with duodenal switch and single-anastomosis duodenoileal bypass with sleeve patients differed significantly from RYGB patients in specific preoperative characteristics and operative outcomes. ConclusionThe most common procedure SG is converted to is the RYGB. GERD was the most common reason for SG conversion, followed by WR/IWL.

Primary single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) versus sleeve gastrectomy to SADI conversions: a comparison study of prevalence and safety.

Conversion from sleeve gastrectomy (SG) to single anastomosis duodeno-ileal bypass (SADI) is becoming increasingly common, but data regarding safety is of these conversions is scarce. As such, the objective of this study was to compare the 30-day rate of serious complications and mortality of primary SADI (p-SADI-S) with SG to SADI (SG-SADI) conversions. This retrospective cohort study analyzed the MBSAQIP database.Patients undergoing p-SADI-S and SG-SADI were included. Data collection was limited to 2020 and 2021. A multivariable logistic regression analysis was performed between groups to determine if SG-SADI was an independent predictor of 30-day serious complications or mortality. A total of 783 patients were included in this study, 488 (62.3%) underwent p-SADI-S and 295 (37.6%) underwent SG-SADI. The mean body mass index (BMI) at the time of surgery was lower in the SG-SADI cohort (45.1 vs 51.4kg/m2, p < 0.001). Indications for revision in the SG-SADI cohort included weight recurrence (50.8%), inadequate weight loss (41.0%), other (3.0%), GERD (2.7%), and persistent comorbidities (2.5%). SG-SADI had longer operative times (156.7 vs 142.1min, p < 0.001) and was not associated with a higher rate of serious complications (5.7 vs 6.9%, p = 0.508) compared to p-SADI-S. p-SADI-S was associated with a higher rate of pneumonia (1.2 vs 0.0%, p < 0.001), and SG-SADI was not correlated with higher rates of reoperation (3.0 vs 3.2%, p = 0.861), readmission (5.4 vs 5.5%, p = 0.948) and death (0.0 vs 0.2%, p = 0.437). On multivariable analysis, SG-SADI was not independently predictive of serious complications (OR 0.81, 95% CI 0.43 to 1.52, p = 0.514) when adjusting for age, sex, BMI, comorbidities, and operative time. The prevalence of SG-SADI is high, representing 37.6% of SADI-S procedures. Conversion from sleeve to SADI, is safe, and as opposed to other studies of revisional bariatric surgery, has similar 30-day complication rates to primary SADI-S.

Clinical outcomes and complications of single anastomosis duodenal-ileal bypass with sleeve gastrectomy: A 2-year follow-up study in Bogotá, Colombia.

The global prevalence of obesity has increased over the past 40 years, and bariatric surgery has proven to be the most effective therapy for long-term weight loss. Its principles are based on modifying the brain-gut axis by altering the gastrointestinal anatomy and affecting the function of gastrointestinal hormones, thereby modifying satiety signals. Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) combines both techniques and has become an alternative to gastric bypass and biliopancreatic diversion procedures for treating severe obesity and associated metabolic diseases in selected patients. To describe the outcomes and complications of SADI-S. We retrospectively analyzed the data of patients who underwent SADI-S laparoscopically at the Clínica Reina Sofía in Bogotá, Colombia. This study assessed the therapeutic effectiveness of SADI-S in terms of short-term preoperative clinical characteristics, postoperative complications, comorbidities, nutritional defi-ciencies, and intraoperative complications during a 2-year follow-up. Sixty-one patients with a mean body mass index (BMI) of 50 ± 7.1 kg/m2 underwent laparoscopic SADI-S. The mean operative time and hospital stays were 143.8 ± 42 min and 2.3 ± 0.8 d, respectively. The mean follow-up period was 18 mo, and the mean BMI decreased to 28.5 ± 12.2 kg/m2. The excess BMI loss was 41.8% ± 13.5%, and the weight loss percentage was 81.1% ± 17.0%. Resolution of obesity-related comorbidities, including type 2 diabetes mellitus, hypertension, dyslipidemia, and obstructive sleep apnea, was achieved and defined as complete or partial remission. No intraoperative complications were observed. Short-term complications were observed in four (6.8%) patients. However, larger studies with longer follow-up periods are required to draw definitive conclusions. SADI-S has a low intraoperative and postoperative complication rate and is effective for weight loss and improving obesity-related comorbidities, including hypertension, type 2 diabetes mellitus, dyslipidemia, and sleep apnea syndrome.

Comparative analysis of 5-year efficacy and outcomes of single anastomosis procedures as revisional surgery for weight regain following sleeve gastrectomy.

It is imperative to assess the results of revisional procedures following Sleeve Gastrectomy (SG), given the substantially growing population of patients who experience weight regain within a few years after undergoing this procedure. Examine the comparative effectiveness of the Single Anastomosis Duodeno-Ileal Bypass (SADI-S) and the One Anastomosis Gastric Bypass (OAGB-MGB) as revisional procedures, with respect to their impact on weight loss, resolution of comorbidities, incidence of complications, and rates of reoperation in patients who had weight regain after SG with up to or more than 5 years of follow-up. Hamad General Hospital, Academic tertiary referral center, Qatar. This study retrospectively analyzed a database of patients who underwent the Single Anastomosis Duodeno-Ileal Switch (SADI-S) or the One Anastomosis Gastric Bypass - Mini Gastric Bypass- (OAGB-MGB) as revisional procedures for weight recidivism after a primary Laparoscopic Sleeve Gastrectomy (LSG). The follow-up period was at least 5years, during which the impact of both procedures on weight loss, comorbidities, nutritional deficiencies, complications, and outcomes were compared. The study comprised 91 patients, with 42 and 49 in the SADI-S and OAGB-MGB groups, respectively. Significant weight loss (measured by total weight loss percentage, TWL%) was observed at the 5-year follow-up for the SADI-S group compared to the OAGB-MGB group (30.0 ± 18.4 vs. 19.4 ± 16.3, p = 0.008). Remission of comorbidities, specifically diabetes mellitus and hypertension, was more prevalent in the SADI-S group. Notably, the OAGB-MGB group had a higher incidence of complications (28.6% vs. 21.42%) and reoperations (5 patients vs. 1 in the SADI-S group). No mortality events were reported in either group. While both the OAGB-MGB and SADI-S have demonstrated efficacy as revisional procedures for weight regain following SG, the SADI-S exhibits superior outcomes compared to the OAGB-MGB with regard to weight loss, resolution of comorbidities, complication rates, and reoperation rates.

A230 Retrograde filling of the afferent limb, a very rare complication of Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S): A video case report

A230 Retrograde filling of the afferent limb, a very rare complication of Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S): A video case report

Hypoabsorptive surgeries cause limb-dependent changes in the gut endocannabinoidome and microbiome in association with beneficial metabolic effects.

To determine whether the metabolic benefits of hypoabsorptive surgeries are associated with changes in the gut endocannabinoidome (eCBome) and microbiome. Biliopancreatic diversion with duodenal switch (BPD-DS) and single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) were performed in diet-induced obese (DIO) male Wistar rats. Control groups fed a high-fat diet (HF) included sham-operated (SHAM HF) and SHAM HF-pair-weighed to BPD-DS (SHAM HF-PW). Body weight, fat mass gain, fecal energy loss, HOMA-IR, and gut-secreted hormone levels were measured. The levels of eCBome lipid mediators and prostaglandins were quantified in different intestinal segments by LC-MS/MS, while expression levels of genes encoding eCBome metabolic enzymes and receptors were determined by RT-qPCR. Metataxonomic (16S rRNA) analysis was performed on residual distal jejunum, proximal jejunum, and ileum contents. BPD-DS and SADI-S reduced fat gain and HOMA-IR, while increasing glucagon-like peptide-1 (GLP-1) and peptide tyrosine tyrosine (PYY) levels in HF-fed rats. Both surgeries induced potent limb-dependent alterations in eCBome mediators and in gut microbial ecology. In response to BPD-DS and SADI-S, changes in gut microbiota were significantly correlated with those of eCBome mediators. Principal component analyses revealed connections between PYY, N-oleoylethanolamine (OEA), N-linoleoylethanolamine (LEA), Clostridium, and Enterobacteriaceae_g_2 in the proximal and distal jejunum and in the ileum. BPD-DS and SADI-S caused limb-dependent changes in the gut eCBome and microbiome. The present results indicate that these variables could significantly influence the beneficial metabolic outcome of hypoabsorptive bariatric surgeries.

Patient-Reported Outcomes and Quality of Life After Single-Anastomosis Duodeno-ileal Bypass with Sleeve Gastrectomy (SADI-S): a Cross-Sectional Study with 283 Patients from a Single Institution.

Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a safe and effective technique with good short- and mid-term weight control and associated medical problems remission for patients with a body mass index (BMI) > 45kg/m2. The aim of this study was to analyze patient-reported symptoms, specifically symptomatic gastroesophageal reflux disease symptoms (GERD), depositional habit, and quality of life (QOL) following SADI-S, using telemedicine and validated tests. A prospective unicentric cross-sectional study was conducted including all patients submitted to SADI-S in the University Hospital of Bellvitge from May 2014 to September 2019. A baseline control group was composed of 67 patients who were planning to undergo SADI-S in the following 4months. Patients were divided into four groups: pre-SADIS, < 2years, 2-3years, and > 3years after surgery. The information gathered via a telematic questionnaire was analyzed and compared with its presence in patients' clinical history derived from the last presential visit. The response rate to telematic tests was 86.9%. The mean BMI exhibited significant differences depending on the moment of evaluation: 50.8kg/m2, 30.0kg/m2, 31.1kg/m2, and 32.7kg/m2 at pre-SADIS, < 2, 2-3, and > 3years follow-up, respectively (p < 0.001). The proportion of GERD symptoms increased over time (17.9%, 18.8%, 26.9%, and 30.2%, p = 0.320). After SADIS, the percentage of patients with loose stools was progressively higher (17.4% vs 25.4% vs 30.2%, p = 0.04). Patients with < 2-year follow-up presented an improvement in both physical component (PCS) and mental component (MCS) summaries compared to the baseline group (PCS = 51.3, and MCS = 49.4). The mean BMI of patients with PCS ≥ 50 was 31.9kg/m2, compared with 41.7kg/m2 in the PCS < 50 group (p < 0.001). In the MCS ≥ 50 group, there were more patients with a BMI < 35kg/m2 than the MCS < 50 group (66.7% vs 48.7%, p = 0.004). Telematic follow-up offered a more systemic and detailed information: in the last presential visit only, 13.9% of patients had complete data regarding weight evolution, remission of associated medical problems, GERD symptoms, and depositional habit in comparison with the 82.9% of patients with telematic follow-up (p < 0.001). Weight control is the main factor related to long-term QOL after SADI-S. The incidence of GERD symptoms and diarrhea was up to 30% in patients with > 3-year follow-up. Monitoring postoperative patient-related symptoms with validated objective tests seems a feasible and useful resource for the long-term follow-up of patients submitted to SADI-S.