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

  • 2023 SAGES Oral
  • Published:
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Abstract

Background

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.

Methods

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.

Results

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 51.4 kg/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 142.1 min, 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.

Conclusions

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.

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Data availability

Data was extracted from the MBSAQIP data registry which captures information from 902 accredited American and Canadian centers. For this study, only data from 2020 to 2021 participant user file (PUF) was included, as there was a modification in 2020 that included additional details on revisional surgery that were previously not reported. In this dataset, there were specific descriptions for the initial procedure and the conversion procedure which we used to identify the initial SG and subsequent SADI or primary SADI-S. In the 2020 and 2021 versions of the MBSAQIP, emergency cases were not codified and all surgical approaches were included in this analysis.

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Authors and Affiliations

  1. Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

    Juan S. Barajas-Gamboa & John Rodriguez

  2. Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA

    Soon Moon, Gustavo Romero-Velez, Andrew T. Strong, Matthew Allemang, Salvador Navarrete, Ricard Corcelles, Matthew Kroh & Jerry T. Dang

  3. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    Matthew Allemang, Ricard Corcelles, John Rodriguez, Matthew Kroh & Jerry T. Dang

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  1. Juan S. Barajas-Gamboa
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Correspondence to Jerry T. Dang.

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Disclosures

Dr. Barajas-Gamboa, Dr. Moon, Dr. Romero-Velez, Dr. Strong, Dr. Allemang, Dr. Navarrete, Dr. Corcelles, Dr. Rodriguez, Dr. Kroh and Dr. Dang have no conflicts of interest or financial ties to disclose.

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Barajas-Gamboa, J.S., Moon, S., Romero-Velez, G. et al. Primary single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) versus sleeve gastrectomy to SADI conversions: a comparison study of prevalence and safety. Surg Endosc 37, 8682–8689 (2023). https://doi.org/10.1007/s00464-023-10305-5

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