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Duodenal Switch vs. Single-Anastomosis Duodenal Switch (SADI-S) for the Treatment of Grade IV Obesity: 5-Year Outcomes of a Multicenter Prospective Cohort Comparative Study

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Abstract

Purpose

The aims were to compare the 5-year outcomes of duodenal switch (DS) and single-anastomosis duodenal switch (SADI-S) in terms of weight loss; remission of comorbidities; nutritional status short- and long-term complications; postoperative mortality; and need for revisional surgery.

Materials and Methods

Multicenter prospective observational study of all consecutive patients undergoing DS or SADI-S in three high-volume hospitals.

Results

A total of 87 patients were included in the study, 43 submitted to DS and 44 to SADI-S, with similar basal characteristics, nutritional parameters, and BMI (52.9 kg/m2 DS vs. 52.5 kg/m2 SADI-S). Operative time was 152 min (± 32.6) in DS vs. 116 min (± 21.9) in SADI-S (p = 0.043). Short-term complications were similar for DS and SADI-S, both overall (11.8% vs. 11.6%), and ranged as Clavien-Dindo > II (4.5% vs. 4.7%), with no mortality. At 5 years, DS and SADI-S results were as follows: BMI 30.6 vs. 33.3 kg/m2 (p = 0.023); %EWL 80.5% vs. 68.6% (p = 0.006); and %TWL 42.1 vs. 36.0 (p = 0.006). Comorbidity remission rates for DS and SADI-S were as follows: for diabetes, 92.8% vs. 85.7% (n.s.); for hypertension, 95.2% vs. 85.1% (n.s.); for sleep apnea, 75% vs. 73.3% (n.s.); and for dyslipidemia, 76.4% vs. 73.3% (n.s.). DS showed lower levels of vitamin B12, iron, vitamin E, and zinc than SADI-S (p =  < 0.005). In the long term, there were 4 surgical reinterventions (due to 1 internal hernia in the DS group and 1 internal hernia and 2 biliary refluxes in the SADI-S group) with no cases of persistent diarrhea or malnutrition.

Conclusion

Both DS and SADI-S allowed good weight control and resolution of comorbidities. DS achieved a greater weight loss compared to SADI-S, at the expense of longer operative time and lower vitamin and mineral levels.

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Author notes

    Authors and Affiliations

    1. Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona,, C/Feixa Llarga S/N, 08907, L’Hospitalet de Llobregat, Barcelona, Spain

      Jordi Pujol Gebellí, Claudio Lazzara, Amador García Ruiz de Gordejuela, Javier Osorio & Lucia Sobrino

    2. Department of Obesity Surgery, Centro Hospital de Entre O Douro E Vouga, Santa Maria da Feira, Portugal

      Mario Nora & Ana Marta Pereira

    3. Department of General Surgery and Upper Gastrointestinal Unit, Hospital Clínico San Carlos, Madrid, Spain

      Andrés Sánchez-Pernaute & Antonio J. Torres García

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    1. Jordi Pujol Gebellí
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    Correspondence to Claudio Lazzara.

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    All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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    Key Points

    - Hypoabsorptive procedures are safe in referral centers.

    - In the long term, DS achieved better weight results than SADI-S.

    - Patients’ long-term follow-up is crucial to avoid malnutrition.

    Jordi Pujol Gebellí and Claudio Lazzara have contributed equally to this work.

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    Gebellí, J.P., Lazzara, C., de Gordejuela, A.G.R. et al. Duodenal Switch vs. Single-Anastomosis Duodenal Switch (SADI-S) for the Treatment of Grade IV Obesity: 5-Year Outcomes of a Multicenter Prospective Cohort Comparative Study. OBES SURG 32, 3839–3846 (2022). https://doi.org/10.1007/s11695-022-06317-0

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