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

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Abstract

Purpose

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.

Methods

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 250 cm from the ileocecal valve and at least 2 cm after the pylorus.

Results

Mean age was 44.1 years 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 51.1 kg/m2 and 44.6 kg/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 4 years 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.

Conclusion

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.

Graphical Abstract

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Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors would like to thank Miguel Chagnon, Statistics Consultation Service, University of Montreal and Kathleen Beaumont for editing and manuscript review.

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Authors and Affiliations

  1. Department of Bariatric, Robotic and Minimally Invasive Surgery, CIUSSS Nord-de-L’Ile-de-Montréal, Hôpital du Sacré-Coeur de Montréal, 5400 Boul. Gouin Ouest Montréal, Québec, H4J 1C5, Canada

    Alexis Deffain, Ronald Denis, Radu Pescarus, Pierre Y. Garneau, Henri Atlas & Anne-Sophie Studer

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  1. Alexis Deffain
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  2. Ronald Denis
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Corresponding author

Correspondence to Alexis Deffain.

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Ethical Approval

All procedures performed in studies involving human participants 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.

Informed Consent

Informed consent does not apply to this retrospective review of a prospectively collected database.

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The authors declare no competing interests.

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Key points

• SADI-S showed good weight loss at 4 years PO as a primary or two-stage surgery.

• Primary/two-stage SADI-S is efficient for resolution/remission of comorbidities.

• Primary SADI-S is possible for BMI 50-60 and well-controlled comorbidities.

• Two-stage SADI-S is indicated for non-responders to SG or for BMI above 60.

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Deffain, A., Denis, R., Pescarus, R. et al. Single Anastomosis Duodeno-Ileal bypass (SADI-S) as Primary or Two-Stage Surgery: Mid-Term Outcomes of a Single Canadian Bariatric Center. OBES SURG 34, 1207–1216 (2024). https://doi.org/10.1007/s11695-024-07095-7

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  • DOI: https://doi.org/10.1007/s11695-024-07095-7

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