Abstract
Background
In patients with insufficient weight loss after sleeve gastrectomy (SG) or in super obese individuals, among many surgical options available, a single-anastomosis duodeno-ileal bypass (SADI) after SG (SADI-S) could be considered. Due to the limited information available about the use of SADI as a second-step procedure, the objective of this study was to evaluate the mid-term results and responsiveness of SADI after sleeve gastrectomy.
Methods
We present prospective data from 30 consecutive patients with a mean BMI of 40.1 kg/m2, a mean excess weight of 44.7 kg, and a mean excess weight loss (EWL) of 37.5%, who were submitted to a SADI as a second-step revisional procedure.
Results
There were no intraoperative complications. Four early complications (13.34%) occurred within the first 24 postoperative hours. Six, 12, and 24-month follow-up number of patients available was 30 (100%), 22 (73.3%), and 16 (53.34%), respectively. Percent total weight loss (%WL) was 28.1 at the time of revision and 46.26% 24 months after SADI. Global %EWL was 78.93 ± 35.5. The complete remission rate after SG was 50% for diabetes, 33.3% for dyslipidemia, and 25% for hypertension, and 71.4%, 31.2%, and 27.7%, respectively, after SADI. Three (10%) patients required revisional surgery due to hypoalbuminemia.
Conclusions
SADI as a second-step strategy in super obese patients or after failed SG offers a more than satisfactory ponderal weight loss and an acceptable comorbidities resolution. However, the risk of severe malnutrition after distal SADI-S makes necessary a careful patient selection.
Similar content being viewed by others
References
Gagner M, Deitel M, Erickson AL, et al. Survey on laparoscopic sleeve gastrectomy (LSG) at the Fourth International Consensus Summit on Sleeve Gastrectomy. Obes Surg. 2013 Dec;23(12):2013–7.
Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252(2):319–24.
Chaudhry UI, Kanji A, Sai-Sudhakar CB, et al. Laparoscopic sleeve gastrectomy in morbidly obese patients with end-stage heart failure and left ventricular assist device: medium-term results. Surg Obes Relat Dis. 2015;11(1):88–93.
Magee CJ, Barry J, Arumugasamy M, et al. Laparoscopic sleeve gastrectomy for high-risk patients: weight loss and comorbidity improvement—short-term results. Obes Surg. 2011;21(5):547–05.
Yoon J, Sherman J, Argiroff A, Chin E, Herron D, Inabnet W, Kini S, Nguyen S. Laparoscopic Sleeve gastrectomy and gastric bypass for the aging population. Obes Surg. 2016.
Inge TH, Courcoulas AP, Jenkins TM, et al. Weight loss and health status 3 years after bariatric surgery in adolescents. N Engl J Med. 2016;374(2):113–23.
Silecchia G, Boru C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg. 2006;16(9):1138–44.
Homan J, Betzel B, Aarts EO, et al. Secondary surgery after sleeve gastrectomy: Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis. 2015;11(4):771–7.
Sánchez-Pernaute A, Rubio Herrera MA, Pérez-Aguirre E, et al. Proximal duodenal-ileal end-to-side bypass with sleeve gastrectomy: proposed technique. Obes Surg. 2007;17(12):1614–8.
Sánchez-Pernaute A, Rubio MÁ, Pérez Aguirre E, et al. Single-anastomosis duodenoileal bypass with sleeve gastrectomy: metabolic improvement and weight loss in first 100 patients. Surg Obes Relat Dis. 2013;9(5):731–5.
Sánchez-Pernaute A, Herrera MA, Pérez-Aguirre ME, et al. Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). One to three-year follow-up. Obes Surg. 2010;20(12):1720–6.
Sánchez-Pernaute A, Rubio MÁ, Conde M, et al. Single-anastomosis duodenoileal bypass as a second step after sleeve gastrectomy. Surg Obes Relat Dis. 2015;11(2):351–5.
AlSabah S, Alsharqawi N, Almulla A, Akrof S, Alenezi K, Buhaimed W, Al-Subaie S, Al Haddad M. Approach to poor weight loss after laparoscopic sleeve gastrectomy: re-sleeve vs. gastric bypass. Obes Surg. 2016.
Cheung D, Switzer NJ, Gill RS, et al. Revisional bariatric surgery following failed primary laparoscopic sleeve gastrectomy: a systematic review. Obes Surg. 2014;24(10):1757–63.
Alexandrou A, Felekouras E, Giannopoulos A, et al. What is the actual fate of super-morbid-obese patients who undergo laparoscopic sleeve gastrectomy as the first step of a two-stage weight-reduction operative strategy? Obes Surg. 2012;22(10):1623–8.
Gautier T, Sarcher T, Contival N, et al. Indications and mid-term results of conversion from sleeve gastrectomy to Roux-en-Y gastric bypass. Obes Surg. 2013;23(2):212–5.
Carmeli I, Golomb I, Sadot E, et al. Laparoscopic conversion of sleeve gastrectomy to a biliopancreatic diversion with duodenal switch or a Roux-en-Y gastric bypass due to weight loss failure: our algorithm. Surg Obes Relat Dis. 2015;11(1):79–85.
Nett P, Borbély Y, Kröll D. Micronutrient supplementation after biliopancreatic diversion with duodenal switch in the long term. Obes Surg. 2016.
Bolckmans R, Himpens J. Long-term (>10 Yrs) outcome of the laparoscopic biliopancreatic diversion with duodenal switch. Ann Surg. 2016.
Lee WJ, Lee KT, Kasama K, et al. Laparoscopic single-anastomosis duodenal-jejunal bypass with sleeve gastrectomy (SADJB-SG): short-term result and comparison with gastric bypass. Obes Surg. 2014;24(1):109–13.
Marceau P, Biron S, Marceau S, et al. Long-term metabolic outcomes 5 to 20 years after biliopancreatic diversion. Obes Surg. 2015;25(9):1584–93.
Acknowledgements
Authors would like to thank Dr. Mireia Guerrero and Mrs. Neus Castillejo for their appreciated work attending all our patients as a part of our multidisciplinary team.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
The study protocol was approved by our Institution’s Ethics Committee. Accordingly, all clinical and demographical data were prospectively collected in an encrypted database after obtaining informed consent from all patients.
Funding Source
None.
Conflict f Interest
Dr. Balibrea and Dr. Vilallonga report personal fees from Ethicon Endo Surgery Inc., outside the submitted work.
Rights and permissions
About this article
Cite this article
Balibrea, J.M., Vilallonga, R., Hidalgo, M. et al. Mid-Term Results and Responsiveness Predictors After Two-Step Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy. OBES SURG 27, 1302–1308 (2017). https://doi.org/10.1007/s11695-016-2471-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-016-2471-y