Skip to main content

Advertisement

Log in

Mid-Term Results and Responsiveness Predictors After Two-Step Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. 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.

    Article  PubMed  Google Scholar 

  2. Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252(2):319–24.

    Article  PubMed  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. 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.

  6. 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.

    Article  CAS  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. 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.

  14. 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.

    Article  PubMed  Google Scholar 

  15. 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.

    Article  CAS  PubMed  Google Scholar 

  16. 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.

    Article  PubMed  Google Scholar 

  17. 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.

    Article  PubMed  Google Scholar 

  18. Nett P, Borbély Y, Kröll D. Micronutrient supplementation after biliopancreatic diversion with duodenal switch in the long term. Obes Surg. 2016.

  19. Bolckmans R, Himpens J. Long-term (>10 Yrs) outcome of the laparoscopic biliopancreatic diversion with duodenal switch. Ann Surg. 2016.

  20. 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.

    Article  PubMed  Google Scholar 

  21. 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.

    Article  PubMed  Google Scholar 

Download references

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

Authors

Corresponding author

Correspondence to José M. Balibrea.

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

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-016-2471-y

Keywords

Navigation