Skip to main content

Advertisement

SpringerLink
Log in

Mid-term 4-Year Outcomes with Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy Surgery at a Single US Center

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

Abstract

Background

Single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) is a modification of Roux-en-Y duodenal switch (RYDS). Long-term data on this operation is lacking in the literature. We reviewed our mid-term data of this RYDS modification.

Purpose

To analyze the outcomes with SADI-S at 4 years.

Methods

Data from patients who underwent a primary SADI-S procedure performed by three surgeons at a single institution from June 2013 through February 2018 were retrospectively reviewed. All revision bariatric surgeries were excluded. Regression analyses were performed for all follow-up weight loss data.

Results

There were 437 patients in our database. The pre-operative mean body mass index (BMI) was 49.8 ± 8.8 kg/m2. The 30-day complication rate was 7.7%. The 30-day readmission, reoperation, and mortality rates were 1.8, 1.3, and 0.2%, respectively. The long-term complication rate was 10.9%. Seventy-nine patients were 4 years post SADI-S surgery and follow-up was possible for 44 patients (55.7%). At 4 years, patients had an average change in BMI of 18.1 ± 6 units with an excess weight loss (EWL) of 85.7 ± 27.3%. At 4 years, 97.6% patients were able to maintain HbA1c < 6% with or without the use of diabetic medication. There was a statistically significant difference between most of the pre-operative and post-operative nutritional data.

Conclusions

SADI-S is a safe and effective procedure in both short- and mid-term data points. Diabetes resolution and weight loss appear similar to traditional RYDS and better than RYGB.

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

Access this article

Log in via an institution

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. Hess DS, Hess DW, Oakley RS. The biliopancreatic diversion with the duodenal switch: results beyond 10 years. Obes Surg. 2005;15(3):408–16.

    Article  PubMed  Google Scholar 

  2. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.

    Article  PubMed  CAS  Google Scholar 

  3. Mitzman B, Cottam D, Goriparthi R, et al. Stomach intestinal pylorus sparing (SIPS) surgery for morbid obesity: retrospective analyses of our preliminary experience. Obes Surg. 2016;26(9):2098–104.

    Article  PubMed  Google Scholar 

  4. Surve A, Zaveri H, Cottam D. A safer and simpler technique of duodenal dissection and transection of the duodenal bulb for duodenal switch. Surg Obes Relat Dis. 2016;12(4):923–4.

    Article  PubMed  Google Scholar 

  5. Surve A, Zaveri H, Cottam D, et al. A retrospective comparison of biliopancreatic diversion with duodenal switch with single anastomosis duodenal switch (SIPS-stomach intestinal pylorus sparing surgery) at a single institution with two year follow-up. Surg Obes Relat Dis. 2017;13(3):415–22.

    Article  PubMed  Google Scholar 

  6. Marceau P, Hould FS, Simard S, et al. Biliopancreatic diversion with duodenal switch. World J Surg. 1998;22(9):947–54.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  8. Nightingale J, Woodward JM. Guidelines for management of patients with short bowel. Gut. 2006;55(Suppl 4):v1–12.

    Google Scholar 

  9. Brown WA, Ooi G, Higa K, et al. Single anastomosis duodenal-ileal bypass with sleeve gastrectomy/one anastomosis duodenal switch (SADI-S/OADS) IFSO position statement. Obes Surg. 2018;28:1207–16.

    Article  PubMed  Google Scholar 

  10. Sánchez-Pernaute A, Rubio 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 

  11. Neichoy BT, Schniederjan B, Dr C, et al. Stomach intestinal pylorus-sparing surgery for morbid obesity. JSLS. 2018;22(1):e2017.00063.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Sanchez-Pernaute A, Rubio MA, Cabrerizo L, et al. Single-anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) for obese diabetic patients. Surg Obes Relat Dis. 2015;11(5):1092–8.

    Article  PubMed  Google Scholar 

  13. Surve A, Cottam D, Sanchez-Pernaute A, et al. The incidence of complications associated with loop duodeno-ileostomy after single-anastomosis duodenal switch procedures among 1328 patients: a multicenter experience. In: Surg Obes Relat Dis, vol. 14; 2018. p. 594–601.

    Google Scholar 

  14. Sethi M, Chau E, Youn A, et al. Long-term outcomes after biliopancreatic diversion with and without duodenal switch: 2-, 5-, and 10-year data. Surg Obes Relat Dis. 2016;12(9):1697–705.

    Article  PubMed  Google Scholar 

  15. Biertho L, Lebel S, Marceau S, et al. Perioperative complications in a consecutive series of 1000 duodenal switches. Surg Obes Relat Dis. 2013;9(1):63–8.

    Article  PubMed  Google Scholar 

  16. Obied N, Malick W, Concors S, et al. Long-term outcomes after Roux-en-Y gastric bypass: 10-13 year data. Surg Obes Relat Dis. 2016;12(1):11–20.

    Article  Google Scholar 

  17. Higa KD, Boone KB, Ho T. Complications of the laparoscopic Roux-en-Y gastric bypass: 1040 patients. What have we learned? Obes Surg. 2000;10:509–13.

    Article  PubMed  CAS  Google Scholar 

  18. Marceau P, Biron S, Marceau S, et al. Biliopancreatic diversion duodenal switch: independent contributions of sleeve resection and duodenal exclusion. Obes Surg. 2014;24:1843–9.

    Article  PubMed  Google Scholar 

  19. Cottam A, Cottam D, Roslin M, et al. A matched cohort analysis of sleeve gastrectomy with and without 300 cm loop duodenal switch with 18-month follow-up. Obes Surg. 2016;26(10):2363–9.

    Article  PubMed  Google Scholar 

  20. Surve A, Zaveri H, Cottam D, et al. Mid-term outcomes of gastric bypass weight loss failure to duodenal switch. Surg Obes Relat Dis. 2016;12(9):1663–70.

    Article  PubMed  Google Scholar 

  21. DeMaria EJ. Bariatric surgery for morbid obesity. N Engl J Med. 2007;356:2176–83.

    Article  PubMed  CAS  Google Scholar 

  22. Goldner Ws SJA, Lyden E, et al. Finding the optimal dose of vitamin D following Roux-en-Y gastric bypass: a prospective, randomized, pilot clinical trial. Obes Surg. 2009;19:173–9.

    Article  PubMed  Google Scholar 

  23. Einarsdottir K, Preen DB, Clay TD, et al. Effect of a single “megadose” intramuscular vitamin D (600000 IU) injection on vitamin D concentrations and bone mineral density following biliopancreatic diversion surgery. Obes Surg. 2010;20:732–7.

    Article  PubMed  Google Scholar 

  24. Dolan K, Hatzifotis M, Newbury L, et al. A clinical and nutritional comparison of biliopancreatic diversion with and without duodenal switch. Ann Surg. 2004;240:51–6.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Abd-Elatif A, Yousser T, Farid M, et al. Nutritional markers after loop duodenal switch (SADI-S) for morbid obesity: a technique with favorable nutritional outcome. J Obes Weight Loss Ther. 2015;5(3):1000268.

    Google Scholar 

  26. Surve A, Zaveri H, Cottam D. Retrograde filling of the afferent limb as a cause of chronic nausea after single anastomosis loop duodenal switch. Surg Obes Relat Dis. 2016;12(4):e39–42.

    Article  PubMed  Google Scholar 

  27. Zhang H, Han X, Yu H, Di J, Zhang P, Jia W. Effect of Roux-en-Y gastric bypass on remission of T2D: medium-term follow-up in Chinese patients with different BMI obesity class. Obes Surg 2016:1–9.

  28. Purnell JQ, Selzer F, Wahed AS, et al. Type 2 diabetes remission rates after laparoscopic gastric bypass and gastric banding: results of the longitudinal assessment of bariatric surgery study. Diabetes Care. 2016;39(7):1101–7.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  29. Sjostrom L, Peltonen M, Jacobsen P, et al. Association of bariatric surgery with long term remission of type 2 diabetes with microvascular and macrovascular complications. JAMA. 2014;311(22):2297–304.

    Article  PubMed  CAS  Google Scholar 

  30. Bretheur SA, Aminian A, Romero-Talamas H, et al. Can diabetes be surgically cured. Long term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus. Ann Surg. 2013;258(4):628–37.

    Google Scholar 

  31. Digiorgi M, Rosen DJ, Choi JJ, et al. Re-emergence of diabetes after gastric bypass in patients with mid-to long term follow-up. Surg Obes Relat Dis. 2010;6(3):254–9.

    Article  Google Scholar 

  32. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. N Engl J Med. 2017;376:641–51.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Roslin MS, Gagner M, Goriparthi R, et al. The rationale for a duodenal switch as the primary surgical treatment of advanced type 2 diabetes mellitus and metabolic disease. Surg Obes Relat Dis. 2015;11:704–10.

    Article  PubMed  Google Scholar 

  34. Marceau P, Biron S, Marceau S, et al. Long-term metabolic outcomes 5 to 20 years after biliopancreatic diversion. Obes Surg. 2015;25:1584–93.

    Article  PubMed  Google Scholar 

  35. Scopinaro N. Biliopancreatic diversion: mechanisms of action and long term results. Obes Surg. 2006;16:683–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA

    Hinali Zaveri, Amit Surve, Daniel Cottam, Austin Cottam, Walter Medlin, Christina Richards, LeGrand Belnap, Samuel Cottam & Benjamin Horsley

Authors
  1. Hinali Zaveri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amit Surve
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniel Cottam
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Austin Cottam
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Walter Medlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christina Richards
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. LeGrand Belnap
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Samuel Cottam
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Benjamin Horsley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel Cottam.

Ethics declarations

Statement of Human and Animal Rights

I certify that the manuscript did not involve the use of animal or human subjects.

Since this is a retrospective study, the formal consent is not required for this type of study.

Conflict of Interest

Daniel Cottam, the corresponding author reports personal fees and other from Medtronic, outside the submitted work.

Hinali Zaveri has no conflict of interest to declare.

Amit Surve has no conflict of interest to declare.

Austin Cottam has no conflict of interest to declare.

Walter Medlin has no conflict of interest to declare.

Christina Richards has no conflict of interest to declare.

LeGrand Belnap has no conflict of interest to declare.

Samuel Cottam has no conflict of interest to declare.

Benjamin Horsley has no conflict of interest to declare.

All other authors have no commercial associations that might be a conflict of interest in relation to this article.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zaveri, H., Surve, A., Cottam, D. et al. Mid-term 4-Year Outcomes with Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy Surgery at a Single US Center. OBES SURG 28, 3062–3072 (2018). https://doi.org/10.1007/s11695-018-3358-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-018-3358-x

Keywords

Search

Navigation