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A Multi-institutional Study on the Mid-Term Outcomes of Single Anastomosis Duodeno-Ileal Bypass as a Surgical Revision Option After Sleeve Gastrectomy

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Abstract

Introduction

Recently, a single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) has become increasingly popular for patients with BMI > 50 as a primary or staged surgery. Staging allows surgeons to do the sleeve gastrectomy (SG) first with the conversion only happening when a failure or technical challenge is identified.

Purpose

We present the mid-term outcomes of SADI bypass surgery after SG.

Method

A retrospective analysis was performed on a prospective database from four institutions. Ninety-six patients were identified from 2013 to 2018. Patients were divided into two groups: one had two-stage SADI because of insufficient weight loss, the second had planned two-stage SADI because of super obesity (BMI > 50 kg/m2). Incidence of complications was divided into < 30 days and > 30 days.

Result

Of 96 patients, 3 patients were completely lost to follow-up. The mean age was 44.8 ± 11.3 years. There were no deaths or conversion to open surgery. The postoperative early complication and late complication rate was 5.3% and 6.4% respectively. At 24 months, group 2 had higher %weight loss (WL) and change in BMI units compared to group 1 with statistically significant difference. The average WL and change in BMI for entire patient’s population at 24 months after 2nd stage SADI was 20.5% and 9.4 units respectively. The remission rate for DM was 93.7% with or without the use of medication.

Conclusion

The two-stage approach to SADI-S appears technically simpler than a single compromised operation. However, this approach needs more patients to understand its limitations.

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Authors and Affiliations

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

    Hinali Zaveri, Amit Surve, Daniel Cottam, Walter Medlin, Christina Richards & LeGrand Belnap

  2. Rex Bariatric Specialist, 4207 Lake Boone Trail, Suite 120, Raleigh, NC, 27607, USA

    Peter C. Ng, Lindsey S. Sharp, Dustin M. Bermudez, Tricia A. Burns, Krista Herrell, Sophia E. Menozzi & John Ambrose Student

  3. WakeMed Bariatric Specialist of NC, 160 Macgregor Pines Dr #310, Cary, NC, 27511, USA

    Paul Enochs & Jaime Bull

  4. Ventura Advanced Surgical Associates, 3200 Telegraph Rd, Ventura, CA, 93003, USA

    Helmuth Billy & Ryan Fairley

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  1. Hinali Zaveri
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  2. Amit Surve
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Corresponding author

Correspondence to Daniel Cottam.

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Conflict of Interest

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

Peter C. Ng has an active consulting agreement with Medtronic and Johnson & Johnson as proctor/lecturer.

Paul Enochs reports personal fees and other from Medtronic, outside the submitted work.

All other authors have no conflicts of interests to declare.

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

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Zaveri, H., Surve, A., Cottam, D. et al. A Multi-institutional Study on the Mid-Term Outcomes of Single Anastomosis Duodeno-Ileal Bypass as a Surgical Revision Option After Sleeve Gastrectomy. OBES SURG 29, 3165–3173 (2019). https://doi.org/10.1007/s11695-019-03917-1

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