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Single anastomosis duodenal switch versus Roux-en-Y gastric bypass in patients with BMI ≥ 50 kg/m2: a multi-centered comparative analysis

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Abstract

Background

Roux-en-Y gastric bypass (RYGB) has consistently demonstrated excellent weight loss and comorbidity resolution. However, outcomes vary based on patient’s BMI. Single anastomosis duodeno-ileostomy with sleeve (SADI-S) is a novel procedure with promising short-term results. The long-term outcomes of SADI-S in patients with BMI ≥ 50 kg/m2 are not well described. We aim to compare the safety and efficacy of SADI-S with RYGB in this patient population.

Methods

We performed a multicenter retrospective study of patients with a BMI ≥ 50 kg/m2 who underwent RYGB or SADI-S between 2008 and 2023. Patient demographics, peri- and post-operative characteristics were collected. Complication rates were reported at 6, 12, 24, and 60 months postoperatively. A multivariate linear regression was used to evaluate and compare weight loss outcomes between both procedures.

Results

A total of 968 patients (343 RYGB and 625 SADI-S; 68.3% female, age 42.9 ± 12.1 years; BMI 57.3 ± 6.7 kg/m2) with a mean follow-up of 3.6 ± 3.6 years were included. Patients who underwent RYGB were older, more likely to be female, and have a higher rate of sleep apnea (p < 0.001), hypertension (p = 0.015), dyslipidemia (p < 0.001), and type 2 diabetes (p = 0.016) at baseline. The rate of bariatric surgery-specific complications was lower after SADI-S compared to RYGB. We reported no bariatric surgery related deaths after 1 year following both procedures. SADI-S demonstrated statistically higher and sustained weight loss at each time interval compared to RYGB (p < 0.001) even after controlling for multiple confounders. Lastly, the rate of surgical non-responders was lower in the SADI-S cohort.

Conclusions

In our cohort, SADI-S was associated with higher and sustained weight-loss results compared to RYGB. Comorbidity resolution was also higher after SADI-S. Both procedures demonstrate a similar safety profile. Further studies are required to validate the long-term safety of SADI-S compared to other bariatric procedures.

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA

    Karl Hage, Kamal Abi Mosleh, Michael L. Kendrick & Omar M. Ghanem

  2. Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr., 1st Floor, Orlando, FL, USA

    Andre F. Teixeira, Romulo Lind, Muhammad A. Jawad & Muhammad Ghanem

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

    Amit Surve & Daniel Cottam

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  1. Karl Hage
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  2. Andre F. Teixeira
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Contributions

K.H, A.F.T, D.C, and O.M.G contributed to the conception of the work; K.H, A.S, R.L, and K.A.M contributed to the analysis, interpretation of data for the work, drafting the first manuscript; A.F.T, M.A.J, M.G, M.L.K, D.C, and O.M.G critically reviewed the manuscript. All authors gave approval of the final version to be published.

Corresponding author

Correspondence to Omar M. Ghanem.

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Disclosures

Karl Hage, Andre F. Teixeira, Amit Surve, Romulo Lind, Muhammad A. Jawad, Muhammad Ghanem, Kamal Abi Mosleh, Michael L. Kendrick, Daniel Cottam, Omar M. Ghanem have no conflicts of interest or financial ties to disclose.

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Hage, K., Teixeira, A.F., Surve, A. et al. Single anastomosis duodenal switch versus Roux-en-Y gastric bypass in patients with BMI ≥ 50 kg/m2: a multi-centered comparative analysis. Surg Endosc (2024). https://doi.org/10.1007/s00464-024-10765-3

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