Owing to the possibility of weight regain after the long-term follow-up of gastric bypass patients and because of the high morbidity of biliopancreatic diversion with duodenal switch, single-anastomosis duodeno-ileal switch (SADIS) has emerged as a rescue procedure in bariatric surgery.
The purpose of this review is to summarize the literature data on SADIS.
University Hospital, NY.
A comprehensive literature review was performed through October 2016 to identify English studies on SADIS performed in human subjects. Outcomes of interest were technical considerations, postoperative complications, weight loss outcome, comorbidity resolution rate, and nutritional deficiency after SADIS.
A total of 12 studies including 581 SADIS patients (217 males and 364 females) were included. SADIS was a primary procedure in 508 patients (87.4%) and a conversion procedure in 73 patients (12.6%). The length of common limb was 300 cm in 54.2%, 250 cm in 23%, and 200 cm in 13.4% of patients. Anastomosis technique was a linear stapler in 26.7% and a hand sewn suture technique in 73.3% of patients. Diarrhea was the most common complication (1.2%). The average %EWL was 30% at 3 months, 55% at 6 months, 70% at 1 year, and 85% at 2 years. Co-morbidity resolution rate was 74.1% for type 2 diabetes mellitus, 96.3% for hypertension, 68.3% for dyslipidemia, 63.3% for obstructive sleep apnea, and 87.5% for GERD. Overall, vitamin A, selenium, and iron deficiency were the most common nutritional deficiencies with the possibility of the protein malnutrition in up to 34% of the patients when measured.
As a modified bariatric procedure, SADIS has promising outcomes for weight loss and comorbidity resolution in morbidly obese patients. When measured, there was a high prevalence of macro-nutrient deficiencies following SADIS. There is a high technical variability, and long-term data are required before any meaningful conclusion can be made.
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Laferrere B. Diabetes remission after bariatric surgery: is it just the incretins? Int J Obes. 2011;35(Suppl 3):S22–5.
Shoar S, Saber AA. Long-term and midterm outcomes of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass: a systematic review and meta-analysis of comparative studies. Surg Obes Relat Dis. 2017;13(2):170–80.
Shoar S, Nguyen T, Ona MA, et al. Roux-en-Y gastric bypass reversal: a systematic review. Surg Obes Relat Dis. 2016;12(7):1366–72.
Sanchez-Pernaute A, Rubio Herrera MA, Perez-Aguirre E, et al. Proximal duodenal-ileal end-to-side bypass with sleeve gastrectomy: proposed technique. Obes Surg. 2007;17(12):1614–8.
Sanchez-Pernaute A, Herrera MA, Perez-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.
Sanchez-Pernaute A, Rubio MA, Perez 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.
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.
Roslin M. SIPS: stomach intestinal pylorus sparing surgery. 2015.
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.
Sanchez-Pernaute A, Rubio MA, Conde M, et al. Single-anastomosis duodenoileal bypass as a second step after sleeve gastrectomy. Surg Obes Relat Dis. 2015;11(2):351–5.
Vilallonga R, Fort JM, Caubet E, et al. Robotically assisted single anastomosis duodenoileal bypass after previous sleeve gastrectomy implementing high valuable technology for complex procedures. J Obes. 2015;2015:586419.
Zaveri H, Surve A, Cottam D, et al. Stomach intestinal pylorus sparing surgery (SIPS) with laparoscopic fundoplication (LF): a new approach to gastroesophageal reflux disease (GERD) in the setting of morbid obesity. Spring. 2015;4:596.
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.
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.
Surve A, Zaveri H, Cottam D. A video case report of stomach intestinal pylorus sparing surgery with laparoscopic fundoplication: a surgical procedure to treat gastrointestinal reflux disease in the setting of morbid obesity. Surg Obes Relat Dis. 2016;12(5):1133–5.
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.
Summerhays C, Cottam D, Cottam A. Internal hernia after revisional laparoscopic loop duodenal switch surgery. Surg Obes Relat Dis. 2016;12(1):e13–5.
Cottam A, Cottam D, Medlin W, et al. A matched cohort analysis of single anastomosis loop duodenal switch versus Roux-en-Y gastric bypass with 18-month follow-up. Surg Endosc. 2016;30(9):3958–64.
Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62(10):e1–34.
Cochrane handbook for systematic reviews of interventions 5.1.0. In: Higgins J, Green S, editors. The Cochrane Collaboration. 2011.
Potoczna N, Harfmann S, Steffen R, et al. Bowel habits after bariatric surgery. Obes Surg. 2008;18(10):1287–96.
Wasserberg N, Hamoui N, Petrone P, et al. Bowel habits after gastric bypass versus the duodenal switch operation. Obes Surg. 2008;18(12):1563–6.
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.
Hedberg J, Sundstrom J, Sundbom M. Duodenal switch versus Roux-en-Y gastric bypass for morbid obesity: systematic review and meta-analysis of weight results, diabetes resolution and early complications in single-centre comparisons. Obes Rev. 2014;15(7):555–63.
Lebel S, Dion G, Marceau S, et al. Clinical outcomes of duodenal switch with a 200-cm common channel: a matched, controlled trial. Surg Obes Relat Dis. 2016;12(5):1014–20.
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):1697–1705.
We are extending our appreciation to Anabela Rodrigues for her endeavors in preparation of this manuscript.
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The authors declare that they have no conflict of interest.
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Shoar, S., Poliakin, L., Rubenstein, R. et al. Single Anastomosis Duodeno-Ileal Switch (SADIS): A Systematic Review of Efficacy and Safety. OBES SURG 28, 104–113 (2018). https://doi.org/10.1007/s11695-017-2838-8
- Single-anastomosis duodeno-ileal switch (SADIS)
- Ileoduodenal switch
- Duodeno-ileal bypass
- Biliopancreatic diversion
- Bariatric surgery
- Systematic review