Abstract
Background
Laparoscopic single anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) is a recently developed one- or two-stage operation based on biliopancreatic diversion that is used to treat morbid obesity. Some midterm outcomes suggest that malabsorption is a possible complication following the procedure. Therefore, conversion to a less malabsorptive procedure may be required. We aim to describe and analyze the outcomes after laparoscopic conversion of SADI-S to non-malabsorptive or less malabsorptive procedures.
Methods
From January 2015 to April 2017, five patients underwent laparoscopic conversion to single anastomosis duodenojejunal bypass with sleeve gastrectomy (SADJ-S) (video) following SADI-S, and one female patient underwent laparoscopic conversion to gastric bypass (GBP) following SADI-S, after presenting with severe protein-calorie malnutrition, nutritional deficiencies, poor quality of life, or increased number of bowel movements.
Results
Mean preoperative BMI was 24.0 kg/m2 (20.4–27.5 kg/m2). Four patients underwent SADI-S to SADJ-S conversions and one underwent a SADI-S to Roux-en-Y duodenojejunal bypass. All cases were performed laparoscopically. No relevant postoperative complications or mortality was reported and the mean hospital stay was 4.6 days. Malabsorptive symptoms resolved in all patients. All patients experienced weight regain. Mean BMI increase was 7.1 kg/m2 (5–10.8 kg/m2).
Conclusions
Outcomes of laparoscopic conversion to SADJ-S or GBP after SADI-S were acceptable, showing clinical improvement of malnutrition, nutritional deficiencies, and quality of life in all cases. Weight regain must be advised. These techniques appear feasible and free of severe long-term complications. Further investigation is warranted to understand the best common channel length for patients undergoing SADI-S.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Juodeikis Ž, Brimas G. Long-term results after sleeve gastrectomy: a systematic review. Surg Obes Relat Dis. 2017;13(4):693–699.
Iannelli A, Schneck AS, Topart P, et al. Laparoscopic sleeve gastrectomy followed by duodenal switch in selected patients versus single-stage duodenal switch for superobesity: case-control study. Surg Obes Relat Dis. 2013;9:531–8.
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;11:351–5.
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;20:1720–6.
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;17:1614–8.
Balibrea JM, Vilallonga R, Hidalgo M, Ciudin A, González Ó, Caubet E, SánchezPernaute A, Fort JM, Armengol-Carrasco M. Mid-term results and responsiveness predictors after two-step single-anastomosis duodeno-ileal bypass with sleeve gastrectomy. Obes Surg. 2016.
Ma P, Reddy S, Higa KD. Revisional bariatric/metabolic surgery: what dictates its indications? Curr Atheroscler Rep. 2016;18:42.
Angrisani L, Santonicola A, Iovino P, Vitiello A, Zundel N, Buchwald H, Scopinaro N. Bariatric surgery and endoluminal procedures: IFSO Worldwide Survey 2014. Obes Surg. 2017 Apr 13.
Switzer NJ, Karmali S, Gill RS, et al. Revisional bariatric surgery. Surg Clin North Am. 2016;96:827–42.
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;9:731–5.
Parrott J, Frank L, Rabena R, Craggs-Dino L, Isom KA, Greiman L. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: micronutrients. Surg Obes Relat Dis. 2017.
Strain GW, Torghabeh MH, Gagner M, et al. Nutrient status 9 years after biliopancreatic diversion with duodenal switch (BPD/DS): an observational study. Obes Surg. 2017; https://doi.org/10.1007/s11695-017-2560-6.
Topart PA, Becouarn G. Revision and reversal after biliopancreatic diversion for excessive side effects or ineffective weight loss: a review of the current literature on indications and procedures. Surg Obes Relat Dis. 2015;11:965–72.
Martini F, Paolino L, Marzano E, et al. Single-anastomosis pylorus-preserving bariatric procedures: review of the literature. Obes Surg. 2016;26:2503–15.
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;12:1014–20.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Author 1 and 2 are occasional consultants for Ethicon Endo-Surgery. All other authors have no conflicts of interest. The manuscript has been read and approved by all authors. No financial support for the manuscript preparation.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Vilallonga, R., Balibrea, J.M., Curell, A. et al. Technical Options for Malabsorption Issues After Single Anastomosis Duodenoileal Bypass with Sleeve Gastrectomy. OBES SURG 27, 3344–3348 (2017). https://doi.org/10.1007/s11695-017-2931-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-017-2931-z