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One-Stage Vs. Two-Step One Anastomosis Duodenal Switch (OADS/SADI-S): A Safety and Efficacy Single-Center Propensity-Score Matched Analysis

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Abstract

Introduction

One Anastomosis Duodenal Switch (OADS/SADI-S) is used both as a one stage and a second-step procedure, either planned or revisional after a failed sleeve gastrectomy. However, there is lack of adjusted comparative evidence validating its use.

Material and Methods

Propensity-score matched comparison between patients submitted to one-stage vs. two-step OADS, adjusted by age, gender, and initial body mass index (BMI).

Results

One hundred ninety-five patients (130 one-stage and 65 two-step OADS) were included, with mean initial BMI 52.4 kg/m2. Overall complication rate was 6.6% in the short-term (3.3% Clavien-Dindo ≥ III), and 7.3% in the long-term, with no differences between groups. Follow-up at 1 and 3 years was 83.6% and 61.5%. After one-stage OADS, total weight loss was 36.6 ± 8.2% at 1 year and 30.4 ± 10.3% at 3 years, vs. 30.2 ± 9.4% and 25.6 ± 10.2% after two-steps OADS (p = 0.021). Resolution rates of diabetes mellitus, hypertension, dyslipidemia, and obstructive sleep apnea were 86.4%, 80.4%, 78.0%, and 73.3%, with no differences between groups.

Conclusion

One-stage OADS is a safe and effective bariatric technique for patients with grade III and IV obesity. The two-step strategy does not reduce postoperative risks and may compromise weight loss results at mid-term.

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Acknowledgements

The authors would like to thank Esther García Lerma and Natàlia Pallarès Fontanet, specialists in biostatistics, for their essential help in this study’s design and analysis. We would also like to thank Fernando Guerrero, endocrinologist, and the rest of the severe obesity treatment multidisciplinary team in Bellvitge University Hospital, for their contribution in the study, treatment, and follow-up of all patients.

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Authors and Affiliations

  1. Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, Carrer de La Feixa Llarga, S/N. 08907 L’Hospitalet de Llobregat, Barcelona, Spain

    Javier Osorio, Víctor Admella, David Merino, Lucía Sobrino, Carlota Tuero & Claudio Lazzara

  2. Department of Endocrinology, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain

    Núria Vilarrasa

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  1. Javier Osorio
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Correspondence to Javier Osorio.

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Key Points

• One-stage OADS is a safe and effective bariatric technique.

• Two-step OADS does not reduce postoperative risks in comparison to one-stage OADS.

• Two-step OADS may compromise weight loss results at mid-term.

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Osorio, J., Admella, V., Merino, D. et al. One-Stage Vs. Two-Step One Anastomosis Duodenal Switch (OADS/SADI-S): A Safety and Efficacy Single-Center Propensity-Score Matched Analysis. OBES SURG (2024). https://doi.org/10.1007/s11695-024-07280-8

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  • DOI: https://doi.org/10.1007/s11695-024-07280-8

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