Single Anastomosis Duodenal Switch (SADI-S)

Abstract

Laparoscopic single-anastomosis duodenal switch or SADI-S (single-anastomosis duodeno-ileal bypass with sleeve gastrectomy) was first described in 2007 with the intention of simplifying a complex surgical technique, the biliopancreatic diversion with duodenal switch (BPD-DS).

From May 2007 to April 2017, 239 patients have been consecutively submitted to SADI-S. Thirty-three patients were submitted to SADI after a failed sleeve, 3 after a failed vertical banded gastroplasty, and 3 were converted from a failed gastric bypass.

Surgical times ranged from 210 to 75 min, with a mean time of between 90 and 120 min. The mean age of the patients was 47 years (22–71), with a mean weight of 119 kg and a mean BMI of 44.6 kg/m². Sixty percent of patients presented type 2 diabetes or had insulin resistance; among them 40% were receiving insulin treatment and had a mean duration of the disease of 9.8 years.

Anastomotic leakage has presented in 1.9% of the patients. Peritoneal bleeding has occurred in one case and gastric bleeding in another patient who was endoscopically treated.

Long-term complications are usually nutritional issues. In the first series of patients with a 200 cm common limb, four patients had to be revised to a longer common channel for recurrent undernutrition and diarrhoea. In the second series with a 250 cm common channel and sometimes 300 cm (aged patients, low BMI), this initial 8% revisional rate has decreased to 2.5%. Dietary counselling and micronutrient supplementation are necessary to warrant an adequate outcome.