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Revisional Laparoscopic SADI-S vs. Duodenal Switch Following Failed Primary Sleeve Gastrectomy: a Single-Center Comparison of 101 Consecutive Cases

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Abstract

Background

Single-anastomosis duodeno-ileal bypass (SADI-S) is being proposed for obese patients with insufficient weight loss or weight regain after sleeve gastrectomy (SG), but limited information is available. The purpose of this study is to assess the safety and efficacy of SADI-S as a revisional surgery after SG, compared with standard duodenal switch (DS).

Methods

Unicentric cohort study including all patients submitted to SADI-S and DS after failed SG in a high-volume institution, between 2008 and 2020.

Results

Forty-six patients submitted to SADI-S and 55 to DS were included, 37.2 and 41.5 months after SG (p = 0.447), with initial BMI of 56.2 vs. 56.6 (p = 0.777) and 39.2 vs. 39.7 before revisional surgery (p = 0.675). All surgeries were laparoscopic. Clavien-Dindo > II complication rate was 6.5% for SADI-S and 10.9% for DS (p = 0.095), with no 90-day mortality. Follow-up at 2 years was available for 38 SADI-S’ and 38 DS’ patients, with total weight loss of 35.3% vs. 41.7% (p = 0.009), and excess weight loss 64.1% vs. 75.3% (p = 0.014). Comorbidities resolution for SADI-S and DS was: 44.4% vs. 76.9% for diabetes (p = 0.029) and 36.4% vs. 87.5% for hypertension (p = 0.006); with no differences for resolution of dyslipidemia (72.7% vs. 88.9%, p = 0.369) and obstructive sleep apnea (93.3% vs. 91.7%, p = 0.869). DS’ patients required more extra nutritional supplementation. Three SADI-S patients needed conversion to DS, two for biliary reflux and one for weight regain.

Conclusion

After a failed SG, revisional DS permits better weight control and diabetes and hypertension resolution than SADI-S, at the expense of higher supplementation needs.

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Acknowledgements

The authors would like to thank Dr. Núria Vilarrasa and Dr. Fernando Guerrero, from the department of Endocrinology and Nutrition, Bellvitge University Hospital, for their contribution in patients’ preoperative circuit and follow-up. They are also grateful to Ana Aguilar and John Hothersall for their English language assistance.

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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, C/Feixa Llarga s/n. L’Hospitalet de Llobregat, 08907, Barcelona, Spain

    Javier Osorio, Claudio Lazzara, Victor Admella, Sofia Franci-León & Jordi Pujol-Gebellí

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  1. Javier Osorio
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  2. Claudio Lazzara
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Correspondence to Javier Osorio.

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Due to the retrospective nature of this study, formal consent was not required.

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Dr. Osorio and Dr. Pujol-Gebelli report personal fees from Ethicon Endo Surgery Inc., outside the submitted work. The rest of authors have no conflict of interest.

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Key Points

• Duodenal switch is more effective than SADI-S after a failed sleeve gastrectomy.

• Both revisional procedures are safe in experienced hands.

• Duodenal switch is associated to more extra supplementation needs.

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Osorio, J., Lazzara, C., Admella, V. et al. Revisional Laparoscopic SADI-S vs. Duodenal Switch Following Failed Primary Sleeve Gastrectomy: a Single-Center Comparison of 101 Consecutive Cases. OBES SURG 31, 3667–3674 (2021). https://doi.org/10.1007/s11695-021-05469-9

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