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Evaluation of Metabolic Outcomes Following SADI-S: a Systematic Review and Meta-analysis

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Abstract

Purpose

Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) offers a novel bariatric procedure. This systematic review and meta-analysis evaluates observational and comparative studies evaluating SADI-S, with meta-analysis comparing outcomes to other malabsorptive procedures (MPs).

Materials and Methods

Systematic search of MEDLINE, Embase, Scopus, and Web of Science was conducted in March 2021. The study followed PRISMA guidelines. Studies evaluating SADI-S with n > 5 were included. Primary outcome was diabetes (DM) remission, and secondary outcomes included perioperative outcomes, comorbidity resolution, and weight loss.

Results

We reviewed 2285 studies with 16 included evaluating 3319 patients and 1704 (51.3%) undergoing SADI-S. SADI-S patients had increased BMI (49.6 kg/m2 vs 48.8 kg/m2) and weight (139.7 kg vs 137.1 kg), were more likely to have DM (46.3% vs 42.1%), and dyslipidemia (36.6% SADI-S vs 32.7%).

SADI-S had a shorter operative duration than MPs (MD − 36.74, p < 0.001), 0.85-day shorter post-operative stay (p < 0.001), and trended towards fewer complications (OR 0.69, p = 0.06). Rate of reoperation (OR 0.83, p = 0.59) was similar and DM remission was similar (OR 0.07, p = 0.1). Subgroup analysis suggested greater DM remission than Roux-en-Y gastric bypass (OR 4.42, p = 0.04). SADI-S had fewer malabsorptive complications, though follow-up was shorter. Weight loss was 37.3% compared to 35.6% total weight loss after SADI-S and MPs, respectively.

Conclusion

SADI-S demonstrates improved metabolic and weight loss outcomes with lower perioperative risks. SADI-S represents a promising bariatric procedure but long-term outcomes are needed to guide future uptake.

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Authors and Affiliations

  1. Department of Surgery, University of Alberta, Edmonton, AB, Canada

    Kevin Verhoeff, Valentin Mocanu, Jerry Dang & Noah J. Switzer

  2. University of Alberta, Edmonton, AB, Canada

    Aiden Zalasky

  3. John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada

    Janice Y. Kung

  4. Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada

    Daniel W. Birch & Shahzeer Karmali

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  1. Kevin Verhoeff
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Key Points

• SADI-S may offer improved diabetes remission than LRYGB.

• SADI-S perioperative risks are comparable to OAGB and LRYGB.

• SADI-S represents a comparatively faster bariatric procedure.

• SADI-S may offer fewer malabsorptive complications than DS.

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Verhoeff, K., Mocanu, V., Zalasky, A. et al. Evaluation of Metabolic Outcomes Following SADI-S: a Systematic Review and Meta-analysis. OBES SURG 32, 1049–1063 (2022). https://doi.org/10.1007/s11695-021-05824-w

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