Direct and two-step single anastomosis duodenal switch (SADI-S): Unicentric comparative analysis of 232 cases.

Abstract

INTRODUCTION\nThe Single Anastomosis Duodeno-Ileal bypass with Sleeve gastrectomy (SADI-S) is a bariatric surgery conceived to simplify the duodenal switch in order to reduce its postoperative complications. The objective of this study is to assess the safety and efficacy of SADI-S, comparing its results in both direct and two-step procedure.\n\n\nMETHODS\nUnicentric cohort study that includes patients submitted to SADI-S, both direct or in two-step, between 2014 and 2019.\n\n\nRESULTS\nTwo hundred thirty-two patients were included, 192 were submitted to direct SADI-S and 40 had previously undergone a sleeve gastrectomy. The severe complications rate (Clavien-Dindo\u202f≥\u202fIIIA) was 7.8%, being hemoperitoneum and duodenal stump leak the most frequent ones. One patient was exitus between the first 90 days after surgery (0.4%). Patients submitted to direct SADI-S had an initial body mass index (BMI) of 49.6\u202fkg/m2 in comparison of 56.2\u202fkg/m2 in the two-step SADI-S (P\u202f<\u202f.001). The mean excess weight loss (EWL) at two years was higher in direct SADI-S (77.3 vs. 59.3%, P\u202f<\u202f.05). Rate of comorbidities resolution was 88.5% for diabetes, 73.0% for hypertension, 77.0% for dyslipidemia and 85.7% for sleep apnea, with no differences between both techniques.\n\n\nCONCLUSION\nIn medium term, SADI-S is a safe and effective technique that offers a satisfactory weight loss and remission of comorbidities. Patients submitted to two-step SADI-S had a higher initial BMI and presented a lower EWL than direct SADI-S.