Background

A common channel length of 250 cm offers very good bariatric and metabolic results in SADI-S. The possibility of malnutrition makes many surgeons choose a more conservative but still effective 300 cm length.

Methods

235 patients with 5 years follow-up were included. Mean age was 47 years and mean BMI 47.2 kg/m2. 116 patients had diabetes. 48 patients had a previous bariatric operation. Limb length was 250 cm in 178 cases and 300 in 57.

Results

Patients submitted to SADI-S 250 had a significantly higher preoperative BMI (48 vs 45 kg/m2) and a higher diabetes prevalence (50 vs 45%, p = 0.026). At 5 years, TWL > 30% was achieved in 52% of the cases after SADI-S 300 and in 86% after 250. Remission of type-2 diabetes was higher for patients undergoing SADI-S 250, 64 vs 29%, p = 0.01, and levels of HbA1c were significantly lower, 5.51% vs 6.07%, p = 0.01. Patients submitted to SADI-S 250 had significantly lower levels of calcium and vitamin D, and higher levels of AST and ALT. There were no differences in the number of bowel movements. Nine patients were reoperated for malnutrition in the group of SADI-S 250 and 0 in the group of SADI-S 300 (p = 0.08).

Conclusions

SADI-S is a highly effective operation, either with a 250 cm common limb or with a 300 cm one. Weight loss results are better for patients with a shorter common limb, but the incidence of malnutrition is also higher.