Background

Single anastomosis duodenoileostomy with sleeve (SADI-S) is becoming increasingly popular due to its decreased technical complexity yet excellent outcomes with perceived lower complication rates compared to the biliopancreatic diversion with duodenal switch (BPD-DS). Our goal was to compare the early outcomes of patients undergoing conversion from a vertical sleeve gastrectomy (VSG) to either a BPD/DS or SADI-S.

Methods

The prospectively maintained Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database from 2020-2021 was used to compare patients who underwent VSG conversion to a BPD/DS or SADI-S. A 1:1 nearest neighbor propensity score-matched analysis was performed.

Results

1,874 patients underwent conversion from VSG to either BPD/DS (n=1,152) or SADI-S (n=722). Patients undergoing SADI-S were more likely to have a history of deep vein thrombosis (3.74% vs 2.08%; p=0.046). Of the 708 patient pairs, SADI-S patients had an increased rate of outpatient dehydration treatment (2.97% vs 1.27%; p=0.045). There were no statistically significant differences in any major postoperative complications including reintervention, readmission, reoperation, leak, postoperative bleeding, or death within thirty days. Interestingly, there was no significant difference in operative times between the matched SADI-S and BPD/DS groups (148min +- 70 vs 149min +- 67;p=0.717).

Conclusions

Early postoperative complications are similar when converting VSG to BPD-DS or SADI-S. While conclusions can only be made about early postoperative complications, BPD-DS appears to have a similar safety profile compared to SADI-S. Long-term benefits and complications need to be further defined for more definitive recommendations regarding procedure choice when converting VSG.