Background

Single-anastomosis duodenoileal bypass (SADI) is an efficacious revision to address weight gain after laparoscopic sleeve gastrectomy (LSG). Controversy remains regarding optimal length of the common channel for weight loss and potential adverse outcomes.ObjectiveTo analyze SADI revision for LSG, comparing 250cm (SADI-250) versus 300cm (SADI-300) common channel length.Setting: Community Hospital, Bariatric Center of Excellence, USA

Methods

Data were collected prospectively from 58 patients who had a revision of LSG to SADI (35 with SADI-250; 23 with SADI-300). Outcomes included percent total weight loss (%TWL), complications, reoperations, and malabsorptive symptoms.

Results

Data at 2 years were available for 56 patients (97%). There were no differences between common channel groups in preoperative weight, BMI and co-morbidities. Average time from original LSG to SADI was 59 months. Patients undergoing SADI-250 experienced greater weight loss than SADI-300 (55 vs 27 lbs; p<.001) and greater %TWL (20.9% vs 10.6%, p<.001) at 2 years. There was one reoperation in the SADI-300 group for a duodenal stump leak and no significant difference in the number of bowel movements or malabsorptive symptoms between groups (p=0.62).

Conclusions

The SADI-250 was associated with significantly greater weight loss at 2 years compared to SADI-300, with no significant findings of malabsorptive states in either group. SADI revision for LSG using a 250 cm common channel leads to significant additional weight loss at rates shown to be associated with durable diabetes remission (20% TWL). Further data will be useful in assessing long-term differences.