José M Balibrea1,2, Ramón Vilallonga3,4, Marta Hidalgo5, Andreea Ciudin6, Óscar González3,4, Enric Caubet3,4, Andrés Sánchez-Pernaute7, José M Fort3,4, Manel Armengol-Carrasco4,5. 1. Metabolic and Bariatric Surgery Unit, EAC-BS Center of Excellence, Vall d'Hebron University Hospital, Barcelona, Spain. balibrea@gmail.com. 2. Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain. balibrea@gmail.com. 3. Metabolic and Bariatric Surgery Unit, EAC-BS Center of Excellence, Vall d'Hebron University Hospital, Barcelona, Spain. 4. Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain. 5. Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain. 6. Department of Endocrinology, Vall d'Hebron University Hospital, Barcelona, Spain. 7. Department of General Surgery, Clínico San Carlos Hospital, Madrid, Spain.
Abstract
BACKGROUND: In patients with insufficient weight loss after sleeve gastrectomy (SG) or in super obese individuals, among many surgical options available, a single-anastomosis duodeno-ileal bypass (SADI) after SG (SADI-S) could be considered. Due to the limited information available about the use of SADI as a second-step procedure, the objective of this study was to evaluate the mid-term results and responsiveness of SADI after sleeve gastrectomy. METHODS: We present prospective data from 30 consecutive patients with a mean BMI of 40.1 kg/m2, a mean excess weight of 44.7 kg, and a mean excess weight loss (EWL) of 37.5%, who were submitted to a SADI as a second-step revisional procedure. RESULTS: There were no intraoperative complications. Four early complications (13.34%) occurred within the first 24 postoperative hours. Six, 12, and 24-month follow-up number of patients available was 30 (100%), 22 (73.3%), and 16 (53.34%), respectively. Percent total weight loss (%WL) was 28.1 at the time of revision and 46.26% 24 months after SADI. Global %EWL was 78.93 ± 35.5. The complete remission rate after SG was 50% for diabetes, 33.3% for dyslipidemia, and 25% for hypertension, and 71.4%, 31.2%, and 27.7%, respectively, after SADI. Three (10%) patients required revisional surgery due to hypoalbuminemia. CONCLUSIONS: SADI as a second-step strategy in super obese patients or after failed SG offers a more than satisfactory ponderal weight loss and an acceptable comorbidities resolution. However, the risk of severe malnutrition after distal SADI-S makes necessary a careful patient selection.
BACKGROUND: In patients with insufficient weight loss after sleeve gastrectomy (SG) or in super obese individuals, among many surgical options available, a single-anastomosis duodeno-ileal bypass (SADI) after SG (SADI-S) could be considered. Due to the limited information available about the use of SADI as a second-step procedure, the objective of this study was to evaluate the mid-term results and responsiveness of SADI after sleeve gastrectomy. METHODS: We present prospective data from 30 consecutive patients with a mean BMI of 40.1 kg/m2, a mean excess weight of 44.7 kg, and a mean excess weight loss (EWL) of 37.5%, who were submitted to a SADI as a second-step revisional procedure. RESULTS: There were no intraoperative complications. Four early complications (13.34%) occurred within the first 24 postoperative hours. Six, 12, and 24-month follow-up number of patients available was 30 (100%), 22 (73.3%), and 16 (53.34%), respectively. Percent total weight loss (%WL) was 28.1 at the time of revision and 46.26% 24 months after SADI. Global %EWL was 78.93 ± 35.5. The complete remission rate after SG was 50% for diabetes, 33.3% for dyslipidemia, and 25% for hypertension, and 71.4%, 31.2%, and 27.7%, respectively, after SADI. Three (10%) patients required revisional surgery due to hypoalbuminemia. CONCLUSIONS: SADI as a second-step strategy in super obesepatients or after failed SG offers a more than satisfactory ponderal weight loss and an acceptable comorbidities resolution. However, the risk of severe malnutrition after distal SADI-S makes necessary a careful patient selection.
Entities:
Keywords:
Duodeno-ileal bypass; Obesity; SADI-S; Sleeve gastrectomy; Weight loss
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