Background

The SADI procedure was introduced to avoid complications associated with the Roux-en-Y gastric bypass including; dumping syndrome, internal hernias and anastomotic ulcers. SADI involves a sleeve gastrectomy and a duodeno-ileostomy with a common channel of 250-300cm. Optimal length for the common channel (CC) and biliary-pancreatic (BP) limb remains contested. Our study aims to perform a retrospective study of patients whom have undergone a SADI and compare outcomes with its modification; the SDJB procedure. The SDJB is similar to the SADI other than the BP limb is shortened to 150cm. The aim was to confirm reduction in malabsorptive complications whilst maintaining weight loss targets.

Methods

A retrospective analysis of a prospective database was performed. Single institution and surgeon data. 78 SADI, 37 SDJB patients and a BMI propensity matched cohort of 116 SG patients were identified. Inclusion criteria: BMI 35-70, operations between December 2015 – December 2021. Exclusion criteria: revisional and Minimizer ring procedures. Data was collected pre and post operative. Outcomes were EWL% at 5 years, Biochemistry at 1,3,5 year post operative, complications including readmissions, reoperations and resolution of metabolic disease.

Results

Shortening limb length proved non inferior to traditional SADI in regards to EWL% at 5 years. (p=0.137) with both SADI and SDJB proving superior to SG alone at 5 years (p=<0.001 and p=0.033 respectively). SDJB proved non inferior to SADI at resolution of T2DM with both groups significantly reducing HBA1C greater than SG group alone post operatively (p=0.006, p=0.009 respectively). All three groups significantly reduced use of CPAP, Statins and antihypertensive medication post operative however there was no significant difference between groups. SDJB group notably significantly improved post operative stool count per day and Bristol stool classification post-op compared to SADI group (p=0.03 and p=0.001 respectively).

Conclusions

Overall shortening limb length proved non inferior to traditional SADI in regard to EWL over 5 years. With SADI /SDJB groups proving superior to SG alone for long term EWL%. SDJB was significantly better then SADI at reducing bowel motions per day and improving stool consistency. SDJB proved overall non inferior to SADI and improved GIT symptoms whilst maintaining long term EWL%.