Background

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 in regards to weight loss and potential adverse outcomes. Objective: To analyze SADI revision for LSG, comparing 300cm (SADI-300) versus 250cm (SADI-250) common channel length. Setting: Community Hospital, Bariatric Center of Excellence, USA

Methods

A retrospective review of a prospectively collected data base was performed. All revision patients met the National Institutes of Health guidelines for bariatric surgery. Outcomes included percent total weight loss (%TWL), complications, reoperations, and malabsorptive symptoms.

Results

Forty-five patients underwent SADI revision of LSG. Preoperative weight, BMI and co-morbidities were similar between cohorts. Follow-up was available for 100% of patients at 1 year. Average time from original LSG to SADI was 58 months. Twenty-two patients underwent SADI-300 and 23 patients underwent SADI-250. Patients undergoing SADI-250 experienced greater weight loss than SADI-300 (49 vs 37 lbs; p= 0.045) and greater %TWL (18.5% vs 13.9%, p= 0.03). 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=0.19). Interestingly, the SADI-300 group experienced some weight regain at 24 months with %TWL dropping to 9.7%.

Conclusions

The SADI-250 was associated with significantly greater weight loss at 1 year compared to SADI-300, with no significant findings of malabsorptive states in either group. Further data will be useful in assessing long-term differences.