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Becerril S, Cienfuegos JA, Rodríguez A, Catalán V, Ramírez B, Valentí V, Moncada R, Unamuno X, Gómez-Ambrosi J, Frühbeck G. Single anastomosis duodeno-ileal bypass with sleeve gastrectomy generates sustained improvement of glycemic control compared with sleeve gastrectomy in the diet-induced obese rat model. J Physiol Biochem 2024; 80:149-160. [PMID: 37935948 PMCID: PMC10810039 DOI: 10.1007/s13105-023-00993-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/10/2023] [Indexed: 11/09/2023]
Abstract
Bariatric surgery has become a recognized and effective procedure for treating obesity and type 2 diabetes (T2D). Our objective was to directly compare the caloric intake-independent effects of sleeve gastrectomy (SG) and single anastomosis duodenoileal bypass with SG (SADI-S) on glucose tolerance in rats with diet-induced obesity (DIO) and to elucidate the differences between bariatric surgery and caloric restriction.A total of 120 adult male Wistar rats with DIO and insulin resistance were randomly assigned to surgical (sham operation, SG, and SADI-S) and dietary (pair-feeding the amount of food eaten by animals undergoing the SG or SADI-S surgeries) interventions. Body weight and food intake were weekly monitored, and 6 weeks after interventions, fasting plasma glucose, oral glucose and insulin tolerance tests, plasma insulin, adiponectin, GIP, GLP-1, and ghrelin levels were determined.The body weight of SADI-S rats was significantly (p < 0.001) lower as compared to the sham-operated, SG, and pair-fed groups. Furthermore, SADI-S rats exhibited decreased whole body fat mass (p < 0.001), lower food efficiency rates (p < 0.001), and increased insulin sensitivity, as well as improved glucose and lipid metabolism compared to that of the SG and pair-fed rats.SADI-S was more effective than SG, or caloric restriction, in improving glycemic control and metabolic profile, with a higher remission of insulin resistance as well as long-term weight loss.
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Affiliation(s)
- Sara Becerril
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Avda. Pío XII, 36, 31008, Pamplona, Spain.
- CIBER Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain.
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain.
| | - Javier A Cienfuegos
- CIBER Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain
- Department of Surgery, Clínica Universidad de Navarra, 31008, Pamplona, Spain
| | - Amaia Rodríguez
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Avda. Pío XII, 36, 31008, Pamplona, Spain
- CIBER Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Victoria Catalán
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Avda. Pío XII, 36, 31008, Pamplona, Spain
- CIBER Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Beatriz Ramírez
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Avda. Pío XII, 36, 31008, Pamplona, Spain
- CIBER Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Víctor Valentí
- CIBER Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain
- Department of Surgery, Clínica Universidad de Navarra, 31008, Pamplona, Spain
| | - Rafael Moncada
- CIBER Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain
- Department of Anesthesia, Clínica Universidad de Navarra, Pamplona, Spain
| | - Xabier Unamuno
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Avda. Pío XII, 36, 31008, Pamplona, Spain
- CIBER Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain
- Medical Engineering Laboratory, University of Navarra, Pamplona, Spain
| | - Javier Gómez-Ambrosi
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Avda. Pío XII, 36, 31008, Pamplona, Spain
- CIBER Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Gema Frühbeck
- Metabolic Research Laboratory, Clínica Universidad de Navarra, Avda. Pío XII, 36, 31008, Pamplona, Spain.
- CIBER Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Pamplona, Spain.
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain.
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Avda. Pío XII, 36, Pamplona, Spain.
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Ataya K, Bsat A, Al Tannir AH, Al Jaafareh AM, Rabih Al A, Abi Saad G. Single Anastomosis Duodeno-Ileal Bypass (SADI) as a Second Step After Failed Sleeve Gastrectomy: Systematic Review and Meta-analysis. JOURNAL OF METABOLIC AND BARIATRIC SURGERY 2023; 12:35-43. [PMID: 38196784 PMCID: PMC10771976 DOI: 10.17476/jmbs.2023.12.2.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 01/11/2024]
Abstract
Purpose Our aim in this study is to assess single anastomosis duodeno-ileal bypass (SADI) as a salvage procedure following sleeve gastrectomy (SG), examining its technical feasibility, outcomes, and potential complications. Materials and Methods A systematic review and meta-analysis were conducted, drawing data from PubMed, Medline, and the Cochrane library. The analysis encompassed 14 studies, involving 1,066 patients. We evaluated operative time, comorbidity resolution (hypertension, dyslipidemia, diabetes), post-operative diarrhea incidence, excess weight loss (EWL) at six, twelve, and twenty-four months, and post-operative leak rates. Results SADI as a salvage procedure following SG yielded positive outcomes. Mean operative time was 125.98 minutes (95% CI 102.50-149.46, I2=99%). Importantly, SADI led to comorbidity resolution in a notable proportion of cases: hypertension in 48% (95% CI 38-57%, I2=44%), dyslipidemia in 55% (95% CI 40-69%, I2=30%), and diabetes in 63% (95% CI 53-72%, I2=30%) of patients. Post-operative diarrhea incidence was relatively low at 2% (95% CI 1-9%, I2=75%). In terms of weight loss, SADI patients exhibited substantial EWL: 47.73% (95% CI 37.86-57.61, I2=95%) at six months, 59.39% (95% CI 51.18-67.61, I2=95%) at twelve months, and 23.84% (95% CI 5.76-41.92, I2=100%). At twenty-four months. Furthermore, post-operative leak rate was relatively low, reported in only 1% (95% CI 0-5%, I2=80%) of cases. Conclusion SADI as a salvage procedure post-SG demonstrates technical feasibility and marked effectiveness. It offers substantial comorbidity resolution, significant weight loss, and low post-operative complication rates, notably post-operative leaks. Further research should investigate the long-term impact of SADI on patient nutritional status to facilitate its broader adoption.
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Affiliation(s)
- Karim Ataya
- Department of Bariatric Surgery, Kings College Hospital London, London, UK
| | - Ayman Bsat
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdul Hafiz Al Tannir
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Amir Rabih Al
- Lebanese University Faculty of Medical Sciences, Beirut, Lebanon
| | - George Abi Saad
- Department of General Surgery, American University of Beirut, Beirut, Lebanon
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Esparham A, Roohi S, Ahmadyar S, Dalili A, Moghadam HA, Torres AJ, Khorgami Z. The Efficacy and Safety of Laparoscopic Single-Anastomosis Duodeno-ileostomy with Sleeve Gastrectomy (SADI-S) in Mid- and Long-Term Follow-Up: a Systematic Review. Obes Surg 2023; 33:4070-4079. [PMID: 37880461 DOI: 10.1007/s11695-023-06846-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/13/2023] [Accepted: 09/24/2023] [Indexed: 10/27/2023]
Abstract
This systematic review of 10 studies aimed to investigate the mid- and long-term results of duodeno-ileostomy with sleeve gastrectomy (SADI-S) according to the PRISMA guideline. Related articles, which reported outcomes of laparoscopic SADI-S with follow-up ≥ 3 years, were selected and analyzed. The percentage of excess weight loss (EWL) was 70.9-88.7%, and 80.4% at 6, and 10 years, respectively. The more common late complications were malabsorption (6.3%) and gastroesophageal reflux disease (GERD) (3.6%). The remission rates of hypertension, diabetes, GERD, obstructive sleep apnea, and dyslipidemia were 62.9%, 81.3%, 53.2%, 60.9%, and 69.7%, respectively. In conclusion, SADI-S is a safe and effective surgical technique with durable weight loss and a high rate of comorbidity resolution in mid and long term.
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Affiliation(s)
- Ali Esparham
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samira Roohi
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Soheil Ahmadyar
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Dalili
- Department of General Surgery, School of Medicine, Surgical Oncology Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hengameh Anari Moghadam
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Antonio José Torres
- General and Digestive Surgery Service, Hospital Clínico San Carlos, Department of Surgery, Complutense University Medical School, Universidad Complutense de Madrid (UCM), IdISSC, Madrid, Spain
| | - Zhamak Khorgami
- Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK, USA.
- Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK, 1919 S. Wheeling Avenue, Suite 600, Tulsa, OK, USA.
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Skulsky SL, Kolozsvari O, Stacey D, Shorr R, Gu J. Decision-making in the management of obesity: a scoping review protocol. JBI Evid Synth 2022; 20:2760-2773. [PMID: 36081388 DOI: 10.11124/jbies-21-00350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This scoping review will evaluate the current published literature on decision-making in obesity management. INTRODUCTION Obesity is increasing in incidence worldwide. Although indications have been established for a variety of available treatment modalities, treatment selection must also factor in patient preferences, clinician expertise, and resource availability. Such considerations are crucial given the exponential expansion of new surgical techniques and pharmacologic options in the last decade. Although literature exists for decision-making on various obesity management topics, there are no scoping reviews systematically mapping the literature. This scoping review is timely given that the treatment of obesity has evolved into a multidisciplinary endeavor with myriad management decisions that both patients and clinicians must navigate. INCLUSION CRITERIA The review will consider for inclusion full-text primary studies, published in English from the year 2000 onwards, pertaining to decision-making in obesity management for health care providers involved in obesity management for patients aged ≥18 years. METHODS This scoping review will be conducted in accordance with the JBI methodology for scoping reviews. Embase (Elsevier), MEDLINE (PubMed), Scopus (Elsevier), Web of Science (Clarivate), CINAHL Complete (EBSCO), PsycINFO (EBSCO), and Cochrane Central (Wiley) will be systematically searched using a predefined strategy. Two independent reviewers will conduct a 3-tiered screen of identified articles, with a third reviewer resolving disputes. Data extraction will be performed using a predefined, yet flexible form. Descriptive summaries and mapping will be provided for included studies. Available evidence and knowledge gaps will be identified and summarized as they relate to specific concepts, populations, and contexts in obesity management decision-making.
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Affiliation(s)
| | - Oana Kolozsvari
- The Ottawa Hospital Bariatric Centre of Excellence, Ottawa, ON, Canada
| | - Dawn Stacey
- Department of Clinical Epidemiology, University of Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Risa Shorr
- Learning Services, The Ottawa Hospital, Ottawa, ON, Canada
| | - Jeffrey Gu
- Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
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Lind RP, Ghanem M, Teixeira AF, Jawad MA, Osorio J, Lazzara C, Sobrino L, Ortiz-Ciruela D, de Gordejuela AGR. Single- Versus Double-Anastomosis Duodenal Switch: Outcomes Stratified by Preoperative BMI. Obes Surg 2022; 32:3869-3878. [DOI: 10.1007/s11695-022-06315-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 10/31/2022]
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Single Versus Double Anastomosis Duodenal Switch in the Management of Obesity: A Meta-analysis and Systematic Review. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2022; 32:595-605. [PMID: 36130714 DOI: 10.1097/sle.0000000000001102] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/12/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Biliopancreatic diversion with duodenal switch (BPD-DS) is an effective yet technically challenging bariatric surgery with many complications. Alternatively, single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) was recently introduced as a simplified bariatric procedure. This meta-analysis aimed to assess the safety and efficacy of SADI-S compared with BPD-DS in the management of patients with obesity. METHODS Cochrane, Embase, PubMed, Scopus, and Web of Science were searched for articles from their inception to May 2022 by 2 independent reviewers using the Preferred Reporting Items for Systematic Reviews and Meta-analysis system. The review was registered prospectively with PROSPERO (CRD42022333521). RESULTS From 123 studies screened, 6 studies met the eligibility criteria, with a total of 1847 patients with obesity undergoing either SADI-S (n=818) or BPD-DS (n=1029). Preoperative body mass index was similar between the 2 groups, and the BPD-DS group had a greater % excess body mass index loss (EBMIL) (MD=-10.16%, 95% confidence interval: -11.80, -8.51, I2=0%) at 2 years compared with the SADI-S group. There was no difference observed in preoperative comorbidities and remission, including diabetes, hypertension, and dyslipidemia between SADI-S and BPD-DS cohorts. Compared with BPD-DS, SADI-S had shorter hospital stays (MD=-1.36 d, 95% CI: -2.39, -0.33, I2=86%), and fewer long-term (>30 d) complications (OR=0.56, 95% CI: 0.42, 0.74, I2=20%). Conversely, among nutritional deficiency outcomes, the SADI-S group had few patients with abnormal vitamin D (OR=0.51, 95% CI: 0.36, 0.72, I2=0%) values than the BPD-DS group. CONCLUSIONS SADI-S has shown to be a possible alternative treatment option to BPD-DS in managing patients with obesity. Despite the promising results, further randomized controlled studies with more extended follow-up periods are necessary to ascertain the safety and efficacy of the treatment.
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Verhoeff K, Mocanu V, Jogiat U, Forbes H, Switzer NJ, Birch DW, Karmali S. Patient Selection and 30-Day Outcomes of SADI-S Compared to RYGB: a Retrospective Cohort Study of 47,375 Patients. Obes Surg 2022; 32:1-8. [PMID: 35445967 PMCID: PMC9022408 DOI: 10.1007/s11695-022-06068-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/07/2022] [Accepted: 04/13/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) offers a novel bariatric procedure with few comparative studies evaluating patient selection or perioperative outcomes. We aim to compare SADI-S to Roux-en-Y gastric bypass (RYGB). MATERIALS AND METHODS The 2020 Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) registry was analyzed, comparing SADI-S to RYGB. Bivariate analysis was performed to determine intergroup differences. Multivariable logistic regression determined factors associated with serious complications and mortality. RESULTS We evaluated 47,375 patients, with 501 (1.1%) receiving SADI-S. Patients undergoing SADI-S had higher body mass index (51.4 ± 9.7 kg/m2 SADI-S vs. 44.6 ± 7.9 kg/m2 RYGB; p < 0.001), and more metabolic comorbidities including non-insulin dependent diabetes (21.7% SADI-S vs 19.0% RYGB; p = 0.011), insulin dependent diabetes (12.0% SADI-S vs. 8.6% RYGB; p = 0.011), and hypertension (54.9% SADI-S vs 47.6% RYGB; p < 0.001). Patients undergoing SADI-S experienced more anastomotic leaks (2.2% vs. 0.5%; p < 0.001), reoperations (5.0% vs 2.6%; p < 0.001), pneumonias (1.6% vs 0.5%; p < 0.001), had sepsis more frequently (1.4% vs 0.3%; p < 0.001), and required more unplanned reintubations (1.2% vs 0.3%; p = 0.004). SADI-S was independently associated with serious complications (OR 1.45, CI 1.09-1.95, p < 0.001) but was not a predictor of mortality (OR 3.29, p = 0.060). CONCLUSIONS In comparison to RYGB, patients undergoing SADI-S were found to have more metabolic comorbidities. Compared to RYGB, SADI-S has worse perioperative outcomes and is independently associated with serious complications. It remains unclear whether this represents a learning curve or true findings and prospective studies analyzing the risk-benefit ratio following SADI-S are needed.
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Affiliation(s)
- Kevin Verhoeff
- Department of Surgery, University of Alberta, Edmonton, AB, Canada.
| | - Valentin Mocanu
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Uzair Jogiat
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Hayley Forbes
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Noah J Switzer
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Daniel W Birch
- Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Shahzeer Karmali
- Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada
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Ortiz-Zuñiga AM, Costa Forner P, Cirera de Tudela A, Garcia Ruiz A, Comas Martinez M, Palmas F, Morer Liñan C, Vilallonga R, Ciudin A. The Impact of the Length of the Common Intestinal Loop on Metabolic and Nutritional Outcomes of Patients with Severe Obesity Who Undergo of Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy: 5-Year Follow-Up. J Laparoendosc Adv Surg Tech A 2022; 32:955-961. [PMID: 35363561 DOI: 10.1089/lap.2021.0863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Introduction: Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a recent bariatric surgery technique, highly effective in terms of weight loss. Nevertheless, data regarding the impact of SADI-S at mid-long term (after >5 years of follow-up) are scarce. Objectives: To evaluate the effect of lengths of common intestinal loop on the evolution of patients with morbid obesity (MO), who undergo SADI-S. Materials and Methods: Descriptive study (case series), including patients with MO who underwent SADI-S procedure between January 2012 and December 2015 with at least 5 years of follow-up. Patients were classified as "Old-SADI-S" (OS) when length of the common alimentary loop was <2.5 m and "New-SADI-S" (NS) when length was >2.5 m. Clinical parameters and nutritional parameters were included. Results: Twenty-nine cases were included (17 OS; 12 NS), 86.2% women and mean age 46.7 ± 1 years. After 12 months, OS had significantly lower body mass index (29.7 ± 4.8 kg/m2 versus 32.0 ± 5.1 kg/m2, P = .01), without significant differences in the resolution of comorbidities. Nevertheless, OS group had severe malabsorptive complications requiring surgical conversion of OS to NS in 7 patients after 8 months. At 5 years of follow-up, no significant difference was seen between the two groups and resolution of comorbidities was maintained during this period of time. Conclusions: SADI-S is effective in terms of weight loss and resolution of comorbidities at 5 years of follow-up, regardless of the length of the common intestinal loop. However, a common intestinal loop <2.5 m was associated with severe malabsorptive complications that determined the surgical re-conversion in all cases.
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Affiliation(s)
- Angel Michael Ortiz-Zuñiga
- Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pilar Costa Forner
- Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Arturo Cirera de Tudela
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Amador Garcia Ruiz
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Comas Martinez
- Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Fiorella Palmas
- Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carla Morer Liñan
- Departament de Salut, Centro de Salud (CAP) Rio de Janeiro, Servicio Atención Primaria (SAP) Muntanya, Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andreea Ciudin
- Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Pennestrì F, Sessa L, Prioli F, Salvi G, Gallucci P, Ciccoritti L, Greco F, De Crea C, Raffaelli M. Single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S): experience from a high-bariatric volume center. Langenbecks Arch Surg 2022; 407:1851-1862. [PMID: 35352174 PMCID: PMC9399205 DOI: 10.1007/s00423-022-02501-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/21/2022] [Indexed: 12/14/2022]
Abstract
Abstract
Purpose
Biliopancreatic diversion with duodenal switch and single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) are technically demanding hypo-absorptive bariatric procedures generally indicated in super-obese patients (BMI ≥ 50 kg/m2). Data from the literature prove the procedure to be safe and effective, with promising bariatric and metabolic effects. Anyway, international societies support the creation of multicentric national and international registries to obtain more homogeneous data over the long period. We aimed to report our experience with this procedure.
Methods
Among 2313 patients who underwent bariatric procedures at our institution, between July 2016 and August 2021, 121 (5.2%) consenting patients were scheduled for SADI-S as primary (SADIS) or revisional procedure after sleeve gastrectomy (SADI) (respectively 87 and 34 patients). Early and late post-operative complications, operative time, post-operative stay, and follow-up data were analyzed.
Results
Overall, the median preoperative BMI was 52.3 (48.75–57.05) kg/m2 with a median age of 44 (39–51) years, the median operative time was 120 (100–155) min. Complications at 30th-day post-op were registered in 4 (3.3%) patients and late complications in 4 (3.3%) patients. At a median follow-up of 31 (14–39) months, the median percentage excess weight loss was 79.8 (55.15–91.45)%, and the median total weight loss was 57.0650 (43.3925–71.3475)%.
Conclusion
Our data, coherently with the literature, confirm that SADI-S is a safe, effective procedure with acceptable complications rate. Larger studies with longer follow-ups are necessary to draw definitive conclusions.
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Affiliation(s)
- Francesco Pennestrì
- U.O.C. Chirurgia Endocrina E Metabolica, Centro Dipartimentale Di Chirurgia Endocrina E Dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Sessa
- U.O.C. Chirurgia Endocrina E Metabolica, Centro Dipartimentale Di Chirurgia Endocrina E Dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
- Centro Malattie Endocrine E Obesità, Fondazione Gemelli Giglio Cefalù, Cefalù (Palermo), L.go A. Gemelli 8, 00168, Rome, Italy.
| | - Francesca Prioli
- U.O.C. Chirurgia Endocrina E Metabolica, Centro Dipartimentale Di Chirurgia Endocrina E Dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giulia Salvi
- U.O.C. Chirurgia Endocrina E Metabolica, Centro Dipartimentale Di Chirurgia Endocrina E Dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pierpaolo Gallucci
- U.O.C. Chirurgia Endocrina E Metabolica, Centro Dipartimentale Di Chirurgia Endocrina E Dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luigi Ciccoritti
- U.O.C. Chirurgia Endocrina E Metabolica, Centro Dipartimentale Di Chirurgia Endocrina E Dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Greco
- U.O.C. Chirurgia Endocrina E Metabolica, Centro Dipartimentale Di Chirurgia Endocrina E Dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carmela De Crea
- U.O.C. Chirurgia Endocrina E Metabolica, Centro Dipartimentale Di Chirurgia Endocrina E Dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Raffaelli
- U.O.C. Chirurgia Endocrina E Metabolica, Centro Dipartimentale Di Chirurgia Endocrina E Dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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10
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Evaluation of Metabolic Outcomes Following SADI-S: a Systematic Review and Meta-analysis. Obes Surg 2022; 32:1049-1063. [PMID: 35001254 DOI: 10.1007/s11695-021-05824-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/13/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) offers a novel bariatric procedure. This systematic review and meta-analysis evaluates observational and comparative studies evaluating SADI-S, with meta-analysis comparing outcomes to other malabsorptive procedures (MPs). MATERIALS AND METHODS Systematic search of MEDLINE, Embase, Scopus, and Web of Science was conducted in March 2021. The study followed PRISMA guidelines. Studies evaluating SADI-S with n > 5 were included. Primary outcome was diabetes (DM) remission, and secondary outcomes included perioperative outcomes, comorbidity resolution, and weight loss. RESULTS We reviewed 2285 studies with 16 included evaluating 3319 patients and 1704 (51.3%) undergoing SADI-S. SADI-S patients had increased BMI (49.6 kg/m2 vs 48.8 kg/m2) and weight (139.7 kg vs 137.1 kg), were more likely to have DM (46.3% vs 42.1%), and dyslipidemia (36.6% SADI-S vs 32.7%). SADI-S had a shorter operative duration than MPs (MD - 36.74, p < 0.001), 0.85-day shorter post-operative stay (p < 0.001), and trended towards fewer complications (OR 0.69, p = 0.06). Rate of reoperation (OR 0.83, p = 0.59) was similar and DM remission was similar (OR 0.07, p = 0.1). Subgroup analysis suggested greater DM remission than Roux-en-Y gastric bypass (OR 4.42, p = 0.04). SADI-S had fewer malabsorptive complications, though follow-up was shorter. Weight loss was 37.3% compared to 35.6% total weight loss after SADI-S and MPs, respectively. CONCLUSION SADI-S demonstrates improved metabolic and weight loss outcomes with lower perioperative risks. SADI-S represents a promising bariatric procedure but long-term outcomes are needed to guide future uptake.
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11
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Luesma MJ, Fernando J, Cantarero I, Lucea P, Santander S. Surgical Treatment of Obesity. Special Mention to Roux-en-Y Gastric Bypass and Vertical Gastrectomy. Front Endocrinol (Lausanne) 2022; 13:867838. [PMID: 35432187 PMCID: PMC9010401 DOI: 10.3389/fendo.2022.867838] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/01/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The prevalence of obesity has increased exponentially in recent decades, being one of the diseases that most affects global health. It is a chronic disease associated with multiple comorbidities, which lead to a decrease in life expectancy and quality of life. It requires a multidisciplinary approach by a specialized medical team. Obesity can be treated with conservative or with surgical treatments that will depend on the characteristics of the patient. OBJECTIVE/METHODOLOGY The referenced surgery can be performed using different surgical techniques that are analyzed in the present work through an exhaustive narrative bibliographic review in the PubMed and Cochrane databases, as well as in UpToDate. RESULTS Currently, those most used are restrictive techniques, specifically vertical gastrectomy and mixed techniques, with gastric bypass being the "gold standard". CONCLUSIONS In order to choose one technique or another, the characteristics of each patient and the experience of the surgical team must be taken into account.
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Affiliation(s)
- María José Luesma
- Department of Human Anatomy and Histology, School of Medicine, University of Zaragoza, Zaragoza, Spain
- *Correspondence: Sonia Santander, ; María José Luesma,
| | - José Fernando
- General Surgery and Digestive System Service, Royo Villanova Hospital, Zaragoza, Spain
| | - Irene Cantarero
- Department of Morphological and Social Health Sciences, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
| | - Pilar Lucea
- Department of Human Anatomy and Histology, School of Medicine, University of Zaragoza, Zaragoza, Spain
| | - Sonia Santander
- Department of Pharmacology and Physiology, School of Medicine, University of Zaragoza, Zaragoza, Spain
- *Correspondence: Sonia Santander, ; María José Luesma,
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12
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Vilallonga R, Nedelcu A, Cirera de Tudela A, Palermo M, Pérez-Aguirre E, Josa-Martínez BM, Armengol Carrasco M, Noel P, Torres A, Nedelcu M. Single Anastomosis Duodeno-ileal Bypass As a Revisional Procedure Following Sleeve Gastrectomy: Review of the Literature. J Laparoendosc Adv Surg Tech A 2021. [PMID: 34569824 DOI: 10.1089/lap.2021.0511] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Laparoscopic sleeve gastrectomies (LSGs) can experience weight-loss failure and conversion to another bariatric procedure. An analysis of the bariatric literature concerning the single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) as revisional surgery after LSG in terms of safety and efficacy identified 607 studies. Fifty-nine studies were analyzed for full content review and 9 primary studies (398 patients) were included. Revisional single anastomosis duodeno-ileal bypass (SADI) was performed in 294 patients at a mean interval of 37.7 months (range 11-179). Total weight loss (%) varies from 20.5% to 46.2%. Early complications after surgery occurred in 4.1% surgeries including leak (7 cases -1.9%). Mortality was nil. SADI after LSG, after failed sleeve gastrectomy or as a sequential procedure, offers a satisfactory weight loss result. Both early and late term complications are acceptable.
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Affiliation(s)
- Ramon Vilallonga
- General Surgery Department and Universitat Autònoma de Barcelona, General Surgery and Advanced Laparoscopy Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Anamaria Nedelcu
- General Surgery Department, Clinique Saint-Michel, Toulon, France
| | - Arturo Cirera de Tudela
- Universitat Autònoma de Barcelona, Department of General and Digestive Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mariano Palermo
- Department of Surgery, University of Buenos Aires, Centro CIEN-Diagnomed, Buenos Aires, Argentina
| | - Elia Pérez-Aguirre
- Department of Surgery, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Benito Miguel Josa-Martínez
- Department of Surgery, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Manuel Armengol Carrasco
- Universitat Autònoma de Barcelona, Department of General and Digestive Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Patrick Noel
- Department of Surgery, Centre Chirurgical de l'Obesite, Clinique Saint-Michel, Toulon, France
| | - Antonio Torres
- Department of Surgery, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Marius Nedelcu
- Department of Surgery, Centre Chirurgical de l'Obesite, Clinique Saint-Michel, Toulon, France
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13
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Iranmanesh P, Boudreau V, Barlow K, Malik PRA, Ramji K, Gmora S, Hong D, Anvari M. Comparison of single- versus double-anastomosis duodenal switch: a single-center experience with 2-year follow-up. Int J Obes (Lond) 2021; 45:1782-1789. [PMID: 33976377 DOI: 10.1038/s41366-021-00844-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/31/2021] [Accepted: 04/26/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Single-anastomosis duodenal switch (SADS) has emerged in recent years as an alternative to the standard double-anastomosis duodenal switch (DADS). The objective of this study was to compare short- and medium-term outcomes between SADS and DADS. METHODS Data collected in the Ontario Bariatric Registry between 2010 and 2019 were used for this retrospective study to determine outcomes of patients undergoing primary laparoscopic SADS versus DADS at a Canadian tertiary hospital and bariatric center of excellence. The primary outcome was weight loss at 1 and 2 years after surgery. Short-term secondary outcomes included operative times, intra- and early postoperative complications, hospital length of stay (LOS), and 30-day readmissions. Medium-term secondary outcomes included late postoperative complications as well as nutritional deficiencies and persistent diarrhea at 1 and 2 years after surgery. Subgroup analyses were performed to compare patients undergoing one- and two-stage procedures. RESULTS Data of 107 patients who underwent SADS (n = 25) or DADS (n = 82) were included in the study. Follow-up data were available for 59/107 (55.1%) patients at 1 year and 47/107 (43.9%) at 2 years after surgery. Patients in the SADS and DADS groups had similar %TBWL at 1 year (23.6 versus 26.2, P = 0.617) and 2 years (24.8 versus 30.2, P = 0.116) after surgery. Short- and medium-term outcomes were similar between groups. There was no difference between patients undergoing one- versus two-stage procedures. CONCLUSION This study showed that patients undergoing SADS and DADS had similar weight loss at 1 and 2 years. Early and late postoperative morbidity, operative times, early readmissions, and LOS were also similar between groups. Further studies with longer follow-up are required to confirm these results.
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Affiliation(s)
- Pouya Iranmanesh
- Center for Minimal Access Surgery (CMAS), St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada.
| | - Vanessa Boudreau
- Center for Minimal Access Surgery (CMAS), St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Karen Barlow
- Center for Minimal Access Surgery (CMAS), St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Peter R A Malik
- Center for Minimal Access Surgery (CMAS), St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Karim Ramji
- Center for Minimal Access Surgery (CMAS), St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Scott Gmora
- Center for Minimal Access Surgery (CMAS), St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Dennis Hong
- Center for Minimal Access Surgery (CMAS), St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Mehran Anvari
- Center for Minimal Access Surgery (CMAS), St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
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14
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Chen G, Zhang GX, Peng BQ, Cheng Z, Du X. Roux-En-Y Gastric Bypass Versus Sleeve Gastrectomy Plus Procedures for Treatment of Morbid Obesity: Systematic Review and Meta-Analysis. Obes Surg 2021; 31:3303-3311. [PMID: 33956302 DOI: 10.1007/s11695-021-05456-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 02/07/2023]
Abstract
Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most commonly performed bariatric procedures globally, but both techniques have shortcomings. Several modifications of SG (SG plus procedures) have been developed, but the efficacy of the different procedures has not been completely elucidated. In this meta-analysis, we aimed to evaluate the efficacy and safety of SG plus procedures. Out of the initially identified 2357 studies, thirteen were selected for this meta-analysis: two studies on banded sleeve gastrectomy (BSG), four studies on sleeve gastrectomy plus duodenal-jejunal bypass (SG + DJB) or sleeve gastrectomy with loop duodenal-jejunal bypass (SADJB), two studies on sleeve gastrectomy with jejunal-jejunal bypass (SG + JJB), four studies on single anastomosis duodenal-ileal switch (SADI-S), and one study on stomach intestinal pylorus-sparing surgery (SIPS). SADI-S procedure was found to achieve significantly greater percentage of excess weight loss than the RYGB. SG + DJB and SADJB achieved greater weight loss than the RYGB. Major complications were fewer with SG + JJB than with RYGB, but the difference was not significant. Overall, SG plus procedures appear to achieve better weight loss and cause fewer complications than RYGB.
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Affiliation(s)
- Gang Chen
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Gui-Xiang Zhang
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Bo-Qiang Peng
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Zhong Cheng
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao Du
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, China.
- Department of General Surgery, Yaan People's Hospital, Yaan, China.
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15
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Lin S, Li C, Guan W, Liang H. Three-Year Outcomes of Sleeve Gastrectomy Plus Jejunojejunal Bypass: a Retrospective Case-Matched Study with Sleeve Gastrectomy and Gastric Bypass in Chinese Patients with BMI ≥35 kg/m 2. Obes Surg 2021; 31:3525-3530. [PMID: 33861412 DOI: 10.1007/s11695-021-05411-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 04/02/2021] [Accepted: 04/07/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Sleeve gastrectomy plus jejunojejunal bypass (SG+JJB) is a novel bariatric procedure. In this study, we compared the 3-year outcomes of SG+JJB to those of sleeve gastrectomy (SG) and gastric bypass (RYGB). METHODS This retrospective study included 113 patients (SG, N=31; RYGB, N=33; SG+JJB, N=49) with a preoperative BMI≥35 kg/m2. Among them, 31 pairs of patients who underwent SG+JJB/SG and 33 pairs who underwent SG+JJB/RYGB were matched by sex, age (±2 years), and BMI (±2 kg/m2). Postoperative weight loss, diabetes remission, and patient complaints at the 3-year follow-up were compared. RESULTS SG+JJB yielded higher 3-year total weight loss (TWL) than SG alone (35.5±9.1% vs 31.5±7.3%, P=0.031) and equivalent 3-year %TWL to RYGB. The diabetes remission rate of SG+JJB was similar to that of SG or RYGB. SG+JJB resulted in a higher incidence of malodorous flatus than SG (25.8% vs 0, P<0.05). Compared to RYGB, SG+JJB resulted in a higher incidence of postoperative de novo gastroesophageal reflux disease (GERD) symptoms (30.3% vs 0, P<0.05). CONCLUSIONS In the present study, we found that SG+JJB yielded higher weight loss than SG and similar weight loss to RYGB at the 3-year follow-up. SG+JJB increased the risk of malodorous flatus compared to SG and de novo GERD symptoms compared to RYGB.
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Affiliation(s)
- Shibo Lin
- Department of General surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Cong Li
- Department of General surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Wei Guan
- Department of General surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Hui Liang
- Department of General surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
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16
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Efficacy and Drawbacks of Single-Anastomosis Duodeno-Ileal Bypass After Sleeve Gastrectomy in a Tertiary Referral Bariatric Center. Obes Surg 2021; 31:2691-2700. [PMID: 33834374 PMCID: PMC8113294 DOI: 10.1007/s11695-021-05323-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 12/13/2022]
Abstract
Background The need for revisional procedures after sleeve gastrectomy (SG) for insufficient weight loss or weight regain, gastroesophageal reflux, or other complications is reported to be 18–36% in studies with 10-year follow-up. Single-anastomosis duodeno-ileal bypass (SADI) may be performed as a revisional procedure after SG. This study aims to evaluate the short- and mid-term outcomes of SADI after SG in a referral center for bariatric surgery. Materials and Methods Data of patients who underwent SADI between March 2015 and March 2020 were collected prospectively and analyzed retrospectively. Follow-up comprised clinical and biochemical assessment at 1, 3, 6, 12, 18, and 24 months postoperatively, and once a year thereafter. Results Overall, 106 patients underwent SADI after a previous SG. The timeframe between SG and SADI was 50 ± 31.3 months. Postoperative mortality was observed in two cases (1.8%) and morbidity in 15.1% of patients. At 24 months, %total weight loss was 37.6 ± 12.3 and %excess weight loss 76.9 ± 25.2 (64 patients). Three patients were treated for malnutrition during follow-up, two with medical treatment and one with SADI reversal. Conclusion SADI after SG provides effective weight loss results in the short-term, even if in the present series the postoperative complication rate was non-negligible. Further trials are needed to establish the more advantageous revisional bariatric procedure after failed SG. Supplementary Information The online version contains supplementary material available at 10.1007/s11695-021-05323-y.
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17
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Malik PRA, Doumouras AG, Malhan RS, Lee Y, Boudreau V, Barlow K, Karpinski M, Anvari M. Obesity, Cancer, and Risk Reduction with Bariatric Surgery. Surg Clin North Am 2021; 101:239-254. [PMID: 33743967 DOI: 10.1016/j.suc.2020.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The prevalence of noncommunicable diseases has increased dramatically in North America and throughout the world and is expected to continue increasing in coming years. Obesity has been linked to several types of cancers and is associated with increased morbidity and mortality following cancer diagnosis. Bariatric surgery has emerged as the prominent model to evaluate the effects of intentional weight loss on cancer incidence and outcomes. Current literature, comprising prospective cohort investigations, indicates site-specific reductions in cancer risk with select bariatric procedures. Future research is required to establish evidence-based indications for bariatric surgery in the context of cancer prevention.
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Affiliation(s)
- Peter R A Malik
- Department of Surgery and Centre for Minimal Access Surgery, St. Joseph's Healthcare, 50 Charlton Avenue East, Rm T2141 Hamilton, Ontario L8N 4A6, Canada; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, Ontario L8S 4K1, Canada
| | - Aristithes G Doumouras
- Department of Surgery and Centre for Minimal Access Surgery, St. Joseph's Healthcare, 50 Charlton Avenue East, Rm T2141 Hamilton, Ontario L8N 4A6, Canada
| | - Roshan S Malhan
- Department of Surgery and Centre for Minimal Access Surgery, St. Joseph's Healthcare, 50 Charlton Avenue East, Rm T2141 Hamilton, Ontario L8N 4A6, Canada
| | - Yung Lee
- Department of Surgery and Centre for Minimal Access Surgery, St. Joseph's Healthcare, 50 Charlton Avenue East, Rm T2141 Hamilton, Ontario L8N 4A6, Canada
| | - Vanessa Boudreau
- Department of Surgery and Centre for Minimal Access Surgery, St. Joseph's Healthcare, 50 Charlton Avenue East, Rm T2141 Hamilton, Ontario L8N 4A6, Canada; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, Ontario L8S 4K1, Canada
| | - Karen Barlow
- Department of Surgery and Centre for Minimal Access Surgery, St. Joseph's Healthcare, 50 Charlton Avenue East, Rm T2141 Hamilton, Ontario L8N 4A6, Canada
| | - Marta Karpinski
- Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, Ontario L8S 4K1, Canada
| | - Mehran Anvari
- Department of Surgery and Centre for Minimal Access Surgery, St. Joseph's Healthcare, 50 Charlton Avenue East, Rm T2141 Hamilton, Ontario L8N 4A6, Canada.
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18
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Safety and feasibility of laparoscopic sleeve gastrectomy with loop duodenojejunal bypass for obesity. THE JOURNAL OF MINIMALLY INVASIVE SURGERY 2021; 24:10-17. [PMID: 35601283 PMCID: PMC8965984 DOI: 10.7602/jmis.2021.24.1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/10/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022]
Abstract
Purpose Laparoscopic sleeve gastrectomy (SG) with loop duodenojejunal bypass (LDJB) is a combination of SG and one anastomosis gastric bypass surgeries. This study was intended to evaluate the safety and feasibility of SG-LDJB surgery. Methods This was a retrospective study analyzing SG-LDJB surgery using 250-cm length biliopancreatic limbs that was performed between May 2013 and December 2017 in 113 Indians with obesity. All demographic, clinical, operative, and follow-up data were analyzed for weight loss and diabetes remission efficacy. Weight-loss success was defined as percentage of total weight loss (%TWL) ≥ 25%. Diabetes remission was defined as hemoglobin A1c < 6% without the need for antidiabetic medications. Safety and feasibility were analyzed in terms of intraoperative and postoperative complications and serum albumin, iron, and calcium levels. Results The %TWL was 35.0% and 31.0% at the 1-year and 3-year follow-ups, respectively. The weight-loss success rate was 91.3% and 78.1% at the 1-year and 3-year follow-ups, respectively. Sixty-six out of 113 patients had type 2 diabetes. Diabetes remission was 80.0% and 75.4% at the 1-year and 3-year follow-ups, respectively. Major perioperative complications occurred in 0.9% of the patients. The 30-day mortality rate was zero. None of the patients had serum albumin levels of <3 g/dL at the 1-year and 3-year follow-ups or symptoms of hypoproteinemia. Conclusion SG-LDJB surgery using a 250-cm biliopancreatic limb is a safe and effective procedure to treat obesity. It is technically complex but has the advantages of endoscopic access to the stomach and negligible postoperative complications or hypoproteinemia.
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19
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Vennapusa A, Bhargav Panchangam R, Kesara C, Vyshnavi Vanta GR, Madivada MS. Metabolic efficacy following laparoscopic sleeve gastrectomy with loop duodenal switch surgery for type 2 diabetes in Indian patients with severe obesity. Diabetes Metab Syndr 2021; 15:581-587. [PMID: 33706190 DOI: 10.1016/j.dsx.2021.02.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/24/2021] [Accepted: 02/27/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Metabolic surgery improves glycemic control in patients with type 2 diabetes (T2DM) and severe obesity. Sleeve gastrectomy with loop duodenal switch (SLDS), a loop modification of biliopancreatic diversion with duodenal switch, is aimed to reduce the malabsorption, without compromising the efficacy. This study was designed to analyze the metabolic efficacy following SLDS. METHODS Eighty patients, who underwent SLDS for T2DM and severe obesity between January 2014 and February 2020 were retrospectively analyzed. Complete T2DM remission was defined as HbA1C < 6% in the absence of anti-diabetic medications. T2DM remission was analyzed at the 6-month and 1-year follow-ups in terms of various predictors. Prediction of T2DM remission by ABCD, DiaRem and IMS scores was analyzed. Lower ABCD scores and higher DiaRem and IMS scores indicate severe T2DM. RESULTS Following SLDS, HbA1C significantly reduced from 8.7% to 5.5% at the 6-month and 5.1% at the 1-year follow-ups. T2DM remission was 82.5% at the 6-month and 90.8% at the 1-year follow-ups. Preoperative glycemic control positively predicted, while T2DM duration and preoperative insulin use negatively predicted T2DM remission. Higher ABCD score, lower DiaRem and IMS scores predicted higher T2DM remission. Severe hypoalbuminemia was 20% in patients with 250 cm common channel and 02% in patients with ≥300 cm common channel at the 1-year follow-up. CONCLUSIONS SLDS is an effective surgery to treat T2DM with severe obesity. Shorter T2DM duration, better preoperative glycemic control and the absence of insulin use were associated with better T2DM remission. Malabsorption was significantly lesser, when common channel was ≥300 versus 250 cm.
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Affiliation(s)
- Amar Vennapusa
- Department of Bariatric & Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Jubilee Hills, Hyderabad, Telangana, India.
| | | | - Charita Kesara
- Department of Bariatric & Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Jubilee Hills, Hyderabad, Telangana, India.
| | - Gitika Raj Vyshnavi Vanta
- Department of Bariatric & Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Jubilee Hills, Hyderabad, Telangana, India.
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20
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Bariatric Surgery-How Much Malabsorption Do We Need?-A Review of Various Limb Lengths in Different Gastric Bypass Procedures. J Clin Med 2021; 10:jcm10040674. [PMID: 33578635 PMCID: PMC7916324 DOI: 10.3390/jcm10040674] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/06/2021] [Accepted: 02/07/2021] [Indexed: 12/18/2022] Open
Abstract
The number of obese individuals worldwide continues to increase every year, thus, the number of bariatric/metabolic operations performed is on a constant rise as well. Beside exclusively restrictive procedures, most of the bariatric operations have a more or less malabsorptive component. Several different bypass procedures exist alongside each other today and each type of bypass is performed using a distinct technique. Furthermore, the length of the bypassed intestine may differ as well. One might add that the operations are performed differently in different parts of the world and have been changing and evolving over time. This review evaluates the most frequently performed bariatric bypass procedures (and their variations) worldwide: Roux-en-Y Gastric Bypass, One-Anastomosis Gastric Bypass, Single-Anastomosis Duodeno-Ileal Bypass + Sleeve Gastrectomy, Biliopancreatic Diversion + Duodenal Switch and operations due to weight regain. The evaluation of the procedures and different limb lengths focusses on weight loss, remission of comorbidities and the risk of malnutrition and deficiencies. This narrative review does not aim at synthesizing quantitative data. Rather, it provides a summary of carefully selected, high-quality studies to serve as examples and to draw tentative conclusions on the effects of the bypass procedures mentioned above. In conclusion, it is important to carefully choose the procedure and small bowel length excluded from the food passage suited best to each individual patient. A balance has to be achieved between sufficient weight loss and remission of comorbidities, as well as a low risk of deficiencies and malnutrition. In any case, at least 300 cm of small bowel should always remain in the food stream to prevent the development of deficiencies and malnutrition.
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Wilson R, Aminian A, Tahrani AA. Metabolic surgery: A clinical update. Diabetes Obes Metab 2021; 23 Suppl 1:63-83. [PMID: 33621412 DOI: 10.1111/dom.14235] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/11/2020] [Accepted: 10/23/2020] [Indexed: 02/06/2023]
Abstract
Metabolic and bariatric surgery has grown beyond 'experimental' weight-loss surgery. As techniques have advanced over the last few decades, so has the growing body of research and evidence, proving that both weight-loss and metabolic health improvement are induced. Metabolic surgery has become the more appropriate term for weight-loss surgery because of the altered gastrointestinal anatomy and subsequent beneficial metabolic effects. Although the tool of metabolic surgery has been well refined, a large portion of the global population does not have adequate access to it. This clinical update aims to (a) inform healthcare providers from all disciplines about the myriad of benefits of metabolic surgery and (b) equip them with the necessary knowledge to bridge the gap between patients in need of metabolic treatment and the therapies in metabolic surgery available to them.
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Key Words
- adjustable gastric banding, atrial fibrillation, bariatric surgery, cancer, cardiovascular disease, gastric bypass, heart failure, hypertension, mortality, obesity, obstructive sleep apnoea, reflux disease, sleeve gastrectomy, type 2 diabetes
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Affiliation(s)
- Rickesha Wilson
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ali Aminian
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Abd A Tahrani
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham, UK
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Spinos D, Skarentzos K, Esagian SM, Seymour KA, Economopoulos KP. The Effectiveness of Single-Anastomosis Duodenoileal Bypass with Sleeve Gastrectomy/One Anastomosis Duodenal Switch (SADI-S/OADS): an Updated Systematic Review. Obes Surg 2021; 31:1790-1800. [PMID: 33452998 DOI: 10.1007/s11695-020-05188-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/09/2020] [Accepted: 12/21/2020] [Indexed: 11/28/2022]
Abstract
Single-anastomosis duodenoileal bypass with sleeve gastrectomy/one anastomosis duodenal switch (SADI-S/OADS) was developed as a bariatric operation with reduced overall morbidity and lasting weight loss results. We performed a systematic review of the literature, including 14 studies reporting on weight loss, comorbidity resolution, postoperative complications, and nutritional deficiencies following SADI-S. Twelve months after SADI-S, the mean total body weight lost ranged from 21.5 to 41.2%, with no weight regain being observed after 24 months. The comorbidity resolution rate was 72.6% for diabetes, 77.2% for dyslipidemia, and 59.0% for hypertension cases. The need for reoperation was the most common postoperative complication. While several patients developed nutrient deficiencies, SADI-S seems to be an overall safe and effective bariatric operation.
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Affiliation(s)
- Dimitrios Spinos
- Derby Royal Hospital, University Hospitals of Derby and Burton NHS Trust, Derby, UK.,Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | - Konstantinos Skarentzos
- Surgery Working Group, Society of Junior Doctors, Athens, Greece.,Department of Medicine, School of Health Sciences, Democritus University of Thrace, Alexandroupolis, Greece
| | - Stepan M Esagian
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | - Keri A Seymour
- Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27710, USA
| | - Konstantinos P Economopoulos
- Surgery Working Group, Society of Junior Doctors, Athens, Greece. .,Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27710, USA.
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Omega Loop Gastroileal Bypass (OLGIBP/SAGI) Versus One Anastomosis Gastric Bypass (OAGB): Medium-Term Results. Obes Surg 2021; 31:1597-1602. [PMID: 33409980 DOI: 10.1007/s11695-020-05165-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 12/01/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In bariatric surgery, new surgical techniques are continually being developed. The one anastomosis gastric bypass (OAGB) has become increasingly common since 2001. However, some patients experience bile reflux or excessive weight loss. This study aimed to assess a new bariatric procedure designed to avoid some of the drawbacks of conventional OAGB. MATERIAL AND METHODS To lower the complication rate and pathophysiological impact after OAGB, we performed an omega loop gastroileal bypass (OLGIBP/SAGI) with a 300-cm common limb. We compared this technique with OAGB. RESULTS Seventeen patients underwent OLGIBP and 23 underwent OAGB. Mean operative time was 108 min for OLGIBP vs 103 min for OAGB. The mean hospital length of stay was 3 days (1 to 7). No complications related to the gastroenterostomy occurred. At 3 years, among OAGB patients, there were 5 (21.7%) cases of bile reflux including 2 (8.7%) requiring a revision to Roux-en-Y gastric bypass. Among OLGIBP patients, there were 3 (17.6%) cases of bile reflux 1 (5.9%) requiring a revision to Roux-en-Y gastric bypass. There was no albumin deficiency. At 3 years, % of total weight loss (TWL) was 43.6 + - 6.2 in the OAGB group vs 48.2 + - 7.4 in the OLGIBP group. CONCLUSIONS The bariatric and metabolic outcomes of OLGIBP are expected to be similar to those of OAGB. The OLGIBP technique should reduce the risks of malnutrition and bile reflux. The two techniques can be safely performed and offer alternatives in bariatric surgery.
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Brown WA, de Leon Ballesteros GP, Ooi G, Higa K, Himpens J, Torres A, Shikora S, Kow L, Herrera MF. Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy/One Anastomosis Duodenal Switch (SADI-S/OADS) IFSO Position Statement-Update 2020. Obes Surg 2021; 31:3-25. [PMID: 33409979 DOI: 10.1007/s11695-020-05134-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/12/2020] [Accepted: 11/23/2020] [Indexed: 12/11/2022]
Abstract
PreambleThe International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) has played an integral role in educating both the metabolic surgical and the medical communities at large about the role of innovative and new surgical and or endoscopic interventions in treating adiposity-based chronic diseases. The single anastomosis duodenal-ileal bypass with sleeve gastrectomy/one anastomosis duodenal switch (SADI-S/OADS) is a relatively new procedure that has been proposed as an alternative to the conventional duodenal switch (DS) procedure. The IFSO published a position paper on SADI-S/OADS in 2018 with which concluded that this procedure was likely to be a safe and efficacious treatment for adiposity and its related diseases. However, it noted that there was insufficient long-term data and minimal high-level evidence available. The position statement called for patients to be enrolled in long-term multidisciplinary care encouraged the registration of patients in national registries, and called for more randomized controlled trials (RCT) (Obes Surg 28:1207-16, 2018) involving the procedure. The following position statement is an update of the previous position statement. It is issued by the IFSO SADI-S/OADS task force and has been reviewed and approved by both the IFSO Scientific Committee and Executive Board. This statement is based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence. It will be reviewed again in 2 years.
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Affiliation(s)
- Wendy A Brown
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy.
| | | | - Geraldine Ooi
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Kelvin Higa
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Jacques Himpens
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Antonio Torres
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Scott Shikora
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Lilian Kow
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
| | - Miguel F Herrera
- International Federation for Surgery of Obesity and Metabolic Disorders, Rione Sirignano, 5, 80121, Naples, Italy
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Single and dual anastomosis duodenal switch for obesity treatment: a single-center experience. Surg Obes Relat Dis 2021; 17:12-19. [DOI: 10.1016/j.soard.2020.09.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/26/2020] [Accepted: 09/16/2020] [Indexed: 12/12/2022]
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Vennapusa A, Panchangam RB, Kesara C, Chivukula T. Response: Factors Predicting Weight Loss after "Sleeve Gastrectomy with Loop Duodenojejunal Bypass" Surgery for Obesity (J Obes Metab Syndr 2020;29:208-14). J Obes Metab Syndr 2020; 29:327-329. [PMID: 33380578 PMCID: PMC7789021 DOI: 10.7570/jomes20132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/14/2020] [Accepted: 12/18/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Amar Vennapusa
- Department of Bariatric and Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Hyderabad, India
| | | | - Charita Kesara
- Department of Bariatric and Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Hyderabad, India
| | - Tejaswi Chivukula
- Department of Bariatric and Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Hyderabad, India
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Vennapusa A, Panchangam RB, Kesara C, Madivada MSS. Metabolic Efficacy and Diabetes Remission Predictors Following 'Sleeve Gastrectomy with Loop Duodenojejunal Bypass' Surgery. JOURNAL OF METABOLIC AND BARIATRIC SURGERY 2020; 9:33-41. [PMID: 36688116 PMCID: PMC9847657 DOI: 10.17476/jmbs.2020.9.2.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/06/2020] [Accepted: 10/14/2020] [Indexed: 06/17/2023]
Abstract
PURPOSE Laparoscopic sleeve gastrectomy with loop duodenojejunal bypass (SLDJB) is a novel metabolic surgery that is a modification of the single anastomosis duodenoileal bypass with sleeve. Compared to conventional surgeries, SLDJB is highly effective in inducing diabetes remission. This study analyzed the metabolic efficacy of SLDJB. MATERIALS AND METHODS Seventy-eight patients with obesity and diabetes who underwent SLDJB between May 2013 and October 2017 were retrospectively analyzed to investigate the efficacy of their surgery and diabetes remission predictors. Complete diabetes remission was defined as an HbA1c level <6% with cessation of insulin and oral hypoglycemic agents. RESULTS Complete diabetes remission occurred in 80.52% and 76.71% of patients at 1- and 3-year follow-ups, respectively. There was no significant difference in the rates of complete diabetes remission between the groups based on gender, preoperative body mass index (BMI), diabetes duration or preoperative insulin use. There was a significantly higher rate of complete remission in patients <50 years of age at the 1-year follow-up. Additionally, the rate of complete remission was significantly less when preoperative glycemic control was poor. Preoperative HbA1c levels negatively predicted complete remission, but was significant only at the 3-year follow-up. CONCLUSION SLDJB is highly effective in treating obesity with type 2 diabetes, and preoperative glycemic control was found to predict complete remission. Patients under 50 years of age had a better short-term response rate; however, the surgery was effective regardless of gender, preoperative BMI, duration of diabetes or preoperative insulin use.
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Affiliation(s)
- Amar Vennapusa
- Department of Bariatric & Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Hyderabad, Telangana, India
| | | | - Charita Kesara
- Department of Bariatric & Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Hyderabad, Telangana, India
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How I Do It: Robotic Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADIS). J Gastrointest Surg 2020; 24:2893-2895. [PMID: 33037552 DOI: 10.1007/s11605-020-04789-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/03/2020] [Indexed: 01/31/2023]
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A Matched Cohort Comparison of Long-term Outcomes of Roux-en-Y Gastric Bypass (RYGB) Versus Single-Anastomosis Duodeno-ileostomy with Sleeve Gastrectomy (SADI-S). Obes Surg 2020; 31:1438-1448. [PMID: 33201398 DOI: 10.1007/s11695-020-05131-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The long-term effectiveness of Roux-en-Y gastric bypass (RYGB) and single-anastomosis duodeno-ileostomy with sleeve gastrectomy (SADI-S) is unknown. PURPOSE Compare the long-term outcomes. SETTING Single private institute, USA. MATERIALS AND METHODS Data from 1254 patients who underwent primary RYGB or SADI-S were used for a retrospective matched cohort. Data were obtained by matching every RYGB patient to a SADI-S patient of the same sex, body mass index (BMI), and weight. Only patients out 5 years and had at least one > 5-year follow-up visit were included. RESULTS The matched cohort included 61 RYGB and 61 SADI-S patients. There was no statistical, demographic difference between the two groups. At 5 years, a 100% follow-up was available in each group. The intraoperative outcomes were significantly better with SADI-S. The 30-day readmission, reoperation, emergency department (ED) visits, and complication rates were statistically similar between the two groups. The long-term complication rates, Clavien-Dindo grade IIIb complications, and number of patients with more than one complication were significantly lower with SADI-S. Weight loss was significantly greater in the SADI-S group at 5 years. The long-term weight-loss failure rate was significantly higher in the RYGB group. The SADI-S procedure was associated with fewer reintervention through 6 years (14.7% patients vs. 39.3% patients, p = 0.001). Conversion or reversal of the procedure was required only in the RYGB group. There also was no significant difference in nutritional outcomes between the two procedures. CONCLUSIONS This study showed that problems, including long-term complications, reinterventions, weight-loss failure, and conversion, were more often associated with RYGB than with SADI-S. The SADI-S may be considered one of the viable alternatives to RYGB.
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Andalib A, Bouchard P, Alamri H, Bougie A, Demyttenaere S, Court O. Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S): short-term outcomes from a prospective cohort study. Surg Obes Relat Dis 2020; 17:414-424. [PMID: 33158766 DOI: 10.1016/j.soard.2020.09.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/29/2020] [Accepted: 09/06/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a modification of the classic duodenal switch (DS). These modifications are intended to address concerns about DS, including malnutrition, longer operative times, and technical challenges, while preserving the benefits. OBJECTIVES To evaluate safety and outcomes of SADI-S as it compares to classic DS procedure. SETTING Bariatric Surgery Center of Excellence, University Hospital, Montreal, Canada. METHODS In a single-institution prospective cohort study, we compared safety and outcomes of the SADI-S versus DS procedures (ClinicalTrials.gov: NCT02792166; registered: 06/2016). Data is depicted as count (percentage) or median (interquartile range). RESULTS There were 42 patients who underwent SADI-S, of whom 11 had it as a second-stage procedure (26%). There were 20 patients who underwent DS, of whom 12 had it as second-stage procedures (60%). Both groups were similar at baseline. The median age was 45 (14) years, 39 (63%) were female, the median body mass index (BMI) was 48.2 (7.7) kg/m2, and 29 (47%) patients had diabetes. The operative time was shorter for 1-stage SADI-S versus DS surgery (211 [70] versus 250 [60] min, respectively; P = .05) but was similar for second-stage procedures (P = .06). The 90-day complication rates were 11.9% (N = 5/42) after SADI-S and 5.0% (N = 1/20) after DS surgery (P = .64). There were no mortalities. Median follow-ups for 1-stage SADI-S and DS were 17 (11) and 12 (24) months, respectively (P = .65). Similar BMI changes were observed after 1-stage SADI-S (17.9 kg/m2 [8.7]) and DS (17.5 kg/m2 [16]; P = .65). At median follow-ups of 10 (20) and 14 (16) months after second-stage SADI-S and DS, respectively (P = .53), surgical procedures yielded added 5.0 kg/m2 (5.8) and 6.5 kg/m2 (7.1) changes in BMI, respectively (P = .26). Complete remission rates for diabetes were 91% after SADI-S (n = 21/23) and 50% after DS (n = 3/6). Compared with the SADI-S procedure, DS surgery was associated with higher frequencies of deficiencies in some fat-soluble vitamins, especially vitamin D. CONCLUSIONS The SADI-S procedure is safe, and its short-term outcomes, including weight loss and the resolution of co-morbidities, are similar to those of DS. SADI-S surgery also has promising potential as a second-stage procedure after sleeve gastrectomy.
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Affiliation(s)
- Amin Andalib
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada.
| | - Philippe Bouchard
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada
| | - Hussam Alamri
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada
| | - Alexandre Bougie
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada
| | - Sebastian Demyttenaere
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada
| | - Olivier Court
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada
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Baltar J, Martis-Sueiro A, Pardo M, Santos F, Sartal MI, Crujeiras AB, Peinó R, Seoane LM, Bárcena M, Bustamante M. Conversion from Duodenal Switch to Single Anastomosis Duodenal Switch to Deal with Postoperative Malnutrition. Obes Surg 2020; 31:431-436. [PMID: 33051790 DOI: 10.1007/s11695-020-05047-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 10/03/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Duodenal switch (DS) is considered one of the most effective bariatric techniques for long-term weight and comorbidity control. After these operations, some patients may get severe complications related to malnutrition and a few of them may need surgical revision. Lengthening the common channel (CC) is usually the solution: changing the Roux anastomosis or with a side-to-side anastomosis (kissing X). We propose that when simplified construction of the DS is used, conversion to single anastomosis DS (SADI-S/OADS) is an easy and safe choice. OBJECTIVES To evaluate the safety and effectiveness of conversion from DS to SADI-S in cases of malnutrition. METHODS We report three patients with severe malnutrition after a DS at 9, 74, and 84 months. One of them had also liver failure related to alcohol abuse and malnutrition. Laparoscopic reoperations included a new ileo-ileal anastomosis and takedown of the Roux-en-Y anastomosis with the aim of lengthening the CC. RESULTS All three patients were successfully converted by laparoscopy. After a median follow-up of 54.6 months [32-76 months], all of them had moderate weight regain and returned to normal biochemical nutritional parameters. Two patients with type 2 diabetes (T2DM) before DS had complete remission before conversion; one of them had recurrence of T2DM after conversion. The patient with liver failure improved significantly after conversion. CONCLUSIONS Conversion from DS to SADI-S/OADS is a simple operation with excellent results in resolving malnutrition in those patients. However, weight regain and recurrence of comorbidities may arise.
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Affiliation(s)
- Javier Baltar
- Servicio de Cirugía General y del Aparato Digestivo, CHU Santiago de Compostela, Rua R Baltar s/n, 15706, Santiago de Compostela, Spain.
| | - Aurelio Martis-Sueiro
- Servicio de Endocrinología, CHU Santiago de Compostela, Santiago de Compostela, Spain
| | - María Pardo
- Grupos de Obesidómica (MP), Epigenomica (ABC) y Fisiopatolgía Endocrina (LMS) del Area de Endocrinología, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Fernando Santos
- Servicio de Cirugía General y del Aparato Digestivo, CHU Santiago de Compostela, Rua R Baltar s/n, 15706, Santiago de Compostela, Spain
| | - Maria Isabel Sartal
- Servicio de Cirugía General y del Aparato Digestivo, CHU Santiago de Compostela, Rua R Baltar s/n, 15706, Santiago de Compostela, Spain
| | - Ana B Crujeiras
- Grupos de Obesidómica (MP), Epigenomica (ABC) y Fisiopatolgía Endocrina (LMS) del Area de Endocrinología, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Roberto Peinó
- Servicio de Endocrinología, CHU Santiago de Compostela, Santiago de Compostela, Spain
| | - Luisa María Seoane
- Grupos de Obesidómica (MP), Epigenomica (ABC) y Fisiopatolgía Endocrina (LMS) del Area de Endocrinología, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - María Bárcena
- Servicio de Anestesiología y Reanimación, CHU Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel Bustamante
- Servicio de Cirugía General y del Aparato Digestivo, CHU Santiago de Compostela, Rua R Baltar s/n, 15706, Santiago de Compostela, Spain
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SADI-S 250 vs Roux-en-Y Duodenal Switch (RY-DS): Results of 5-Year Observational Study. Obes Surg 2020; 31:570-579. [PMID: 33047290 DOI: 10.1007/s11695-020-05031-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/30/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE There are only a small number of studies providing a comparison between SADI-S and Hess-Marceau's BPD/Duodenal Switch (RY-DS) operations. We aimed to compare 5-year results of SADI-S 250 (common limb 250 cm) with RY-DS. MATERIAL AND METHODS Data of patients who underwent open SADI-S (n 226) and RY-DS (n 528) were retrospectively studied. EWL(%), EBMIL(%), TWL(%), antidiabetic effect, complications, and revision rate were compared between the two groups. RESULTS After the first 12 months, EWL% (77.0% vs 73.3%) and TWL% (39.4% vs 38.9%) were statistically significantly better after SADI-S (p < 0.01, and p < 0.05 respectively), but not EBMIL% (p > 0.05). At nadir to 24-36 months, EWL, TBWL, and EBMIL after SADI-S was comparable to the RY-DS group. Up to the fourth and fifth year, better weight loss (TBWL, EBMIL, EWL) was observed after RY-DS than after SADI-S. Early complication rate was less (2.65%) in the SADI-S group vs 5.1% in the RY-DS. Protein deficiency and small bowel obstruction rates were also lower after SADI-S. 93.4% of patients achieved total remission of their diabetes. 7.5% of patients in the SADI-S group had symptoms of bile reflux, which was a main indication for revisions. CONCLUSION SADI-S has many advantages over RY-DS. However, weight loss and antidiabetic effects after the third year were marginally lower after SADI-S compared to RY-DS. SADI-S is less dangerous in terms of malabsorption and looks to be a reasonable alternative to RY-DS as a metabolic operation. RY-DS could be implemented for weight regain and/or bile reflux after SADI-S.
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The outcomes of single anastomosis sleeve jejunal bypass as a treatment for morbid obesity (Two-year follow-up). Surg Endosc 2020; 35:5698-5704. [PMID: 32989534 DOI: 10.1007/s00464-020-08029-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 09/16/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Santoro's operation is a sleeve gastrectomy with transit bipartition. The aim of the procedure is to keep pass to the duodenum to decrease nutritional deficiency and to allow endoscopic management of obstructive jaundice. To be easier, this procedure was rapidly altered to a single anastomosis sleeve ileal bypass (SASI). In this study, we shifted the anastomosis up to the jejunum to evaluate the effect of laparoscopic single anastomosis sleeve jejunal (SASJ) bypass as a treatment for morbid obesity and related comorbidities. In addition, the effect of the SASJ procedure on nutritional deficiency was examined. METHODS In this study, 150 morbidly obese patients underwent SASJ bypass with a biliary limb length of 200-250 cm. All patients were followed up at 1, 3, 6, 12, 18, and 24 months. We evaluated all cases by assessing BMI, complications, nutritional status, and obesity-related comorbidities. RESULTS The mean age of participants was 30.6 years, and the mean body mass index (BMI) was 44.6 kg/m2. Of the patients, 35 (23.2%) had type two diabetes and 47 (31.3%) were hypertensive. Postoperative bleeding occurred in two cases (1.3%). One patient developed a gastric leak (0.7%), and five patients developed biliary gastritis (3.3%). One patient (0.7%) developed a pulmonary embolism. The %EWL reached 85% in 1 year. Normalization of blood glucose occurred within 2 months after surgery in all diabetic patients. Hypertension underwent remittance in 89% of hypertensive patients. All patients were gradually weaned from four types of multivitamin regimens to only one multivitamin regimen without apparent nutritional deficiency. CONCLUSIONS Laparoscopic SASJ bypass is an effective, safe, and simple procedure for treating morbid obesity and comorbid conditions with least nutritional deficiency. However, long-term studies are needed.
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Long Alimentary Limb Duodenal Switch (LADS): an Exploratory Randomized Trial, Results at 2 Years. Obes Surg 2020; 30:5047-5058. [DOI: 10.1007/s11695-020-04968-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 12/30/2022]
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Andalib A, Alamri H, Almuhanna Y, Bouchard P, Demyttenaere S, Court O. Short-term outcomes of revisional surgery after sleeve gastrectomy: a comparative analysis of re-sleeve, Roux en-Y gastric bypass, duodenal switch (Roux en-Y and single-anastomosis). Surg Endosc 2020; 35:4644-4652. [DOI: 10.1007/s00464-020-07891-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 08/05/2020] [Indexed: 01/07/2023]
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Abstract
BACKGROUND Standardization of the key measurements of a procedure's finished anatomic configuration strengthens surgical practice, research, and patient outcomes. A consensus meeting was organized to define standard versions of 25 bariatric metabolic procedures. METHODS A panel of experts in bariatric metabolic surgery from multiple continents was invited to present technique descriptions and outcomes for 4 classic, or conventional, and 21 variant and emerging procedures. Expert panel and audience discussion was followed by electronic voting on proposed standard dimensions and volumes for each procedure's key anatomic alterations. Consensus was defined as ≥ 70% agreement. RESULTS The Bariatric Metabolic Surgery Standardization World Consensus Meeting (BMSS-WOCOM) was convened March 22-24, 2018, in New Delhi, India. Discussion confirmed heterogeneity in procedure measurements in the literature. A set of anatomic measurements to serve as the standard version of each procedure was proposed. After two voting rounds, 22/25 (88.0%) configurations posed for consideration as procedure standards achieved voting consensus by the expert panel, 1 did not attain consensus, and 2 were not voted on. All configurations were voted on by ≥ 50% of 50 expert panelists. The Consensus Statement was developed from scientific evidence collated from presenters' slides and a separate literature review, meeting video, and transcripts. Review and input was provided by consensus panel members. CONCLUSIONS Standard versions of the finished anatomic configurations of 22 surgical procedures were established by expert consensus. The BMSS process was undertaken as a first step in developing evidence-based standard bariatric metabolic surgical procedures with the aim of improving consistency in surgery, data collection, comparison of procedures, and outcome reporting.
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Enochs P, Bull J, Surve A, Cottam D, Bovard S, Bruce J, Tyner M, Pilati D, Cottam S. Comparative analysis of the single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) to established bariatric procedures: an assessment of 2-year postoperative data illustrating weight loss, type 2 diabetes, and nutritional status in a single US center. Surg Obes Relat Dis 2020; 16:24-33. [DOI: 10.1016/j.soard.2019.10.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 10/08/2019] [Accepted: 10/08/2019] [Indexed: 12/15/2022]
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Godoy EPD, Pereira SSDS, Coelho D, Pinto IMDM, Luz VFD, Coutinho JL, Palitot TRDC, Costa HBDF, Campos JM, Brandt CT. Isolated intestinal transit bipartition: a new strategy for staged surgery in superobesity. ACTA ACUST UNITED AC 2019; 46:e20192264. [PMID: 31859724 DOI: 10.1590/0100-6991e-20192264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/15/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE biliopancreatic diversion with duodenal switch is a complex, malabsorptive procedure, associated with improved weight loss and metabolic control. Staged surgery with sleeve gastrectomy as the first stage is an option for reducing complications in superobese patients. However, some problems persist: large livers can hamper the surgical approach and complications such as leaks can be severe. Intestinal transit bipartition is a modified and simplified model of biliopancreatic diversion that complements sleeve gastrectomy. It is similar to the duodenal switch, but with less complexity and fewer nutritional consequences. This study assessed the feasibility and safety of isolated transit bipartition as the initial procedure in a two-step surgery to treat superobesity. METHODS this prospective study included 41 superobese patients, with mean BMI 54.5±3.5kg/m2. We performed a laparoscopic isolated transit bipartition as the first procedure in a new staged approach. We analyzed weight loss and complications during one year of follow-up. RESULTS we completed all the procedures by laparoscopy. After six months, the mean percent excess weight loss was 28%, remaining stable until the end of the study. There were no intraoperative difficulties. Half of the patients experienced early diarrhea, and three had marginal ulcers. There were no major surgical complications or deaths. CONCLUSION isolated laparoscopic transit bipartition is a new option for a staged approach in superobesity, which can provide a safer second procedure after effective weight loss over six months. It may be useful particularly in the management of patients with severe obesity.
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Affiliation(s)
- Eudes Paiva de Godoy
- Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Serviço de Cirurgia Geral, Natal, RN, Brasil
| | | | - Daniel Coelho
- Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Serviço de Cirurgia Geral, Natal, RN, Brasil
| | | | - Vinícius Fernando da Luz
- Universidade Federal do Rio Grande do Norte, Maternidade Escola Januário Cicco, Serviço de Anestesiologia, Natal, RN, Brasil
| | - Jorge Landivar Coutinho
- Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Serviço de Cirurgia Geral, Natal, RN, Brasil
| | | | - Hamilton Belo de França Costa
- Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Serviço de Cirurgia Geral, Natal, RN, Brasil
| | - Josemberg Marins Campos
- Universidade Federal de Pernambuco, Centro de Ciências da Saúde, Faculdade de Medicina, Departamento de Cirurgia, Recife, PE, Brasil
| | - Carlos Teixeira Brandt
- Universidade Federal de Pernambuco, Centro de Ciências da Saúde, Faculdade de Medicina, Departamento de Cirurgia, Recife, PE, Brasil
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Lin E. The State of Single Anastomosis Duodeno-Ileostomy. Bariatr Surg Pract Patient Care 2019. [DOI: 10.1089/bari.2019.29018.el] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Edward Lin
- Emory Bariatric Center, Emory University School of Medicine, Atlanta, Georgia
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Single-anastomosis duodenal ileostomy with sleeve is a safe and effective option for patients in an ambulatory surgical center. Surg Obes Relat Dis 2019; 15:1990-1993. [DOI: 10.1016/j.soard.2019.09.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/23/2019] [Accepted: 09/11/2019] [Indexed: 11/18/2022]
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Zaveri H, Surve A, Cottam D, Cottam A, Medlin W, Richards C, Belnap L, Cottam S, Horsley B. Mid-term 4-Year Outcomes with Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy Surgery at a Single US Center. Obes Surg 2019; 28:3062-3072. [PMID: 29909514 DOI: 10.1007/s11695-018-3358-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) is a modification of Roux-en-Y duodenal switch (RYDS). Long-term data on this operation is lacking in the literature. We reviewed our mid-term data of this RYDS modification. PURPOSE To analyze the outcomes with SADI-S at 4 years. METHODS Data from patients who underwent a primary SADI-S procedure performed by three surgeons at a single institution from June 2013 through February 2018 were retrospectively reviewed. All revision bariatric surgeries were excluded. Regression analyses were performed for all follow-up weight loss data. RESULTS There were 437 patients in our database. The pre-operative mean body mass index (BMI) was 49.8 ± 8.8 kg/m2. The 30-day complication rate was 7.7%. The 30-day readmission, reoperation, and mortality rates were 1.8, 1.3, and 0.2%, respectively. The long-term complication rate was 10.9%. Seventy-nine patients were 4 years post SADI-S surgery and follow-up was possible for 44 patients (55.7%). At 4 years, patients had an average change in BMI of 18.1 ± 6 units with an excess weight loss (EWL) of 85.7 ± 27.3%. At 4 years, 97.6% patients were able to maintain HbA1c < 6% with or without the use of diabetic medication. There was a statistically significant difference between most of the pre-operative and post-operative nutritional data. CONCLUSIONS SADI-S is a safe and effective procedure in both short- and mid-term data points. Diabetes resolution and weight loss appear similar to traditional RYDS and better than RYGB.
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Affiliation(s)
- Hinali Zaveri
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Amit Surve
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Daniel Cottam
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA.
| | - Austin Cottam
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Walter Medlin
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Christina Richards
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - LeGrand Belnap
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Samuel Cottam
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Benjamin Horsley
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
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Effect of single anastomosis duodenal-ileal bypass with sleeve gastrectomy on glucose tolerance test: comparison with other bariatric procedures. Surg Obes Relat Dis 2019; 15:1091-1097. [DOI: 10.1016/j.soard.2019.04.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 03/31/2019] [Accepted: 04/13/2019] [Indexed: 01/22/2023]
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Vilallonga R, Curbelo Y, Sanchez-Cordero S, Roriz-Silva R, Bademci R, Torres AJ. Laparoscopic Conversion from Single Anastomosis Duodeno-Jejunal Bypass with Sleeve Gastrectomy (SADJ-S) to Roux-en-Y Gastric Bypass (GBP): Improving Unsatisfactory Outcomes. Obes Surg 2019; 30:365-368. [PMID: 31183786 DOI: 10.1007/s11695-019-03994-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) can be considered as either a primary procedure or second stage procedure. Malnutrition is rare but could lead to a reversal of the SADI-S. The aim of this manuscript is to present the management and technique of weight regain after proximalization of a SADI-S by converting it to a gastric bypass.
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Affiliation(s)
- Ramon Vilallonga
- Quirobes, Integral Obesity Care, Centro Médico Teknon, C. Marquesa de Vilallonga, 12, 08017, Barcelona, Spain. .,Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Yuhamy Curbelo
- General Surgery Department, Hospital Universitari de Vic (Consorci Hospitalari de Vic), Vic, Spain
| | | | - Renato Roriz-Silva
- Department of Medicine, Federal University of Rondônia-Unir, Porto Velho, Brazil.,Division of General Surgery, Hospital de Base of Porto Velho-Brazil, Porto Velho, Brazil
| | - Refik Bademci
- Camlica Hospital, Istanbul Medipol University, 34767, Istambul, Turkey
| | - Antonio José Torres
- Chief General Surgery Department, Hospital Clínico San Carlos, Universidad Autónoma de Madrid, Madrid, Spain
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Ding L, Zhuo C, Fan Y, Zhang Y, Li H, Qi D, Tang S, Cui J, He Q, Liu M. Comparative long-term effectiveness and safety of primary bariatric surgeries in treating type 2 diabetes mellitus in adults: a protocol for systematic review and network meta-analysis of randomised controlled trials. BMJ Open 2019; 9:e028430. [PMID: 30948619 PMCID: PMC6500318 DOI: 10.1136/bmjopen-2018-028430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Bariatric surgeries are effective in treating obesity related comorbidities, including type 2 diabetes mellitus. More robust evidence is needed to facilitate choice of procedure. In this systemic review, we aim to investigate the comparative long-term effectiveness in inducing remission of type 2 diabetes, halting diabetic complications, reducing mortality and the safety of conventional and emerging bariatric surgeries. METHODS AND ANALYSIS Databases including Cochrane Central Register, EMBASE, MEDLINE and clinical trial registries will be searched for randomised controlled trials with at least 3 years of follow-up, including direct and/or indirect evidence regarding primary bariatric surgeries in overweight or obese adults with type 2 diabetes mellitus, from inception of each database to 2019, with no language or publication type limits imposed. Dual selection of studies, data extraction and risk of bias assessments will be performed. Primary outcomes include full diabetes remission, composite outcome of full or partial diabetes remission and adverse event profiles. Secondary outcomes include anthropometric measurements, cardiovascular risk factor burden, medication burden, diabetic complications and all-cause mortality. Given sufficient homogeneity, network meta-analyses will be performed in a random-effects model based on the Bayesian framework, while assessing for consistency between direct and indirect estimates. Heterogeneities of studies will be explored through meta-regression analysis, and robustness of findings will be checked by sensitivity analysis, and an alternative method under a frequentist framework. All statistical analysis and graphical presentations will be conducted by R software V.3.3.3 (The R Project for Statistical Computing). The overall quality of the evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation criteria for each outcome. ETHICS AND DISSEMINATION Ethics approval is not required as individual patient data will not be included. This review will be subject for publication in a peer reviewed journal. PROSPERO REGISTRATION NUMBER CRD42018110775.
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Affiliation(s)
- Li Ding
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Chuanjun Zhuo
- Laboratory of Psychiatric Neuroimaging, Tianjin Municipal Mental Health Center, Tianjin, China
| | - Yuxin Fan
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Yalan Zhang
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Hui Li
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Dongwang Qi
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Shaofang Tang
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Jingqiu Cui
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Qing He
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Ming Liu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
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Torres AJ. Comment on: The study of single-anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) as the revision surgery for laparoscopic adjustable gastric banding (LAGB). Surg Obes Relat Dis 2019; 15:e11-e13. [PMID: 30808563 DOI: 10.1016/j.soard.2019.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/17/2018] [Accepted: 01/23/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Antonio J Torres
- Hospital Clinico San Carlos, Complutense University of Madrid, Madrid, Spain
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Laparoscopic single-anastomosis duodenal-jejunal bypass with sleeve gastrectomy (SADJB-SG): Surgical risk and long-term results. Surg Obes Relat Dis 2019; 15:236-243. [DOI: 10.1016/j.soard.2018.11.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/23/2018] [Accepted: 11/20/2018] [Indexed: 12/18/2022]
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Wang T, Shen Y, Qiao Z, Wang Y, Zhang P, Yu B. Comparison of Diabetes Remission and Micronutrient Deficiency in a Mildly Obese Diabetic Rat Model Undergoing SADI-S Versus RYGB. Obes Surg 2019; 29:1174-1184. [PMID: 30610678 DOI: 10.1007/s11695-018-03630-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) has launched a huge challenge to classic Roux-en-Y gastric bypass (RYGB). Our objective was to compare diabetes remission and micronutrient deficiency in a mildly obese diabetic rat model undergoing SADI-S versus RYGB. METHODS Thirty adult male mildly obese diabetic rats were randomly assigned to sham (S), SADI-S, and RYGB groups. Body weight, food intake, fasting plasma glucose (FPG), oral glucose tolerance test (OGTT), plasma insulin, GLP-1, and ghrelin levels were measured at indicated time points. Meanwhile, insulin sensitivity and pancreatic β cell function were assessed during OGTT. Finally, plasma micronutrient evaluation and islet β cell mass analysis were performed after all animals were sacrificed. RESULTS As compared to sham, the SADI-S and RYGB groups achieved almost equivalent efficacy in caloric restriction and FPG control without excessive weight loss. During OGTT, the SADI-S and RYGB groups also provided comparable effects on glycemic excursion, insulin sensitivity, and β cell function; however, only rats in the RYGB group showed significant changes in gut hormones, whereas the three groups were found to exhibit no significant difference in β cell mass. In addition, only vitamin E in the RYGB group was deficient as compared with the SADI-S and S groups. CONCLUSION In mildly obese diabetic rat, SADI-S and RYGB procedures have comparable efficacy in diabetes remission and risk of micronutrient deficiency. These data show that each of the surgery accomplishes diabetes improvements through both overlapping and distinct mechanisms requiring further investigation.
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Affiliation(s)
- Tingfeng Wang
- Center for Metabolic and Bariatric Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai, 201399, China
| | - Yunlong Shen
- Center for Metabolic and Bariatric Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai, 201399, China
| | - Zhengdong Qiao
- Center for Medical Research and Innovation, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai, 201399, China
| | - Yueqian Wang
- Center for Medical Research and Innovation, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai, 201399, China
| | - Peng Zhang
- Center for Metabolic and Bariatric Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai, 201399, China. .,Center for Medical Research and Innovation, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai, 201399, China.
| | - Bo Yu
- Center for Metabolic and Bariatric Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai, 201399, China.
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Is There a Better Design for a Bariatric Procedure? The Case for a Single Anastomosis Duodenal Switch. Obes Surg 2018; 28:4077-4086. [DOI: 10.1007/s11695-018-3535-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Surve A, Zaveri H, Cottam D, Cottam A, Cottam S, Belnap L, Medlin W, Richards C. Laparoscopic stomach intestinal pylorus-sparing surgery as a revisional option after failed adjustable gastric banding: a report of 27 cases with 36-month follow-up. Surg Obes Relat Dis 2018; 14:1139-1148. [DOI: 10.1016/j.soard.2018.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/23/2018] [Accepted: 05/02/2018] [Indexed: 01/23/2023]
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