Single Anastomosis Duodenoileal Bypass or Roux-en-Y Gastric Bypass After Failed Sleeve Gastrectomy: Medium-Term Outcomes

Abstract Background Although the sleeve gastrectomy (SG) has good short-term results, it comes with a significant number of patients requiring revisional surgery because of insufficient weight loss or functional complications. Objective To investigate the effectiveness of the single anastomosis duodenoileal bypass (SADI-S) versus the Roux-en-Y gastric bypass (RYGB) on health outcomes in (morbidly) obese patients who had previously undergone SG, with up to 5 years of follow-up. Methods Data from patients who underwent revisional SADI-S or RYGB after SG were retrospectively compared on indication of surgery, weight loss, quality of life, micronutrient deficiencies, and complications. Results From 2007 to 2017, 141 patients received revisional laparoscopic surgery after SG in three specialized Dutch bariatric hospitals (SADI-S n=63, RYGB n=78). Percentage total weight loss following revisional surgery at 1, 2, 3, 4, and 5 years was 22%, 24%, 22%, 18%, and 15% for SADI-S and 10%, 9%, 7%, 8%, and 2% for RYGB (P<.05 for 1–4 years). Patients who underwent RYGB surgery for functional complications experienced no persistent symptoms of GERD or dysphagia in 88% of cases. No statistical difference was found in longitudinal analysis of change in quality of life scores or cross-sectional analysis of complication rates and micronutrient deficiencies. Conclusion Conversion of SG to SADI-S leads to significantly more total weight loss compared to RYGB surgery with no difference in quality of life scores, complication rates, or micronutrient deficiencies. When GERD in sleeve patients has to be resolved, RYGB provides adequate outcomes. Graphical abstract

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Weight Loss and Quality of Life After Sleeve Gastrectomy or One-Anastomosis Gastric Bypass: Results of a Prospective Study of 120 Women with Morbid Obesity

Obesity Surgery ◽

10.1007/s11695-020-04442-2 ◽

2020 ◽

Vol 30 (7) ◽

pp. 2828-2831 ◽

Cited By ~ 1

Author(s):

David Lechaux ◽

David Le Foll ◽

Olivier Rascle

Keyword(s):

Quality Of Life ◽

Morbid Obesity ◽

Weight Loss ◽

Gastric Bypass ◽

Sleeve Gastrectomy ◽

Prospective Study ◽

One Anastomosis Gastric Bypass ◽

A Prospective Study

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Fifteen Years After Sleeve Gastrectomy: Weight Loss, Remission of Associated Medical Problems, Quality of Life, and Conversions to Roux-en-Y Gastric Bypass—Long-Term Follow-Up in a Multicenter Study

Obesity Surgery ◽

10.1007/s11695-021-05475-x ◽

2021 ◽

Author(s):

Daniel M. Felsenreich ◽

Evi Artemiou ◽

Katharina Steinlechner ◽

Natalie Vock ◽

Julia Jedamzik ◽

...

Keyword(s):

Quality Of Life ◽

Weight Loss ◽

Gastric Bypass ◽

Sleeve Gastrectomy ◽

Medical Problems ◽

Remission Rates ◽

Long Term Follow Up

Abstract Purpose Since 2014, sleeve gastrectomy (SG) has been the most frequently performed bariatric-metabolic operation worldwide (2018: 386,096). There are only a few studies reporting a long-term follow-up (up to 11 years) available today. The aim of this study was to evaluate the long-term outcome of SG with a follow-up of at least 15 years regarding weight loss, remission of associated medical problems (AMP), conversions, and quality of life (QOL). Setting Multicenter cross-sectional study; university hospital. Methods This study includes all patients who had SG before 2005 at the participating bariatric centers. History of weight, AMP, conversions, and QOL were evaluated by interview at our bariatric center. Results Fifty-three patients met the inclusion criteria of a minimal follow-up of 15 years. Weight and body mass index at the time of the SG were 136.8kg and 48.7kg/m2. Twenty-six patients (49.1%) were converted to Roux-en-Y gastric bypass (RYGB) for weight regain and gastroesophageal reflux within the follow-up period. Total weight loss after 15 years was 31.5% in the non-converted group and 32.9% in the converted group. Remission rates of AMP and QOL were stable over the follow-up period. Conclusion Fifteen years after SG, a stable postoperative weight was observed at the cost of a high conversion rate. Patients converted to RYGB were able to achieve further weight loss and preserve good remission rates of AMP. SG in patients without the need of a conversion to another bariatric-metabolic procedure may be considered effective. Careful preoperative patient selection is mandatory when performing SG. Graphical abstract

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Prospective multicentre randomised trial comparing the efficacy and safety of single-anastomosis duodeno–ileal bypass with sleeve gastrectomy (SADI-S) versus Roux-en-Y gastric bypass (RYGB): SADISLEEVE study protocol

BMJ Open ◽

10.1136/bmjopen-2020-037576 ◽

2020 ◽

Vol 10 (9) ◽

pp. e037576

Author(s):

Maud Robert ◽

Tigran Poghosyan ◽

Dominique Delaunay ◽

Elise Pelascini ◽

Sylvain Iceta ◽

...

Keyword(s):

Weight Loss ◽

Gastric Bypass ◽

Sleeve Gastrectomy ◽

Failure Rate ◽

Excess Weight Loss ◽

Excess Weight ◽

Complication Rates ◽

Weight Loss Failure ◽

Single Anastomosis ◽

Ileal Bypass

IntroductionDespite the non-negligible weight loss failure rate at midterm, Roux-en-Y gastric bypass (RYGB) remains the reference procedure in the treatment of morbid obesity with metabolic comorbidities. A recently emerged procedure, the single anastomosis duodeno–ileal bypass with sleeve gastrectomy (SADI-S), could be more effective on weight loss with similar morbidity and lower weight loss failure rate than RYGB. We propose the first randomised, open, multicentre superiority trial comparing the SADI-S to RYGB (SADISLEEVE).Methods and analysisThe main objective is to demonstrate the superiority at 2 years after surgery of the SADI-S compared with RYGB in term of excess weight loss percentage. The secondary objectives are the evaluation of nutritional status, metabolic outcomes, overall complication rates and quality of life, within 2 years after surgery. Key inclusion criteria are obese patients with body mass index (BMI) ≥40 kg/m2 or ≥35 kg/m2 with at least one comorbid condition and candidate to a first bariatric procedure or after failure of sleeve gastrectomy. Patients randomised by minimisation in two arms, based on centre, surgery as a revisional procedure, presence of type 2 diabetes and BMI >50 kg/m2 will be included over 2 years.A sample size of 166 patients in each group will have a power of 90% to detect a probability of 0.603 that excess weight loss in the RYGB arm is less than excess weight loss in the SADI-S arm with a 5% two-sided significance level. With a drop-out rate of 10%, it will be necessary to include 183 patients per group.Ethics and disseminationThe study was approved by Institutional Review Board of Centre Hospitalier Universitaire Morvan (CPP1089-HPS1). Study was also approved by the French national agency for drug safety (2018061500148). Results will be reported in peer-reviewed scientific journals.Trial registration numberNCT03610256.

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Effect of Laparoscopic Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass on Weight Loss and Quality of Life at 7 Years in Patients With Morbid Obesity

JAMA Surgery ◽

10.1001/jamasurg.2020.5666 ◽

2020 ◽

Author(s):

Sofia Grönroos ◽

Mika Helmiö ◽

Anne Juuti ◽

Roosa Tiusanen ◽

Saija Hurme ◽

...

Keyword(s):

Quality Of Life ◽

Morbid Obesity ◽

Weight Loss ◽

Gastric Bypass ◽

Sleeve Gastrectomy ◽

Laparoscopic Sleeve Gastrectomy

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Seven-year trajectories of body weight, quality of life and comorbidities following Roux-en-Y gastric bypass and sleeve gastrectomy

International Journal of Obesity ◽

10.1038/s41366-021-01028-5 ◽

2022 ◽

Author(s):

Hans Jørgen Nielsen ◽

Bjørn Gunnar Nedrebø ◽

Alexander Fosså ◽

John Roger Andersen ◽

Jörg Assmus ◽

...

Keyword(s):

Quality Of Life ◽

Weight Loss ◽

Gastric Bypass ◽

Body Weight ◽

Sleeve Gastrectomy ◽

Mixed Effect ◽

Remission Rates ◽

The Impact

Abstract Background/objectives There is limited long-term data comparing the outcomes of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) for severe obesity, both with respect to body weight, quality of life (QOL) and comorbidities. We aimed to determine 7-year trajectories of body mass index (BMI), QOL, obesity-related comorbidities, biomarkers of glucose and lipid metabolism, and early major complications after SG and RYGB. Subjects/methods Patients scheduled for bariatric surgery at two Norwegian hospitals, preferentially performing either SG or RYGB, were included consecutively from September 2011 to February 2015. Data was collected prospectively before and up to 7 years after surgery. Obesity-specific, generic and overall QOL were measured by the Impact of Weight on Quality of Life-Lite, Short-Form 36 and Cantril’s ladder, respectively. Comorbidities were assessed by clinical examination, registration of medication and analysis of glucose and lipid biomarkers. Outcomes were examined with linear mixed effect models and relative risk estimates. Results Of 580 included patients, 543 (75% women, mean age 42.3 years, mean baseline BMI 43.0 kg/m2) were operated (376 SG and 167 RYGB). With 84.2% of participants evaluable after 5–7 years, model-based percent total weight-loss (%TWL) at 7 years was 23.4 after SG versus 27.3 after RYGB (difference 3.9%, p = 0.001). All levels of QOL improved similarly after the two surgical procedures but remained below reference data from the general population at all timepoints. Remission rates for type 2 diabetes, dyslipidemia, obstructive sleep-apnea and gastroesophageal reflux disease (GERD) as well as the rate of de novo GERD significantly favored RYGB. SG had fewer major early complications, but more minor and major late complications combined over follow-up. Conclusion In routine health care, both SG and RYGB are safe procedures with significant long-term weight-loss, improvement of QOL and amelioration of comorbidities. Long-term weight-loss and remission rates of main obesity-related comorbidities were higher after RYGB.

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To Sleeve or NOT to Sleeve in Bariatric Surgery?

ISRN Surgery ◽

10.5402/2012/674042 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 10

Author(s):

P. W. J. van Rutte ◽

M. D. P. Luyer ◽

I. H. J. T. de Hingh ◽

S. W. Nienhuijs

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Gastric Bypass ◽

Sleeve Gastrectomy ◽

Weight Loss Surgery ◽

Revisional Surgery ◽

Considerable Proportion ◽

Complication Rates ◽

Long Term Effects ◽

Promising Alternative

Morbid obesity has become a global epidemic during the 20th century. Until now bariatric surgery is the only effective treatment for this disease leading to sustained weight loss and improvement of comorbidities. The sleeve gastrectomy is becoming a promising alternative for the gold standard the gastric bypass and it is gaining popularity as a stand-alone procedure. The effect of the laparoscopic sleeve gastrectomy is based on a restrictive mechanism, but a hormonal effect also seems to play an important role. Similar results are achieved in terms of excess weight loss and resolution of comorbidities compared to the gastric bypass. Inadequate weight loss or weight regain can be treated by revisional surgery. Complication rates after LSG appear to be lower compared with gastric bypass. General guidelines recommend bariatric surgery between the age of 18 and 65. However bariatric surgery in the elderly seems safe with respect to weight loss and resolution of comorbidities. At the same time weight loss surgery is more often performed in adolescent patients failing weight loss attempts. Even though more studies are needed describing long-term effects, there is already enough evidence that this technique is an effective single procedure for a considerable proportion of obese patients.

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Short-Term Results of Single-Anastomosis Gastric Bypass After Failed Sleeve Gastrectomy

QJM ◽

10.1093/qjmed/hcab097.039 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Alaa Abbas Sabry ◽

Karim Sabry Abd-Elsamee ◽

Mohamed Ibrahim Mohamed ◽

Mohammed Mohamed Ahmed Abd-Elsalam

Keyword(s):

Weight Loss ◽

Gastric Bypass ◽

Sleeve Gastrectomy ◽

Weight Regain ◽

Revisional Surgery ◽

One Anastomosis Gastric Bypass ◽

Short Term ◽

Multicenter Studies ◽

Metabolic Outcomes

Abstract Background It is already known that Laparoscopic sleeve gastrectomy (LSG) has gained popularity as a stand-alone procedure with good short-term results for weight loss. However, in the long-term, weight regain is considered as a complication. Demand for secondary surgery is rising, partly for this reason, but through that study we try to discover the efficacy of conversion of failed sleeve gastrectomy to one anastomosis gastric bypass (OAGB) regarding weight loss and metabolic outcomes. Objective To asses the efficacy and safety of one anastomosis gastric bypass (OAGB) as a conversion surgery post Sleeve Gastrectomy failure as regard weight loss and metabolic outcomes. Patients and Methods This study is a retrospective cohort study which included 20 patients underwent one anastomosis gastric bypass at Ain-Shams University El-Demerdash Hospital, Cairo, Egypt and specialized bariatric center, Cairo, Egypt From February 2019 to July 2019 with 6 months of postoperative follow up till January 2019. Results In this study, we reviewed and analyzed the outcomes from the revision of the SG due to either inadequate weight loss or weight regain to one anastomosis gastric bypass (OAGB) with %EBWL of 6.65% at 1 month, 13.61 % at 3 months and 20.86% at 6 months. Conclusion OAGB appears to be an effective and safe therapeutic technique as a revisional surgery for failed primary SG with good short-term results for treating morbid obesity and its associated comorbidities with a significantly low rate of complications. However the EBWL was less than what is reported after primary OAGB weight. Multicenter studies with larger series of patients and longer term follow up after SG revisions to OAGB are warranted.

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Long-Term Quality of Life Outcomes After Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass—a Comparative Study

Obesity Surgery ◽

10.1007/s11695-020-05049-3 ◽

2020 ◽

Author(s):

Cristina Fiorani ◽

Sophie R. Coles ◽

Myutan Kulendran ◽

Emma Rose McGlone ◽

Marcus Reddy ◽

...

Keyword(s):

Quality Of Life ◽

Bariatric Surgery ◽

Gastric Bypass ◽

Sleeve Gastrectomy ◽

Metabolic Effects ◽

Life Outcomes ◽

Post Bariatric Surgery ◽

Comorbidity Resolution

Abstract Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) have been shown to improve metabolic comorbidities as well as quality of life (QoL) in the obese population. The vast majority of previous studies have investigated the metabolic effects of bariatric surgery and there is a dearth of studies examining long-term QoL outcomes post bariatric surgery. The outcomes of 43 patients who underwent bariatric surgery were prospectively assessed, using BAROS questionnaires to quantify QoL and metabolic status pre-operatively, at 1 year and at 8 years. Total weight loss and comorbidity resolution were similar between RYGB and SG. The RYGB cohort experienced greater QoL improvement from baseline and had higher BAROS scores at 8 years. RYGB may provide more substantial and durable long-term benefits as compared to SG.

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