Long-Term Results of Single-Anastomosis Duodeno-ileal Bypass with Sleeve Gastrectomy (SADI-S)

Background Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a simplification of the duodenal switch (DS) in which the alimentary limb is eliminated, and the common channel is lengthened from 200 to 300 cm. Short-term results have demonstrated that SADI-S is safe and reproducible and that weight loss and comorbidities resolution are comparable to biliopancreatic diversion or DS. Objective To analyze the long-term outcomes of SADI-S. Methods From May 2007 to December 2015, 164 patients were consecutively submitted to a one-step SADI-S. The mean age was 47 years, and the mean body mass index (BMI) was 45.8 kg/m2. A total of 101 patients had type 2 diabetes, 91 arterial hypertension, 81 obstructive apnea, and 118 dyslipidemia. Limb length was 200 cm in 50 cases, 250 cm in 99, and 300 cm in 15. Results There was no mortality. One patient had a gastric leak, and 2 patients had an anastomotic leak. A total of 25% of the patients were lost to follow-up at 10 years. Excess weight loss and total weight loss were 87% and 38% at 5 years and 80% and 34% at 10 years. A total of 12 patients were submitted to revisional surgery for hypoproteinemia. Preoperatively 41 diabetics were under insulin treatment; at 5 years, 7 remained with insulin and 12 at 10 years. Mean glycemia was 104 mg/dL at 5 years and 118 mg/dL at 10 years. Mean HbA1c was 5.51% at 5 years and 5.86 at 10 years. Conclusion In the long term, SADI-S offers satisfactory weight loss and comorbidities resolution. Graphical Abstract

Single-Anastomosis Procedures in Metabolic Surgery

The most effective long-term treatment for severe obesity is bariatric surgery with improvement or resolution of obesity-related comorbidities. Single-anastomosis procedures including single-anastomosis duodenoileal bypass and one-anastomosis gastric bypass are relatively new procedures that are gaining popularity worldwide. These surgical techniques are perceived to be less complex with a shorter learning curve in comparison to the standard biliopancreatic diversion with duodenal switch and Roux-en-Y gastric bypass; however, long-term outcomes and complications remain controversial. This article aims to review one-anastomosis procedures, evaluate their outcomes, and review potential complications.

Comparative study between Single Anastomosis Sleeve Ileal Bypass (SASI) and Mini Gastric Bypass (OAGB) in treatment of Morbid Obesity

Background Single anastomosis sleeve ileal bypass (SASI) procedure appears as anew metabolic and bariatric surgery based on santoro's operation, in which sleeve gastrectomy is followed by side to side gastro-ileal loop anastomosis. Aim of the Work to compare between Single Anastomosis Sleeve Ileal Bypass (SASI) and Mini Gastric Bypass (OAGB) in treatment of morbid obesity. Patients and Methods Our study was a prospective randomized comparative study in Ain Shams University hospitals involving 50 patients suffering from morbid obesity and in whom surgical management was indicated. Our patients were randomly divided using closed envelopment method into two groups: Group (1): (25 patients) were treated by laparoscopic SASI. Group (2): (25 patients) were treated by laparoscopic MGB. Results One year after the surgery, there was significant diabetic remission rate and there was improvement of most of obesity-associated metabolic parameters Conclusion Our study suggests that both SASI and MGB are highly effective in controlling diabetes mellitus, hypertension and hyperlipidemia.