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

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.

A safety study of laparoscopic single-anastomosis duodeno-ileal bypass with gastric plication (SADI-GP) in the management of morbid obesity

Background Bariatric surgery is more effective in the management of morbid obesity and related comorbidities than is conservative therapy. Pylorus-preserving single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-SG) is a modified duodenal switch technique. Gastric plication (GP) is an alternate to SG. Methods Morbidly obese (BMI of > 40, or > 35 in the presence of diabetes or prediabetes) patients were recruited and operated on to perform SADI with GP. Complications related to surgery were recorded to assess the feasibility of the procedure. Weight-loss outcomes were analysed to determine efficacy. Minnesota Multiphasic Personality Inventory 2 (MMPI-2) was recorded after 1 year of follow-up, and test scales were used to describe physiological phenomena. Results Seventeen middle-aged (mean: 40 years) patients were involved in our study; 15 of them were females. The mean duration of surgery was 205 min. There were no complications of conversion, death, bleeding, VTE or 30-day readmission to hospital. We did experience CD4a (pulmonary insufficiency due to chronic lung disease) and a CD3b (anastomosis leakage treated laparoscopically) complications. Vomiting occurred in three cases (CD1). Obesity-related comorbidities showed favourable resolution rates (77.8% for hypertension, 81.2% for dyslipidaemia, 100% for diabetes at the 1-year follow-up). Weight-loss outcomes were favourable (53.20 EWL%, and 35.58 TWL% at 1-year follow-up). Greater weight loss caused significantly higher levels of Depression (t(13.958) = − 2.373; p = 0.00; p < 0.05) and Low Positive Emotions (t(13.301) = − 2.954; p = 0.00; p < 0.05) and Introversion/Low Positive Emotionality (t(13.408) = − 1.914; p = 0.02; p < 0.05) in MMPI-2 data. Conclusion According to our safety study, SADI-GP is a promising malabsorptive procedure, but a long-term high-volume case series or a randomised controlled trial is necessary to evaluate complication rates and weight-loss outcomes. Emotional dysregulation is common among bariatric surgery patients according to personality inventory data; therefore, psychological follow-up and psychotherapeutic support are necessary for weight-loss maintenance.

Evaluation of the learning curve for totally robotic single-anastomosis duodenal–ileal bypass with sleeve gastrectomy by CUSUM analysis

Single-anastomosis duodenal–ileal bypass with sleeve gastrectomy (SADI-S) has similar efficacy and lower complication rate in the treatment of morbid obesity and obesity-associated metabolic diseases compared with the biliopancreatic diversion with a duodenal switch. The use of a robotic surgical system reduces surgical difficulties and improves surgical outcomes. The learning curve reflects the rate of skills or knowledge acquired in a certain period of time. However, the learning curve for robotic SADI-S has not been estimated.We used the cumulative sum analysis method to investigate the learning curve of totally robotic SADI-S. Textbook outcome analysis was performed to comprehensively define surgical success or failure.Multivariate analysis was performed to predict independent risk factors for complications and operative time. The moving average method was used to reflect the trends in operative time.This study showed that the learning curve for totally robotic SADI-S was 27 cases. Surgeon experience (case number and successful case number) was an independent predictor of the total operative time. A successful case number was the only independent predictor of surgical success or failure in this study (β = 0.084; P = 0.001). Except for the first assistant level, scrubbed nurse level, operative time, and proportion of abdominal drainage tube, there was no significant difference between the learning stage and mastery stage groups.The learning curve for totally robotic SADI-S was 27 cases. Surgeon experience including case number and successful case number were identified as independent predictors affecting the total operative time. A successful case number was the only independent predictor of surgical success or failure.