Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) Surgery

Abstract

Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-s) is a novel one loop duodenal switch with a 250 cm common limb. A sleeve gastrectomy over a large bore bougie (54 French) is initially performed and the duodenum is transected 2-4 cm from the pylorus. An ileal loop, 250-300 cm from the cecum (initially 200 cm), is ascended antecolically and anastomosed to the duodenum in an end-to-side fashion. Four-hundred and thirty patients have been consecutively operated upon. Mean initial body mass index (BMI) was 48 kg/m2 and 65% of the patients were diabetic. Mean excess weight loss was 90-95%, with only 3% of the patients failing to reach a 50% excess weight loss. Glycemia and HbA1c values normalized in the early postoperative periods, with 85% of the diabetic patients showing levels of HbA1c below 6%. The overall conversion rate for malnutrition is 3.8%, but this fell to 2.3% for patients with a 250 cm common limb and 0% for patients with a 300 cm common limb.