Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, C/Feixa Llarga s/n. L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
Obes Surg. 2021 Aug;31(8):3667-3674. doi: 10.1007/s11695-021-05469-9. Epub 2021 May 12.
Single-anastomosis duodeno-ileal bypass (SADI-S) is being proposed for obese patients with insufficient weight loss or weight regain after sleeve gastrectomy (SG), but limited information is available. The purpose of this study is to assess the safety and efficacy of SADI-S as a revisional surgery after SG, compared with standard duodenal switch (DS).
Unicentric cohort study including all patients submitted to SADI-S and DS after failed SG in a high-volume institution, between 2008 and 2020.
Forty-six patients submitted to SADI-S and 55 to DS were included, 37.2 and 41.5 months after SG (p = 0.447), with initial BMI of 56.2 vs. 56.6 (p = 0.777) and 39.2 vs. 39.7 before revisional surgery (p = 0.675). All surgeries were laparoscopic. Clavien-Dindo > II complication rate was 6.5% for SADI-S and 10.9% for DS (p = 0.095), with no 90-day mortality. Follow-up at 2 years was available for 38 SADI-S' and 38 DS' patients, with total weight loss of 35.3% vs. 41.7% (p = 0.009), and excess weight loss 64.1% vs. 75.3% (p = 0.014). Comorbidities resolution for SADI-S and DS was: 44.4% vs. 76.9% for diabetes (p = 0.029) and 36.4% vs. 87.5% for hypertension (p = 0.006); with no differences for resolution of dyslipidemia (72.7% vs. 88.9%, p = 0.369) and obstructive sleep apnea (93.3% vs. 91.7%, p = 0.869). DS' patients required more extra nutritional supplementation. Three SADI-S patients needed conversion to DS, two for biliary reflux and one for weight regain.
After a failed SG, revisional DS permits better weight control and diabetes and hypertension resolution than SADI-S, at the expense of higher supplementation needs.
单吻合口十二指肠空肠旁路术（SADI-S）被提议用于袖状胃切除术（SG）后体重减轻不足或体重反弹的肥胖患者，但相关信息有限。本研究的目的是评估 SADI-S 作为 SG 后修正手术的安全性和有效性，并与标准十二指肠转流术（DS）进行比较。
这是一项单中心队列研究，纳入了 2008 年至 2020 年期间在一家高容量机构因 SG 失败后接受 SADI-S 和 DS 的所有患者。
46 例患者接受了 SADI-S，55 例患者接受了 DS，SG 后分别为 37.2 个月和 41.5 个月（p = 0.447），初始 BMI 分别为 56.2 和 56.6（p = 0.777），修正术前分别为 39.2 和 39.7（p = 0.675）。所有手术均为腹腔镜下完成。SADI-S 的 Clavien-Dindo > II 级并发症发生率为 6.5%，DS 为 10.9%（p = 0.095），无 90 天死亡率。SADI-S 有 38 例和 DS 有 38 例患者获得了 2 年随访，总减重率分别为 35.3%和 41.7%（p = 0.009），超重减轻率分别为 64.1%和 75.3%（p = 0.014）。SADI-S 和 DS 的合并症缓解率分别为：糖尿病缓解率分别为 44.4%和 76.9%（p = 0.029），高血压缓解率分别为 36.4%和 87.5%（p = 0.006）；血脂异常缓解率分别为 72.7%和 88.9%（p = 0.369），阻塞性睡眠呼吸暂停缓解率分别为 93.3%和 91.7%（p = 0.869），无差异。DS 患者需要更多的额外营养补充。3 例 SADI-S 患者需要转为 DS，2 例为胆反流，1 例为体重反弹。
在 SG 失败后，DS 比 SADI-S 更能控制体重，糖尿病和高血压的缓解率更高，但需要更多的补充。
