Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
Surg Endosc. 2023 Nov;37(11):8682-8689. doi: 10.1007/s00464-023-10305-5. Epub 2023 Jul 27.
Conversion from sleeve gastrectomy (SG) to single anastomosis duodeno-ileal bypass (SADI) is becoming increasingly common, but data regarding safety is of these conversions is scarce. As such, the objective of this study was to compare the 30-day rate of serious complications and mortality of primary SADI (p-SADI-S) with SG to SADI (SG-SADI) conversions.
This retrospective cohort study analyzed the MBSAQIP database. Patients undergoing p-SADI-S and SG-SADI were included. Data collection was limited to 2020 and 2021. A multivariable logistic regression analysis was performed between groups to determine if SG-SADI was an independent predictor of 30-day serious complications or mortality.
A total of 783 patients were included in this study, 488 (62.3%) underwent p-SADI-S and 295 (37.6%) underwent SG-SADI. The mean body mass index (BMI) at the time of surgery was lower in the SG-SADI cohort (45.1 vs 51.4 kg/m, p < 0.001). Indications for revision in the SG-SADI cohort included weight recurrence (50.8%), inadequate weight loss (41.0%), other (3.0%), GERD (2.7%), and persistent comorbidities (2.5%). SG-SADI had longer operative times (156.7 vs 142.1 min, p < 0.001) and was not associated with a higher rate of serious complications (5.7 vs 6.9%, p = 0.508) compared to p-SADI-S. p-SADI-S was associated with a higher rate of pneumonia (1.2 vs 0.0%, p < 0.001), and SG-SADI was not correlated with higher rates of reoperation (3.0 vs 3.2%, p = 0.861), readmission (5.4 vs 5.5%, p = 0.948) and death (0.0 vs 0.2%, p = 0.437). On multivariable analysis, SG-SADI was not independently predictive of serious complications (OR 0.81, 95% CI 0.43 to 1.52, p = 0.514) when adjusting for age, sex, BMI, comorbidities, and operative time.
The prevalence of SG-SADI is high, representing 37.6% of SADI-S procedures. Conversion from sleeve to SADI, is safe, and as opposed to other studies of revisional bariatric surgery, has similar 30-day complication rates to primary SADI-S.
袖状胃切除术（SG）到单吻合口十二指肠空肠旁路术（SADI）的转换越来越常见，但关于这些转换安全性的数据却很少。因此，本研究的目的是比较原发性 SADI（p-SADI-S）与 SG 到 SADI（SG-SADI）转换的 30 天严重并发症和死亡率。
这是一项回顾性队列研究，分析了 MBSAQIP 数据库。纳入接受 p-SADI-S 和 SG-SADI 的患者。数据收集仅限于 2020 年和 2021 年。对两组进行多变量逻辑回归分析，以确定 SG-SADI 是否是 30 天严重并发症或死亡率的独立预测因素。
本研究共纳入 783 例患者，其中 488 例（62.3%）接受 p-SADI-S，295 例（37.6%）接受 SG-SADI。SG-SADI 组手术时的平均体重指数（BMI）较低（45.1 与 51.4 kg/m2，p<0.001）。SG-SADI 组的修订指征包括体重复发（50.8%）、减重不足（41.0%）、其他（3.0%）、胃食管反流病（2.7%）和持续合并症（2.5%）。SG-SADI 的手术时间较长（156.7 与 142.1 min，p<0.001），但与 p-SADI-S 相比，严重并发症发生率无差异（5.7%与 6.9%，p=0.508）。p-SADI-S 与肺炎发生率较高相关（1.2%与 0.0%，p<0.001），而 SG-SADI 与再次手术率（3.0%与 3.2%，p=0.861）、再入院率（5.4%与 5.5%，p=0.948）和死亡率（0.0%与 0.2%，p=0.437）无关。多变量分析显示，调整年龄、性别、BMI、合并症和手术时间后，SG-SADI 不是严重并发症的独立预测因素（OR 0.81，95%CI 0.43 至 1.52，p=0.514）。
SG-SADI 的患病率较高，占 SADI-S 手术的 37.6%。袖状胃切除术到 SADI 的转换是安全的，与其他减重手术的再手术研究相比，其 30 天并发症发生率与原发性 SADI-S 相似。
