Department of General Surgery, Unidade Local de Saúde de Entre o Douro e Vouga, Santa Maria da Feira, Portugal.
UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal.
Obes Facts. 2024;17(4):364-371. doi: 10.1159/000539104. Epub 2024 May 27.
Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a restrictive/hypoabsorptive procedure recommended for patients with obesity class 3. For safety reasons, SADI-S can be split into a two-step procedure by performing a sleeve gastrectomy (SG) first. This stepwise approach also provides an unprecedented opportunity to disentangle the weight loss mechanisms triggered by each component. The objective was to compare weight trajectories and post-prandial endocrine and metabolic responses of patients with obesity class 3 submitted to SADI-S or SG as the first step of SADI-S.
Subjects submitted to SADI-S (n = 7) or SG (n = 7) at a tertiary referral public academic hospital underwent anthropometric evaluation and a liquid mixed meal tolerance test (MMTT) pre-operatively and at 3, 6, and 12 months post-operatively.
Anthropometric parameters, as well as metabolic and micronutrient profiles, were not significantly different between groups, neither before nor after surgery. There were no significant differences in fasting or post-prandial glucose, insulin, C-peptide, ghrelin, insulin secretion rate, and insulin clearance during the MMTT between subjects submitted to SADI-S and SG. There was no lost to follow-up.
The restrictive component seems to be the main driver for weight loss and metabolic adaptations observed during the first 12 months after SADI-S, given that the weight trajectories and metabolic profiles do not differ from SG. These data provide support for surgeons' choice of a two-step SADI-S without jeopardizing the weight loss outcomes.
单吻合口十二指肠-空肠旁路术加袖状胃切除术(SADI-S)是一种限制/低吸收程序,适用于肥胖 3 级患者。出于安全原因,SADI-S 可通过首先进行袖状胃切除术(SG)分为两步进行。这种分步方法还为解开每个组成部分触发的减肥机制提供了前所未有的机会。目的是比较肥胖 3 级患者接受 SADI-S 或 SG 作为 SADI-S 的第一步治疗后的体重轨迹和餐后内分泌代谢反应。
在一家三级转诊公立学术医院接受 SADI-S(n=7)或 SG(n=7)的患者,在术前和术后 3、6 和 12 个月进行了人体测量评估和液体混合餐耐量试验(MMTT)。
在手术前后,两组之间的人体测量参数以及代谢和微量营养素谱均无显著差异。在 MMTT 中,接受 SADI-S 和 SG 的患者之间,空腹或餐后血糖、胰岛素、C 肽、胃饥饿素、胰岛素分泌率和胰岛素清除率均无显著差异。无失访。
鉴于体重轨迹和代谢谱与 SG 没有差异,限制成分似乎是 SADI-S 术后 12 个月内体重减轻和代谢适应的主要驱动因素。这些数据为外科医生选择两步 SADI-S 提供了支持,而不会影响减肥效果。