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Videosurgery and Other Miniinvasive Techniques
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2/2023
vol. 18
 
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Bariatric surgery
abstract:
Original paper

Initial experience with laparoscopic revisional single anastomosis duodeno-ileal bypass (SADI-S) after failed sleeve gastrectomy

Michał Wysocki
1
,
Maciej Borys
1
,
Dorota Budzyńska
1
,
Magdalena Pisarska-Adamczyk
2
,
Piotr Małczak
3
,
Anna Rajtar
1
,
Andrzej Budzynski
1

  1. Department of General Surgery and Surgical Oncology, Ludwik Rydygier Memorial Hospital, Krakow, Poland
  2. Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland
  3. 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
Videosurgery Miniinv 2023; 18 (2): 298–304
DOI: https://doi.org/10.5114/wiitm.2023.128683
Online publish date: 2023/06/15
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Introduction
Laparoscopic sleeve gastrectomy (SG) is currently the most commonly performed bariatric operation, but re-do surgery may be necessary in up to half of the patients. Single anastomosis duodeno-ileal bypass (SADI-S) is quickly gaining recognition as a revisional procedure after failed SG.

Aim
To discuss the surgical technique and analyze initial outcomes after introduction of SADI-S after SG with 1-year follow-up.

Material and methods
This is a retrospective cohort study of consecutive patients who underwent re-do bariatric surgery – revisional SADI-S – in 2021 at a secondary referral public hospital. All patients’ follow-up was completed 1 year after.

Results
14 consecutive patients, 6 (43%) males and 8 females, were included. Median maximal body mass index (BMI) was 52.29 (47.96–77.16) kg/m2, BMI before SADI-S was 43.09 (41.64–48.99) kg/m2. No perioperative morbidity was recorded. Four (28%) patients reported recurrent abdominal crampy pain and diarrhea that required dietary advisement and pharmacological therapy in the postoperative period. No reoperations, mortality or readmissions were recorded during 1-year follow-up. SADI-S was associated with further weight loss, resulting in median BMI of 37.55 (36.29–39.43) kg/m2 1 year after SADI-S. Observed additional percentage total weight loss (%TWL) 1 year after SADI-S was 18.65% (17.25–21.89%), while additional percentage excess body mass index loss (%EBMIL) was 35.88% (29.18–41.92%). There was 1 case of diabetes mellitus type 2 remission and improvement in glycemic control in 1 patient. 4/6 patients (66.67%) had improvement in control of hypertension.

Conclusions
SADI-S is promising re-do surgery after SG with low postoperative morbidity. Additional %TWL 1 year after SADI-S is ~19%, while additional %EBMIL is ~36%, with significant improvement of obesity-related comorbidities.

keywords:

single anastomosis duodeno-ileal bypass, SADI-S, revisional, re-do, sleeve gastrectomy, weight regain, insufficient weight loss
  
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