This type of boffins compared 5-12 months result of SADI-S 250 (popular limb 250 cm) with RY-DS

• SADI-S, a modification of vintage Roux-en-Y DS, try ergo recommended by ASMBS as the a suitable metabolic bariatric medical processes.
• Guide away from much time-identity shelter and you will effectiveness consequences continues to be needed which can be strongly recommended, such with blogged information on SG proportions and common route length.
• Analysis of these strategies off qualified locations would be advertised so you can the new Metabolic and you can Bariatric Functions Certification and you may Quality Improve Program database and you may individually filed once the single-anastomosis DS strategies to support precise research range.
• Here continue to be concerns about intestinal adaptation, health situations, optimum limb lengths, and you can long-name fat loss/win back following this process. As such, ASMBS recommends a careful approach to the brand new use of process, which have awareness of ASMBS-published direction into nutritional and metabolic support out of bariatric clients, in particular for DS diligent.

Pursuing the first 12 months, EWL% (77

Because the up-to-date ASMBS report (Kallies and you may Rogers, 2020) endorses SADI-S due to the fact the ideal metabolic bariatric procedures, moreover it points out one studies out-of long-label security and you can efficacy are still required – a view that is backed by the studies demonstrated more than.

Also, an enthusiastic UpToDate feedback towards “Bariatric steps on the management of really serious being obese: Descriptions” (Lim, 2020) claims that “Some other measures, and additionally you to definitely-anastomosis gastric bypass (OAGB) and you will single anastomosis duodeno-ileal avoid (SADI), will still be sensed investigational when it comes to getting a standard bariatric procedure”

Yashkov et al (2021) stated that there are only a small number of studies providing a comparison between SADI-S and Hess-Marceau’s BPD/Duodenal Switch (RY-DS) operations. Data of patients who underwent open SADI-S (n 226) and RY-DS (n 528) were retrospectively studied. EWL(%), EBMIL(%), TWL(%), anti-diabetic effect, complications, and revision rate were compared between the 2 groups. twoo sign in 0 % versus 73.3 %) and TWL% (39.4 % versus 38.9 %) were statistically significantly better after SADI-S (p < 0.01, and p < 0.05, respectively), but not EBMIL% (p > 0.05). At nadir to 24-36 months, EWL, TBWL, and EBMIL after SADI-S was comparable to the RY-DS group. Up to the 4th and 5th year, better weight loss (TBWL, EBMIL, EWL) was observed after RY-DS than after SADI-S. Early complication rate was less (2.65 %) in the SADI-S group versus 5.1 % in the RY-DS. Protein deficiency and small bowel obstruction rates were also lower after SADI-S; 93.4 % of patients achieved total remission of their diabetes; 7.5 % of patients in the SADI-S group had symptoms of bile reflux, which was a main indication for revisions. The authors concluded that SADI-S has many advantages over RY-DS; however, weight loss and anti-diabetic effects after the 3rd year were marginally lower after SADI-S compared to RY-DS. SADI-S was less dangerous in terms of malabsorption and appeared to be a reasonable alternative to RY-DS as a metabolic operation. RY-DS could be implemented for weight regain and/or bile reflux after SADI-S.

This study had several drawbacks. This was a retrospective analysis of 2 modifications of BPD/DS, one of which (RY-DS) had been performed between 2003 and 2015 and another one (SADI-S), since 2014. For this reason, these investigators compared more recent information regarding 5-year anti-diabetic effects of SADI-S with their preliminary published data regarding 5-year results of RY-DS. There was no learning curve period in the SADI-S group, but there was in RY-DS group. Although the initial weight of the patients in the SADI-S group was higher (p < 0.01), they were also taller, so there was no statistically significant difference in the initial BMI between the 2 groups. More patients from the SADI-S group suffered from diabetes mellitus type 2 (DM2). In the period when thee investigators used SADI-S, a significant number of "easier" patients were suggested as candidates for a sleeve gastrectomy. In cases of DM2, SADI-S was preferable over a sleeve gastrectomy alone. Furthermore, the percentage of patients with DM2 has increased over the last 5 to 10 years because more patients considered their diabetes to be a more significant health problem than obesity itself. Another limitation was that both RY-DSs and SADI-Ss were performed by the authors using an open technique. Although laparotomies are infrequently used in metabolic surgery, in their experience both open RY-DSs and SADI-Ss could be performed safely by laparotomy with a minimal 30-day morbidity (0.38 % for RY-DS and 0.44 % for SADI-S) with low early morbidity (5.1 % and 2.65 % accordingly). In the recently published study from Brazil [Kim, 2016] using a laparoscopic technique, the authors demonstrated 18.9 % early complications after RY-DS and 13.3 % after SADI-S.