Background

The single anastomosis loop duodeno-ileostomy with sleeve gastrectomy (SADI-S) has been proposed as a primary weight loss procedure. The procedure has not yet been thoroughly studied to better understand the risk profile. The goal of this study was to evaluate long-term outcomes after primary laparoscopic SADI-S.

Methods

This was a retrospective study. Patients who underwent a SADI-S by a single surgeon at our institution between 2016-2020 were reviewed. Excess weight loss post-operatively was calculated. Total protein, albumin, vitamin A and D, were followed post-operatively, along with post-operative complaints. Reoperations were analyzed.

Results

93 patients underwent a SADI-S. The mean preoperative BMI was 50.5 +- 8.5 kg/m2. 12 (12.9%) required re-operation due to malnutrition and 81 (87.1%) did not. Re-operation occurred at 11.5 +- 8.2 months. Reoperations included conversion to RNYGB, elongation of the common channel, and feeding tube placement. Low albumin was more prevalent in patients requiring re-operation at 5-7 mos. (72.7% vs 29.4%; p=0.013), and 1 year (75% vs 29.2%; p=0.006). Low total protein levels were more prevalent in the re-operative group at 5-7 mos. (100% vs. 35.3%; p=<0.001) and 1 year (91.7% vs. 42.1%; p=0.003). GERD was present in 41.7% of the re-operative group vs 16% (p=0.051). Diarrhea was present in 66.7% of the re-operative group vs 7.4 (p=<0.001).

Conclusions

SADI-S resulted in significant weight-loss. 12.9% of patients required reoperation due to protein malnutrition. Weight loss was greater in the re-operative group at 6-7 months and 1 year. Diarrhea was a major complaint in those requiring reoperation.