A retrospective study comparing single anastomosis duodeno-ileostomy (SADI-S) and one anastomosis gastric bypass (OAGB-MGB), as a revisional procedure after laparoscopic sleeve gastrectomy, has reported that comparable outcomes in terms of weight and BMI loss, remission of comorbidities and nutritional deficiency in short-to-medium term follow-up. However, SADI-S seems to cause fewer upper gastrointestinal complications and even looks a good option for patients suffering from gastroesophageal reflux disease (GERD) post-primary LSG.
The findings were reported in the paper, 'Single Anastomosis Duodeno-ileostomy (SADI-S) Versus One Anastomosis Gastric Bypass (OAGB-MGB) as Revisional Procedures for Patients with Weight Recidivism After Sleeve Gastrectomy: a Comparative Analysis of Efficacy and Outcomes', published in Obesity Surgery, by researchers from Qatar and Spain.
The researchers prospectively collected data of patients who underwent SADI-S or OAGB-MGB with a minimum one-year follow-up and compared weight loss, comorbidities, nutritional deficiencies, complications and outcomes between the two procedures.
In total, the study included 91 patients who underwent SADI-S (n=42) or OAGB-MGB (n=49) between January 2016 and August 2017 at Hamad General Hospital, Qatar. The mean age in both study groups was approximately 38 years and the majority were female. The mean pre-LSG weight was 133±28 in the OAGB-MGB and 139±27 in the SADI-S group. The mean pre-LSG BMI was 52±11 for OAGB-MGB and 50±8kg/m2 for the SADI-S group.
In the OAGB-MGB group, the mean preoperative BMI was 43.6±7.4 kg/m2 that decreased to 35.3±6.5 one year after revisional surgery, with a significant improvement in A1C, serum cholesterol, HDL and LDL. OAGB-MGB procedure was found to have a drop in Hb after one year (p=0.006).
In the SADI-S group, there was a significant drop in BMI after one year from 43.7±7.1 to 34.3±6.1 and TWL% and EWL% were significantly increased at six and 12 months. There were significant increases in the serum vitamin B12 and iron, and significant decreases in the A1c, vitamin D, triglyceride, HDL and LDL.
The TWL% after one was significantly higher in the SADI-S group vs. OAGB-MGB, but there was no significant difference in TWL% between the procedures after 18 months. In addition, EWL% after one year and 18 months were comparable between the two groups (p>0.05).
There were significantly higher levels of serum protein, serum zinc, serum vitamin D and HDL in patients who had OAGB-MGB vs SADI-S, with pre- and post-operative A1C values comparable between the two groups. There were no statistically significant changes in nutritional deficiency (Hb, albumin, vitamin B12, and INR) in either group, although., a statistically significant drop in zinc was noticed in SADI-S patients (p=0.004) at 12 months.
After one year, two of four patients in the SADI-S group who had hypertension came off medications, seven patients who had GERD symptoms before SADI-S completely resolved and medications were stopped in three patients (one patient had GERD symptoms controlled with PPI), at one year.
In patients who underwent OAGB-MGB, six patients had T2DM and five had hypertension; in one patient T2DM and hypertension were completely resolved, two more reported a decrease in their medications and improvement of their readings during one-year follow-up.
There was no mortalities was reported in either group. The number of complicated cases was 13 out of 49 for OAGB-MGB (27%) vs 8 out of 42 for SADI-S (19%); p=0.39.
Postoperative complications reported in the OAGB-MGB group included anastomotic ulcer, bile reflux, de novo GERD, staple line leak, and revisional surgery, whereas steatorrhea, abdominal collection, and nutritional deficiency were observed in the SADI-S group. Abdominal collection, the only early postoperative (< 30 days) complication following SADI-S, was treated conservatively.
Three patients in OAGB-MGB developed GERD postoperatively and another three patients had severe bile reflux (confirmed by the HIDA scan). One converted to Roux-en-Y gastric bypass (RYGB). one converted to RYGB after developing a staple line leak shortly after OAGB-MGB. Interestingly, two OAGB-MGB patients underwent SADI-S due to weight regain.
“SADI-S and OAGB-MGB are effective revisional procedures post unsuccessful LSG with comparable outcomes in terms of weight and BMI loss, remission of comorbidities, and nutritional deficiency in short-to-medium term follow-up,” the authors concluded. “SADI-S procedure appears to cause less upper gastrointestinal complications and even looks a good option for patients suffering from GERD post-primary LSG. Moreover, the underlying bile reflux may get worse with OAGB-MGB. However, further prospective larger studies are needed.”
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