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. 2015 Sep-Oct;11(5):1092-8.
doi: 10.1016/j.soard.2015.01.024. Epub 2015 Feb 7.

Single-anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) for obese diabetic patients

Andrés Sánchez-Pernaute  1 , Miguel Ángel Rubio  2 , Lucio Cabrerizo  2 , Ana Ramos-Levi  3 , Elia Pérez-Aguirre  4 , Antonio Torres  4
Affiliations

Single-anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) for obese diabetic patients

Andrés Sánchez-Pernaute et al. Surg Obes Relat Dis. 2015 Sep-Oct.

Abstract

Background: Bariatric operations achieve a high remission rate of type 2 diabetes in patients with morbid obesity. Malabsorptive operations usually are followed by a higher rate of metabolic improvement, though complications and secondary effects of these operations are usually higher.

Objectives: Analyze the results of a simplified duodenal switch, the single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) on patients with obesity and type 2 diabetes mellitus (T2 DM).

Setting: University Hospital, Madrid, Spain.

Methods: Ninety-seven T2 DM patients with a mean body mass index (BMI) of 44.3 kg/m(2) were included. Mean preoperative glycated hemoglobin was 7.6%, and mean duration of the disease was 8.5 years. Forty patients were under insulin treatment. SADI-S was completed with a sleeve gastrectomy performed over a 54 French bougie and a 200 cm common limb in 28 cases and 250 cm in 69.

Results: Follow up was possible for 86 patients (95.5%) in the first postoperative year, 74 (92.5%) in the second, 66 (91.6%) in the third, 46 (86.7%) in the fourth and 25 out of 32 (78%) in the fifht postoperative year. Mean glycemia and glycated hemoglobin decreased immediately. Control of the disease, with HbA1c below 6%, was obtained in 70 to 84% in the long term, depending on the initial antidiabetic therapy. Most patients abandoned antidiabetic therapy after the operation. Absolute remission rate was higher for patients under oral therapy than for those under initial insulin therapy, 92.5% versus 47% in the first postoperative year, 96.4% versus 56% in the third and 75% versus 38.4% in the fifth. A short diabetes history and no need for insulin were related to a higher remission rate. Three patients had to be reoperated for recurrent hypoproteinemia.

Conclusion: SADI-S is an effective therapeutic option for obese patients with diabetes mellitus.

Keywords: Biliopancreatic diversion; Diabetes; Duodenal switch; Malabsorptive surgery; Metabolic surgery; One loop; SADI-S.

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