Single-anastomosis duodenal ileostomy with sleeve is a safe and effective option for patients in an ambulatory surgical center

Abstract

Background: The single-anastomosis duodenal ileostomy with sleeve gastrectomy (SADI-S) is gaining popularity in the United States as an alternative to the gastric bypass for patients with a high body mass index (BMI) or who are less likely to succeed with a sleeve. While SADI-S has similar weight loss to the gastric bypass, the complication rate is significantly lower, allowing surgeons to perform SADI-S in an ambulatory surgical center with a 23-hour stay.

Objectives: To determine if SADI-S can be safely performed in an ambulatory surgical setting.

Setting: Private practice.

Methods: All SADI-S procedures performed from August 2015 to March 2019 at 2 bariatric centers were included in this study. Patients selection for SADI-S in the ambulatory surgical center required no end organ damage, no evidence of severe sleep apnea, and BMI <55 for males and BMI <60 for females. All data were gathered retrospectively from prospectively kept databases. Thirty-day complication rates were analyzed using the Clavien-Dindo scale to assess the safety of performing SADI-S in an ambulatory surgical center.

Results: Eighty-two patients were included in this study. The sample was 72% female with an average age of 46 and BMI of 45. All patients received planned intravenous fluid within 3 days after the procedure. There were 2 (2.4%) grade IIIb to V complications. There were no mortalities in this series.

Conclusion: SADI-S can be performed safely in an ambulatory surgery 23-hour setting with appropriate patient selection, perioperative support, and enhanced recovery after surgery protocols.

Keywords: Ambulatory surgical center; Complications; SADI-S; Safety.