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Observational Study
. 2022 Dec;32(12):3839-3846.
doi: 10.1007/s11695-022-06317-0. Epub 2022 Oct 25.

Duodenal Switch vs. Single-Anastomosis Duodenal Switch (SADI-S) for the Treatment of Grade IV Obesity: 5-Year Outcomes of a Multicenter Prospective Cohort Comparative Study

Jordi Pujol Gebellí #  1 , Claudio Lazzara #  2 , Amador García Ruiz de Gordejuela  1 , Mario Nora  3 , Ana Marta Pereira  3 , Andrés Sánchez-Pernaute  4 , Javier Osorio  1 , Lucia Sobrino  1 , Antonio J Torres García  4
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Observational Study

Duodenal Switch vs. Single-Anastomosis Duodenal Switch (SADI-S) for the Treatment of Grade IV Obesity: 5-Year Outcomes of a Multicenter Prospective Cohort Comparative Study

Jordi Pujol Gebellí et al. Obes Surg. 2022 Dec.

Abstract

Purpose: The aims were to compare the 5-year outcomes of duodenal switch (DS) and single-anastomosis duodenal switch (SADI-S) in terms of weight loss; remission of comorbidities; nutritional status short- and long-term complications; postoperative mortality; and need for revisional surgery.

Materials and methods: Multicenter prospective observational study of all consecutive patients undergoing DS or SADI-S in three high-volume hospitals.

Results: A total of 87 patients were included in the study, 43 submitted to DS and 44 to SADI-S, with similar basal characteristics, nutritional parameters, and BMI (52.9 kg/m2 DS vs. 52.5 kg/m2 SADI-S). Operative time was 152 min (± 32.6) in DS vs. 116 min (± 21.9) in SADI-S (p = 0.043). Short-term complications were similar for DS and SADI-S, both overall (11.8% vs. 11.6%), and ranged as Clavien-Dindo > II (4.5% vs. 4.7%), with no mortality. At 5 years, DS and SADI-S results were as follows: BMI 30.6 vs. 33.3 kg/m2 (p = 0.023); %EWL 80.5% vs. 68.6% (p = 0.006); and %TWL 42.1 vs. 36.0 (p = 0.006). Comorbidity remission rates for DS and SADI-S were as follows: for diabetes, 92.8% vs. 85.7% (n.s.); for hypertension, 95.2% vs. 85.1% (n.s.); for sleep apnea, 75% vs. 73.3% (n.s.); and for dyslipidemia, 76.4% vs. 73.3% (n.s.). DS showed lower levels of vitamin B12, iron, vitamin E, and zinc than SADI-S (p = < 0.005). In the long term, there were 4 surgical reinterventions (due to 1 internal hernia in the DS group and 1 internal hernia and 2 biliary refluxes in the SADI-S group) with no cases of persistent diarrhea or malnutrition.

Conclusion: Both DS and SADI-S allowed good weight control and resolution of comorbidities. DS achieved a greater weight loss compared to SADI-S, at the expense of longer operative time and lower vitamin and mineral levels.

Keywords: Biliopancreatic diversion with duodenal switch; Duodenal switch; Hypoabsorptive surgery; SADI-S; Single anastomosis duodenal switch.

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