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Multicenter Study
. 2025 Jun;35(6):2160-2173.
doi: 10.1007/s11695-025-07888-4. Epub 2025 May 9.

Five year outcomes of primary and secondary Single-Anastomosis Duodeno-Ileal bypass with Sleeve gastrectomy (SADI-S)

Mitchell J R Harker #  1   2 , Laura Heusschen #  3 , Valerie M Monpellier  4 , Ronald S L Liem  4 , Magaly J J Van Himbeeck  5 , Simon W Nienhuijs  5 , May Al Nawas  6 , Rene J Wiezer  6 , Guusje Vugts  3 , Eric J Hazebroek  7   8
Affiliations
Multicenter Study

Five year outcomes of primary and secondary Single-Anastomosis Duodeno-Ileal bypass with Sleeve gastrectomy (SADI-S)

Mitchell J R Harker et al. Obes Surg. 2025 Jun.

Abstract

Background: The single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) can be performed as a primary or (planned) secondary metabolic bariatric procedure. The aims of this study were to compare mid-term outcomes up to 5 years after primary vs secondary SADI-S and between different common channel (CC) lengths.

Methods: Multicenter retrospective cohort study including 103 patients who underwent SADI-S between 06-2015 and 02-2019. Outcomes on weight loss, nutrient status, health-related quality of life (HRQoL) and gastro-intestinal symptoms until 5 years postoperatively were evaluated and compared between primary (n = 19) vs secondary SADI-S (n = 84), and CC length ≤ 250 cm (n = 66,) vs > 250 cm (n = 33).

Results: Mean total weight loss (TWL) at 5 years of follow-up was higher for patients who underwent primary SADI-S compared to secondary SADI-S (34.8 (29.8-39.9)% vs 15.9 (13.0-18.9)%, p < 0.001) and for CC length ≤ 250 cm compared to > 250 cm (25.3 (21.8-28.9)% vs 21.3 (17.2-25.4)%, p = 0.12). Patients who underwent primary SADI-S also had significantly higher scores on the domains of the BODY-Q HRQoL questionnaire (p < 0.05 for all), with the exception of sexual well-being. Nutrient status and gastro-intestinal symptoms were comparable between the indication groups, but CC length ≤ 250 cm tended to result in more nutrient deficiencies and higher defecation frequency.

Conclusion: Both primary and secondary SADI-S result in durable weight loss outcomes up to 5 years postoperatively. It is imperative that CC length should be at least 250 cm to prevent malnutrition and gastro-intestinal complaints. Furthermore, focus on HRQoL is essential in future research into SADI-S.

Keywords: Conversion surgery; Recurrent weight gain; SADI-S; Secondary surgery; Single-anastomosis duodeno-ileal bypass; Sleeve gastrectomy.

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Conflict of interest statement

Declarations. Ethical Approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed Consent: Informed consent was obtained from all individual participants included in the study. Competing interests: The authors declare no competing interests

Figures

Fig. 1
Fig. 1
Flowchart patient selection and inclusion population
Fig. 2
Fig. 2
TWL (%) after SADI-S for the total study population and per SADI-S indication. Data are presented as estimated marginal means (95% CI)
Fig. 3
Fig. 3
TWL (%) and BMI per SADI-S indication at 5 years postoperatively, including TWL after SG before the secondary SADI-S procedure
Fig. 4
Fig. 4
TWL (%) after SADI-S per CC length. Data are presented as estimated marginal means (95% CI)
Fig. 5
Fig. 5
Fecal score after SADI-S according to CC length
See this image and copyright information in PMC

References

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