- SADI-S, a general change in antique Roux-en-Y DS, was hence endorsed of the ASMBS while the the right metabolic bariatric medical techniques.
- Publication regarding enough time-label security and efficacy consequences continues to be requisite which can be strongly recommended, including having published info on SG size and you may prominent route duration.
- Studies of these measures away from qualified locations will likely be stated to help you the newest Metabolic and you can Bariatric Operations Certification and you can Quality Improve System database and you may separately recorded since solitary-anastomosis DS actions to support specific investigation range.
- Truth be told there are still concerns about intestinal version, health things, optimal limb lengths chemistry, and you may a lot of time-label weight-loss/regain next procedure. As such, ASMBS recommends a cautious way of brand new adoption associated with techniques, that have attention to ASMBS-blogged advice for the health and you may metabolic service out-of bariatric clients, in particular having DS diligent.
Following the first year, EWL% (77
Just like the upgraded ASMBS report (Kallies and you will Rogers, 2020) endorses SADI-S as the the right metabolic bariatric surgical procedure, it also highlights you to definitely training off much time-title coverage and you will effectiveness continue to be expected – a view which is backed by the studies demonstrated more than.
In addition, an UpToDate review towards the “Bariatric methods towards the handling of serious being obese: Descriptions” (Lim, 2020) states one “Several other methods, together with you to-anastomosis gastric bypass (OAGB) and you will single anastomosis duodeno-ileal avoid (SADI), will always be experienced investigational regarding being a standard bariatric procedure”
Yashkov et al (2021) stated that there are only a small number of studies providing a comparison between SADI-S and Hess-Marceau’s BPD/Duodenal Switch (RY-DS) operations. Data of patients who underwent open SADI-S (n 226) and RY-DS (n 528) were retrospectively studied. EWL(%), EBMIL(%), TWL(%), anti-diabetic effect, complications, and revision rate were compared between the 2 groups. 0 % versus 73.3 %) and TWL% (39.4 % versus 38.9 %) were statistically significantly better after SADI-S (p < 0.01, and p < 0.05, respectively), but not EBMIL% (p > 0.05). At nadir to 24-36 months, EWL, TBWL, and EBMIL after SADI-S was comparable to the RY-DS group. Up to the 4th and 5th year, better weight loss (TBWL, EBMIL, EWL) was observed after RY-DS than after SADI-S. Early complication rate was less (2.65 %) in the SADI-S group versus 5.1 % in the RY-DS. Protein deficiency and small bowel obstruction rates were also lower after SADI-S; 93.4 % of patients achieved total remission of their diabetes; 7.5 % of patients in the SADI-S group had symptoms of bile reflux, which was a main indication for revisions. The authors concluded that SADI-S has many advantages over RY-DS; however, weight loss and anti-diabetic effects after the 3rd year were marginally lower after SADI-S compared to RY-DS. SADI-S was less dangerous in terms of malabsorption and appeared to be a reasonable alternative to RY-DS as a metabolic operation. RY-DS could be implemented for weight regain and/or bile reflux after SADI-S.
This study had several drawbacks. This was a retrospective analysis of 2 modifications of BPD/DS, one of which (RY-DS) had been performed between 2003 and 2015 and another one (SADI-S), since 2014. For this reason, these investigators compared more recent information regarding 5-year anti-diabetic effects of SADI-S with their preliminary published data regarding 5-year results of RY-DS. There was no learning curve period in the SADI-S group, but there was in RY-DS group. Although the initial weight of the patients in the SADI-S group was higher (p < 0.01), they were also taller, so there was no statistically significant difference in the initial BMI between the 2 groups. More patients from the SADI-S group suffered from diabetes mellitus type 2 (DM2). In the period when thee investigators used SADI-S, a significant number of "easier" patients were suggested as candidates for a sleeve gastrectomy. In cases of DM2, SADI-S was preferable over a sleeve gastrectomy alone. Furthermore, the percentage of patients with DM2 has increased over the last 5 to 10 years because more patients considered their diabetes to be a more significant health problem than obesity itself. Another limitation was that both RY-DSs and SADI-Ss were performed by the authors using an open technique. Although laparotomies are infrequently used in metabolic surgery, in their experience both open RY-DSs and SADI-Ss could be performed safely by laparotomy with a minimal 30-day morbidity (0.38 % for RY-DS and 0.44 % for SADI-S) with low early morbidity (5.1 % and 2.65 % accordingly). In the recently published study from Brazil [Kim, 2016] using a laparoscopic technique, the authors demonstrated 18.9 % early complications after RY-DS and 13.3 % after SADI-S.