SADIS - Single anastomosis duodeno-ileal bypass with sleeve gastrectomy as a second step after sleeve gastrectomy
Abstract
Introduction: Sleeve gastrectomy (SG) is the most popular bariatric method at present. In case of unsatisfactory effect of the SG, i.e. in case of insufficient weight loss, improving or threatening diabetes or metabolic syndrome or regain of weight, bariatry offers a second possible step.
One of the possible methods is biliopancreatic diversion type SADIS (BPD/SADIS). Method: Between the years 2009 and 2017, 327 morbidly obese patients underwent laparoscopic sleeve gastrectomy at our surgical department.
Between mid-2011 to the end of 2017, 37 (11.3 %) patients after SG with unsatisfactory effect on diabetes or on metabolic syndrome or in case of weight regain in 23.7 (15-48) months after the SG underwent the second step - BPD/SADIS. The weight loss, change of the BMI and level of the HbA1c were evaluated during two years after procedure.
Results: 31 (83.7 %) patients were evaluated, the others were rejected due to an incomplete follow-up (FU) or a short time elapsed since the procedure. Two years after the SADIS, the average %EBMIL was 47.1 (41.5-52.7) %, average %EWL was 73.9 (65.1-83.7) %, average final BMI was 29.4 (24.6-38.2) kg/m2, which means average decrease of the BMI was 9.3 (2.9-14.1) kg/m2.
Average level of the HbA1c was 37.9 (28-42) mmol/mol, type 2 diabetes was cured in 20 (64.5 %) cases. Conclusion: Biliopancreatic diversion type SADIS offers a satisfactory weight loss effect as well as an improvement of the metabolic syndrome in morbidly obese patients after SG with unsatisfactory result.
In comparison with the classic BPD/DS, SADIS is a technically easier method with lesser incidence of complications along with acceptable rate of malnutrition.