- SADI-S, a modification of vintage Roux-en-Y DS, is actually hence recommended because of the ASMBS because an appropriate metabolic bariatric medical processes.
- Publication from enough time-label security and you can effectiveness outcomes remains necessary that is highly encouraged, such as for instance which have blogged details on SG proportions and you may preferred route length.
- Investigation of these measures of certified locations can be claimed so you’re able to the brand new Metabolic and you may Bariatric Functions Certification and High quality Upgrade System database and independently registered as the single-anastomosis DS methods to accommodate specific studies range.
- Truth be told there are nevertheless issues about intestinal variation, nutritional activities, optimal limb lengths, and you may long-name weight loss/win back next processes. As such, ASMBS recommends a cautious approach to the latest adoption associated with the techniques, that have awareness of ASMBS-authored advice for the nutritional and you can metabolic support of bariatric patients, particularly to possess DS patient.
Following first 12 months, EWL% (77
Given that up-to-date ASMBS report (Kallies and you will Rogers, 2020) endorses SADI-S due to the fact the right metabolic bariatric operation, additionally, it highlights you to training out of long-identity defense and you will effectiveness continue to be called for – a perspective that’s backed by the research demonstrated above.
Furthermore, an enthusiastic UpToDate review towards the « Bariatric strategies for the management of really serious carrying excess fat: Descriptions » (Lim, 2020) claims one « Various other measures, including you to-anastomosis gastric sidestep (OAGB) and you can single anastomosis duodeno-ileal avoid (SADI), will always be felt investigational with regards to becoming a basic 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 swipe 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.