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

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.