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A Matched Cohort Comparison of Long-term Outcomes of Roux-en-Y Gastric Bypass (RYGB) Versus Single-Anastomosis Duodeno-ileostomy with Sleeve Gastrectomy (SADI-S)

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Abstract

Background

The long-term effectiveness of Roux-en-Y gastric bypass (RYGB) and single-anastomosis duodeno-ileostomy with sleeve gastrectomy (SADI-S) is unknown.

Purpose

Compare the long-term outcomes.

Setting

Single private institute, USA.

Materials and Methods

Data from 1254 patients who underwent primary RYGB or SADI-S were used for a retrospective matched cohort. Data were obtained by matching every RYGB patient to a SADI-S patient of the same sex, body mass index (BMI), and weight. Only patients out 5 years and had at least one > 5-year follow-up visit were included.

Results

The matched cohort included 61 RYGB and 61 SADI-S patients. There was no statistical, demographic difference between the two groups. At 5 years, a 100% follow-up was available in each group. The intraoperative outcomes were significantly better with SADI-S. The 30-day readmission, reoperation, emergency department (ED) visits, and complication rates were statistically similar between the two groups. The long-term complication rates, Clavien-Dindo grade IIIb complications, and number of patients with more than one complication were significantly lower with SADI-S. Weight loss was significantly greater in the SADI-S group at 5 years. The long-term weight-loss failure rate was significantly higher in the RYGB group. The SADI-S procedure was associated with fewer reintervention through 6 years (14.7% patients vs. 39.3% patients, p = 0.001). Conversion or reversal of the procedure was required only in the RYGB group. There also was no significant difference in nutritional outcomes between the two procedures.

Conclusions

This study showed that problems, including long-term complications, reinterventions, weight-loss failure, and conversion, were more often associated with RYGB than with SADI-S. The SADI-S may be considered one of the viable alternatives to RYGB.

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Authors and Affiliations

  1. Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA

    Amit Surve, Daniel Cottam, Christina Richards, Walter Medlin & Legrand Belnap

Authors
  1. Amit Surve
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  2. Daniel Cottam
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  3. Christina Richards
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  4. Walter Medlin
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  5. Legrand Belnap
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Contributions

Amit Surve: conceived and designed the analysis, collected the data, performed the analysis, and wrote and revised the manuscript.

Daniel Cottam: primary operating surgery and reviewed the manuscript.

Christina Richards: primary or assisting surgeon.

Walter Medlin: assisting surgeon.

Legrand Belnap: assisting surgeon.

Corresponding author

Correspondence to Daniel Cottam.

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Conflict of Interest

Daniel Cottam, the corresponding author of this report, is part of the speaker bureau for Medtronic and has been awarded a research grant by Medtronic for the study of duodenal switch and reports personal fees and other from Medtronic and GI Windows, outside the submitted work. All other authors have no conflicts of interest to declare.

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Surve, A., Cottam, D., Richards, C. et al. A Matched Cohort Comparison of Long-term Outcomes of Roux-en-Y Gastric Bypass (RYGB) Versus Single-Anastomosis Duodeno-ileostomy with Sleeve Gastrectomy (SADI-S). OBES SURG 31, 1438–1448 (2021). https://doi.org/10.1007/s11695-020-05131-w

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