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These types of experts opposed 5-season result of SADI-S 250 (common limb 250 cm) that have RY-DS

  • SADI-S, a general change in classic Roux-en-Y DS, is actually for this reason supported from the ASMBS while the the right metabolic bariatric medical procedure.
  • Publication of much time-term shelter and effectiveness outcomes continues to be expected and is strongly encouraged, eg that have blogged information on SG size and you may prominent station length.
  • Studies for those actions regarding certified locations is going to be said to the brand new Metabolic and you will Bariatric Procedures Accreditation and you will High quality Improvement System database and you can by themselves filed given that unmarried-anastomosis DS tips to allow for accurate analysis range.
  • Here continue to be issues about abdominal variation, nutritional affairs, max limb lengths, and you can long-identity fat loss/regain after that process. As a result, ASMBS suggests a mindful method to new adoption from the techniques, that have awareness of ASMBS-blogged guidance on nutritional and you may metabolic support regarding bariatric patients, particularly having DS patient.

Following the first 12 months, EWL% (77

Once the current ASMBS declaration (Kallies and you can Rogers, 2020) endorses SADI-S since the the right metabolic bariatric surgical treatment, it also explains you to definitely degree from a lot of time-identity shelter and effectiveness are expected – a view that’s supported by the studies demonstrated over.

Additionally, an enthusiastic UpToDate comment for the “Bariatric actions towards the handling of severe being obese: Descriptions” (Lim, 2020) says you to “Some other actions, in addition to you to-anastomosis gastric avoid (OAGB) and you may unmarried anastomosis duodeno-ileal sidestep (SADI), continue to be considered investigational regarding becoming a simple 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.