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4th INTERNATIONAL CONSENSUS SUMMIT FOR SLEEVE GASTRECTOMY V: Conversions Sleeve to Duodenal Switch/SADI-s by ANTONIO J. TORRES, MD, and ANDRÉS SÁNCHEZ-PERNAUTE, MD Bariatric Times. 2013;10(5 Suppl A):A20–A21 AUTHOR AFFILIATIONS: Drs. Torres and Sánchez-Pernaute are, respectively, Professor and Assistant Professor of Surgery, Department of Surgery, Hospital Clínico San Carlos, Facultad Medicina Universidad Complutense, Madrid, Spain. ADDRESS FOR CORRESPONDENCE: Antonio J. Torres, MD; Phone: 34 91 3303184; Fax: 34 91 3303183; E-mail: ajtorresgarcía@gmail.com FUNDING AND DISCLOSURES: No funding was provided. The authors report no conflicts of interest relevant to the content of this article. KEY POINTS • SADI-s is a novel bariatric operation based on the principles of duodenal switch. • SADI-S is a nice alternative, based on solid physio- pathologic principles, to be implemented as a second step after a "failed" SG. • Longer follow-up is needed to determine the real potential of this operation in comparison with other more standarized procedures. T he single anastomosis duodeno-ileal bypass with sleeve gastrectomy or SADI-s is a novel bariatric operation based on the principles of biliopancreatic diversion (BPD). The reason for developing a new technique or for modifying a pre-existing one was to simplify the procedure, to decrease the potential complication rate, and to maintain or even to improve, if possible, the outcomes of the original operation. In 2007, our group developed a new technique called SADI-s,1 originally based on the duodenal switch (DS), in which only one anastomosis is performed. Figure 1 shows the original technique. At the present time, the duodeno-ileal anastomosis is performed at 250cm from the ileocecal valve. We A20 postulated that reducing the number of intestinal anastomoses would have some advantages over previous procedures, such as less probability of postoperative leaks or anastomotic strictures, a decrease in the operative time, and consequently, less anestheticderived complications. As the mesentery is not opened during this technique, there should be a lower probability of postoperative obstructions. SADI-s is also, theoretically, a nice option as a second-step operation in those patients who have undergone laparoscopic sleeve gastrectomy (LSG) and have experienced weight regain regain or unresolved comorbidities. In this article, we share the results of 11 patients who underwent SADI-s as a second-step operation after previous LSG. Mean age was 41 years. The initial mean body mass index (BMI) was 63kg/m2. All patients presented with hypertension and 40 percent with type 2 diabetes mellitus (T2DM). The mean maximum percentage excess weight loss (%EWL) after the LSG was 33 percent, and the mean BMI at the time of the second surgical procedure (SADI-s) was 49kg/m2. The mean time between the two Bariatric Times • May 2013 • Supplement A operations was two years. There was no mortality and there were no intraoperative complications. No leaks have been detected in the duodeno-ileal anastomosis or in the duodenal stump, which is never invaginated. Oral intake was resumed 1 to 2 days after the operation. Median in-hospital stay was six days. Weight loss has been excellent in these first two years. EWL reached 62 percent after the first postoperative year and 72 percent at 24 months. Initial weight loss with SADI-s has proven to be greater than initial weight loss after a classical bilio- pancreatic diversion or a duodenal switch,3 which makes us think that the SADI-s procedure is more restrictive than the aforementioned. Nevertheless, we had formerly measured the gastric volume of patients who underwent duodenal switch in whom a similar gastrectomy was performed, and the mean volume was 208cc, which is not a restrictive remnant.2 Several markers are used to evaluate patients' nutritional state after the SADI-s, including measurements of blood cell counts and protein levels. We detected few alterations in red blood cell counts: 10 percent of the patients had low