Bariatric Times

ICCDS-1 2016

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

Issue link: http://bariatrictimes.epubxp.com/i/749808

Contents of this Issue

Navigation

Page 10 of 32

B10 Bariatric Times • November 2016 • Supplement B FIRST INTERNATIONAL CONSENSUS CONFERENCE ON DUODENAL SWITCH S ingle-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-s) is a novel one-loop duodenal switch with a 250 cm common limb. A sleeve gastrectomy over a large bore bougie (54 French) is initially performed and the duodenum is transected 2–4 cm from the pylorus. An ileal loop, 200–250 cm from the cecum, is ascended antecolically and anastomosed to the duodenum in an end-to-side fashion. 1 Initially, our technique consisted of a one-loop duodenal switch with a 200 cm common channel. This was based on analysis of outcomes of biliopancreatic diversion (BPD) variants. 2,3 The SADI-s with a 200 cm efferent limb, carried an eight percent incidence of clinical malnutrition, and four of our patients had to be re- operated to lengthen the common channel. Although these lengthening procedures were considered to be secondary to poor dietary compliance, after this experience we considered that it was better to perform a safer procedure by enlarging the common channel to 250 cm. In our series we operated on more than 200 patients. Mean initial body mass index (BMI) was 48kg/m 2 and 60 percent of the patients were diabetic. The initial cohort of 50 patients underwent SADI-s with a 200 cm common channel and the rest with a 250 cm common channel. In 21 cases, the operation was performed as a second step after a sleeve gastrectomy. In four cases, SADI-s was performed after a failed vertical banded gastroplasty, and in one case after a failed Roux-en-Y gastric bypass (RYGB). In the RYGB patient, the gastric bypass was reversed, thus preserving the alimentary limb, and the SADI-s was performed in one stage. There were no intraoperative complications and no postoperative mortality. There was one gastric leak (0.5%) and two anastomotic leaks (1.1%). Only one patient with an early anastomotic leak was submitted to reoperation and the leak was sutured without further complications. One patient suffered gastric tube sleeve hemorrhage and was successfully treated endoscopically. Two patients had re-laparoscopy because of intra- peritoneal hemorrhage, and two patients suffered a herniation through a trocar orifice. Mean excess weight loss (EWL) was 95 percent in the first 12 months, which was maintained through the following five years without significant differences between SADI-S 200 and SADI-s 250. Three percent of the patients have failed to reach a 50- percent EWL. Sixty percent of the patients were diabetics or presented insulin resistance (IR); 40 percent of these patients were under insulin treatment, and mean history of the disease was almost 10 years. Mean preoperative glycemia was 178.2 mg/dL, and mean • Single-anastomosis Duodeno-ileal Bypass with Sleeve Gastrectomy (SADI-s) is a new malabsorptive surgical procedure. • SADI-s is a novel one-loop duodenal switch with a 250 cm common limb. • In SADI-s, a sleeve gastrectomy is initially performed and the duodenum is transected 2–4 cm from the pylorus. • An ileal loop, 200–250 cm from the cecum, is ascended antecolically and anastomosed to the duodenum in an end-to-side fashion. • SADI-s should not be equated to the the "mini gastric bypass" • In our series of more than 200 patients, we have found better results with SADI-s than Roux-en-Y gastric bypass in individuals with obesity and obesity-related comorbidities, such as type 2 diabetes mellitus. KEY POINTS Outcomes of Single-anastomosis Duodeno-ileal Bypass with Sleeve Gastrectomy (SADI-s) Antonio J. Torres, MD, PhD, FACS, FASMBS, and Andrés Sánchez-Pernaute, MD, PhD Bariatric Times. 2016;13(11 Suppl B):B10–B11. AUTHOR AFFILIATIONS: Dr. Antonio Torres is Professor of Surgery, Past President of International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO [2011-2012]), Chairman, IFSO Board of Trustees (2015-present), Governor Capítulo Español del American College of Surgeons (ACS), Chief General Surgery Service, Department of Surgery, Complutense University of Madrid, Hospital Clinico San Carlos in Madrid, Spain. Dr. Sánchez-Pernaute is Chief, Esophago-gastric, Obesity and Metabolic Surgery, Hospital Clínico San Carlos in Madrid, Spain. ADDRESS FOR CORRESPONDENCE: Dr. Antonio J. Torres, General Surgery Service, Department of Surgery, Hospital Clínico San Carlos 3ªSur, Martin Lago s/n. Madrid 28040 Spain; Phone: 34913303184; Fax: 34913303183; E-mail: ajtorresgarcia@gmail.com AUTHOR AFFILIATIONS: No funding was provided. The authors report no conflicts of interest relevant to the content of this article.

Articles in this issue

Links on this page

Archives of this issue

view archives of Bariatric Times - ICCDS-1 2016