A Prospective Multicenter Standard of Care Study of Outpatient Laparoscopic Sleeve Gastrectomy.

A global shift is occurring as hospital procedures move to ambulatory surgical settings. Surgeons have performed outpatient sleeve gastrectomy (SG) in bariatric surgery since 2010. However, prospective trials are needed to ensure its safety before widespread adoption. PURPOSE: The study aimed to present a comprehensive report on the prospective data collection of 30-day outcomes of outpatient primary laparoscopic SG (LSG). This trial seeks to assess whether outpatient LSG is non-inferior to hospital-based surgery in selected patients who meet the outpatient surgery criteria set by the American Society for Metabolic and Bariatric Surgery. MATERIALS AND METHODS: This study is funded by the Society of American Gastrointestinal and Endoscopic Surgeons and has been approved by the Advarra Institutional Review Board (Pro00055990). Cognizant of the necessity for a prospective approach, data collection commenced after patients underwent primary LSG procedures, spanning from August 2021 to September 2022, at six medical centers across the USA. Data centralization was facilitated through ArborMetrix. Each center has its own enhanced recovery protocols, and no attempt was made to standardize the protocols. RESULTS: The analysis included 365 patients with a mean preoperative BMI of 43.7 ± 5.7 kg/m2. Rates for 30-day complications, reoperations, readmissions, emergency department visits, and urgent care visits were low: 1.6%, .5%, .2%, .2%, and 0%, respectively. Two patients (0.5%) experienced grade IIIb complications. There were no mortalities or leaks reported. CONCLUSION: The prospective cohort study suggests that same-day discharge following LSG seems safe in highly selected patients at experienced US centers.

The Safety and Efficacy of Apixaban (Eliquis) in 5017 Post-bariatric Patients with 95.3% Follow-up: a Multicenter Study.

BACKGROUND: Thromboprophylaxis in bariatric surgery is widely debated; however, few large articles evaluate treatment plans and their efficacy. Herein, we make the first large-scale report of the safety and efficacy of apixaban (Eliquis) for thrombus prevention following bariatric surgery. PURPOSE: To evaluate the safety and efficacy of apixaban following bariatric surgery. SETTING: Three private institutes, USA. MATERIALS AND METHODS: Data from 5017 consecutive bariatric patients that were placed on postoperative apixaban for thromboprophylaxis were used for retrospective analysis. The dose prescribed to patients was 2.5 mg PO BID for a total of 30 days starting on day 3 postoperatively. RESULTS: In total, of the 5017 patients, 59.7%, 31.2%, 4.4%, 2.5%, 1.8%, and 0.1% of the patients had undergone sleeve gastrectomy (SG), single-anastomosis duodeno-ileal bypass with SG (SADI-S), Roux-en-Y gastric bypass (RYGB), conversion from SG to SADI, small bowel reconstruction, and RYGB reversal, respectively. The 30-day follow-up rate was 95.3%. In total, 1.7% of patients experienced apixaban-related side effects. The most common side effects were menorrhagia and rash. Two (0.03%) side effects developed into Clavien-Dindo grade II complications. Overall, 10 (0.1%) patients experienced thromboembolic complications (five (0.09%) PVTs and five (0.09%) PEs). In each case, the protocol was not followed for extenuating circumstances. There were no deaths or thromboembolic events in cases where the protocol was able to be fully followed. CONCLUSIONS: In conclusion, 30 days of postoperative apixaban appears to be safe and effective with minimal side effects while preventing thromboembolic events.

Long-Term (> 6 Years) Outcomes of Duodenal Switch (DS) Versus Single-Anastomosis Duodeno-Ileostomy with Sleeve Gastrectomy (SADI-S): a Matched Cohort Study.

BACKGROUND: There are no comparative studies on the long-term outcomes after the primary traditional duodenal switch (DS) and single-anastomosis duodeno-ileostomy with sleeve gastrectomy (SADI-S). PURPOSE: This study aims to compare the long-term outcomes in a matched cohort. SETTING: This study took place in a single private institute, in the USA. MATERIALS AND METHODS: Data from 266 patients who underwent a primary laparoscopic traditional DS or primary laparoscopic SADI-S from September 2011 to December 2015 by four surgeons were used for a retrospective matched cohort. Data were obtained by matching every DS patient to a SADI-S patient of the same age, sex, and body mass index (BMI). In addition, only patients that were out at least 5 years and had a minimum 5-year follow-up were included in the study. RESULTS: The matched cohort included 30 DS and 30 SADI-S patients. There were no statistically significant differences in the preoperative characteristics and baseline comorbidities between both groups. The SADI-S patients had significantly shorter operative time and length of stay. The overall long-term complications, especially the long-term Clavien-Dindo grade IIIb complications, were significantly fewer with SADI-S. At 6 years, the DS patients had statistically higher %EWL; however, the ending BMIs were statistically similar between both groups. There were no significant differences in the long-term comorbidity and nutritional outcomes of both groups. The long-term failure rates were comparable. CONCLUSIONS: Most long-term outcomes of SADI-S were either similar or significantly better than DS. Part of the reasons could be the surgeon's learning curve and the small sample sizes of both groups.

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).

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.

Long-term outcomes of primary single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S).

BACKGROUND: The long-term outcomes of primary single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) have never been reported in the literature. OBJECTIVES: The study aimed to evaluate the long-term outcomes after primary laparoscopic SADI-S (LSADI-S). SETTING: Single, private institute, United States. METHODS: Data from 750 patients who underwent a primary LSADI-S from June 2013 through November 2019 by 3 surgeons were retrospectively analyzed. RESULTS: Seven hundred fifty patients were included in the study. The mean age and preoperative body mass index were 49.3 ± 13.1 years and 50 ± 12.6 kg/m2, respectively. Follow-up was available on 109 patients (61%) at 5 years and on 87 patients (53%) at 6 years. Six patients did not have any follow-up. The average operative time and length of stay were 67.6 ± 27.4 minutes and 1.5 ± .8 days, respectively. The intraoperative, short-term, and long-term complication rates were 0%, 7.8%, 11.7%, respectively. The 30-day emergency room visit, readmission, and reoperation rates were .4%, 1.1%, and 1.1%, respectively. In total, there were 15 (2%) grade IIIb long-term complications unique to LSADI-S. Complete remission of type 2 diabetes was seen in 77% of the diabetic population. At 5 and 6 years, the mean change in body mass index was 17.5 ± 6.9 and 17.6 ± 6.4 kg/m2, respectively. The mortality rate was .5%. CONCLUSIONS: LSADI-S is effective in this retrospective review in achieving good initial weight loss and weight maintenance. Although our data show acceptable nutritional complications, questions still remain because of the retrospective nature of the study.

Single-anastomosis duodenal ileostomy with sleeve is a safe and effective option for patients in an ambulatory surgical center.

BACKGROUND: The single-anastomosis duodenal ileostomy with sleeve gastrectomy (SADI-S) is gaining popularity in the United States as an alternative to the gastric bypass for patients with a high body mass index (BMI) or who are less likely to succeed with a sleeve. While SADI-S has similar weight loss to the gastric bypass, the complication rate is significantly lower, allowing surgeons to perform SADI-S in an ambulatory surgical center with a 23-hour stay. OBJECTIVES: To determine if SADI-S can be safely performed in an ambulatory surgical setting. SETTING: Private practice. METHODS: All SADI-S procedures performed from August 2015 to March 2019 at 2 bariatric centers were included in this study. Patients selection for SADI-S in the ambulatory surgical center required no end organ damage, no evidence of severe sleep apnea, and BMI <55 for males and BMI <60 for females. All data were gathered retrospectively from prospectively kept databases. Thirty-day complication rates were analyzed using the Clavien-Dindo scale to assess the safety of performing SADI-S in an ambulatory surgical center. RESULTS: Eighty-two patients were included in this study. The sample was 72% female with an average age of 46 and BMI of 45. All patients received planned intravenous fluid within 3 days after the procedure. There were 2 (2.4%) grade IIIb to V complications. There were no mortalities in this series. CONCLUSION: SADI-S can be performed safely in an ambulatory surgery 23-hour setting with appropriate patient selection, perioperative support, and enhanced recovery after surgery protocols.

A Video Case Report of Gastric Perforation Following Endoscopic Sleeve Gastroplasty and its Surgical Treatment.

INTRODUCTION: Endoscopic sleeve gastroplasty (ESG) is a novel weight loss procedure that reduces the size of the stomach using an endoscopic suturing device. There are severe adverse events that have been reported following ESG (Brethauer et al. Surg Obes Relat Dis. 6:689-94, 2010; Abu Dayyeh et al. Gastrointest Endosc. 78:530-5, 2013; Nava et al. Endoscopy. 47:449-52, 2015; Nava et al. Endosc Int Open. 4(2):E222-7, 2016). However, complications like gastric perforation following ESG have not been reported. This video presents a case with gastric perforation following ESG and its surgical treatment. METHODS: A 44-year-old female patient with an initial body mass index (BMI) of 38 kg/m2 underwent an ESG. Her comorbidities include gastroesophageal reflux disease (GERD) and polycystic ovary syndrome (PCOS). On postoperative day six, the patient presented with lower abdominal pain. The patient refused to get an esophagogastroduodenoscopy (EGD) or laparoscopy done. An upper gastrointestinal series (UGI) was performed, and a large ileus was noted with no evidence of leak or free air. On postoperative day seven, a computed tomography (CAT) scan showed a large amount of free air and fluid throughout the abdomen and pelvis. The patient was taken to the operating room (OR) for an exploratory laparoscopy. RESULTS: Upon entering the abdomen, a large amount of pus and free fluid was noted. This was irrigated free from the abdominal cavity until it came back clear. We noted six sutures that went intraluminally to extraluminally and entered the anterior abdominal wall. These sutures were taken down until we found the perforation. A GIA stapler was placed over the perforation, and the defect was closed. The staple line was then imbricated. Once done with the imbrication, we spent a significant amount of time laparoscopically irrigating the abdomen with 12 L of fluid. In total, three drains were placed to assist with draining the abdomen. CONCLUSION: ESG is a feasible endobariatric option, but complications like gastric perforation can occur. For such complication, immediate surgical treatment is indicated.

A Multi-institutional Study on the Mid-Term Outcomes of Single Anastomosis Duodeno-Ileal Bypass as a Surgical Revision Option After Sleeve Gastrectomy.

INTRODUCTION: Recently, a single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) has become increasingly popular for patients with BMI > 50 as a primary or staged surgery. Staging allows surgeons to do the sleeve gastrectomy (SG) first with the conversion only happening when a failure or technical challenge is identified. PURPOSE: We present the mid-term outcomes of SADI bypass surgery after SG. METHOD: A retrospective analysis was performed on a prospective database from four institutions. Ninety-six patients were identified from 2013 to 2018. Patients were divided into two groups: one had two-stage SADI because of insufficient weight loss, the second had planned two-stage SADI because of super obesity (BMI > 50 kg/m2). Incidence of complications was divided into < 30 days and > 30 days. RESULT: Of 96 patients, 3 patients were completely lost to follow-up. The mean age was 44.8 ± 11.3 years. There were no deaths or conversion to open surgery. The postoperative early complication and late complication rate was 5.3% and 6.4% respectively. At 24 months, group 2 had higher %weight loss (WL) and change in BMI units compared to group 1 with statistically significant difference. The average WL and change in BMI for entire patient's population at 24 months after 2nd stage SADI was 20.5% and 9.4 units respectively. The remission rate for DM was 93.7% with or without the use of medication. CONCLUSION: The two-stage approach to SADI-S appears technically simpler than a single compromised operation. However, this approach needs more patients to understand its limitations.

Bowel Reconstruction to Treat Chronic Diarrhea and Hypoproteinemia Following Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy: a Single-Site Experience.

BACKGROUND: Single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) is a modification of the biliopancreatic diversion with duodenal switch (BPD-DS) surgery. A concern with SADI-S is chronic diarrhea and hypoproteinemia. Common channel lengthening (CCL) is a surgical procedure to increase absorption in the small intestine to decrease diarrhea. OBJECTIVES: The aim of this study was to assess the occurrence and treatment of hypoproteinemia and chronic diarrhea with CCL following SADI-S surgery. SETTING: Private practice in the USA. METHODS: Patients were included if they underwent SADI-S from September 2013 to March 2018 and following surgery underwent CCL. RESULTS: Average operating time for laparoscopic CCL is 56.5 ± 4.6 min. The average bowel movements for the eight patients before laparoscopic CCL were 9.1 ± 4.7 a day. After the surgery, the bowel movements were reduced to 2.6 ± 0.4 a day. This difference was found to be statistically significantly different (p = .002). The two patients experiencing hypoproteinemia improved protein levels following CCL. CONCLUSION: CCL is an effective way to treat symptomatic chronic diarrhea after SADI-S when conservative treatments have failed.

Does the future of laparoscopic sleeve gastrectomy lie in the outpatient surgery center? A retrospective study of the safety of 3162 outpatient sleeve gastrectomies.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is a safe and effective procedure that can be performed as an outpatient procedure. OBJECTIVES: The aim of the study was to determine whether same-day discharge LSG is safe when performed in an outpatient surgery center. SETTING: Outpatient surgery centers. METHODS: The medical records of 3162 patients who underwent primary LSG procedure by 21 surgeons at 9 outpatient surgery centers from January 2010 through February 2018 were retrospectively reviewed. RESULTS: Three thousand one hundred sixty-two patients were managed with enhanced recovery after surgery protocol and were included in this analysis. The mean age and preoperative body mass index were 43.1 ± 10.8 years and 42.1 ± 7.1 kg/m2, respectively. Sleep apnea, type 2 diabetes, gastroesophageal reflux disease, hypertension, and hyperlipidemia were seen in 14.4%, 13.5%, 24.7%, 30.4%, and 17.6% patients, respectively. The mean total operative time was 56.4 ± 16.9 minutes (skin to skin). One intraoperative complication (.03%) occurred. The hospital transfer rate was .2%. The 30-day follow-up rate was 85%. The postoperative outcomes were analyzed based on the available data. The 30-day readmission, reoperation, reintervention, and emergency room visit rates were .6%, .6%, .2%, and .1%, respectively. The 30-day mortality rate was 0%. The total short-term complication rate was 2.5%. CONCLUSIONS: Same-day discharge seems to be safe when performed in an outpatient surgery center in selected patients. It would appear that outpatient surgery centers are a viable option for patients with minimal surgical risks.

Is pneumatic balloon dilation safe and effective primary modality of treatment for post-sleeve gastrectomy strictures? A retrospective study.

BACKGROUND: The optimal treatment of sleeve strictures has not been agreed upon at the current time. At our institution, we began using pneumatic balloon dilation to help resolve these obstructions in 2010. Herein we report our experience with pneumatic balloon dilation for the treatment of sleeve strictures. METHODS: From Jan 2010 to Dec 2016 we retrospectively reviewed our prospectively kept database for patients who developed a Laparoscopic Sleeve Gastrectomy (LSG) stricture within 90 days of surgery. If the stricture was found, then we dilated all our patients initially at 30 mm at 10 PSI for 10-20 min (14.5 min average) and increased the balloon size (30-40 mm) and duration (10-30 min) in subsequent sessions if the first session was unsuccessful. RESULTS: The review found that 1756 patients underwent either LSG or the first step of a Laparoscopic Duodenal Switch (LDS) (1409 LSG & 356 LDS). Of the 1756 patient 33 patients (24 underwent LSG, and 9 underwent LDS) developed a stricture as a complication of LSG. The average age of the patients was 46.4 (±9.6) years, and the average BMI was 43.7 (±6.4). The most common location for stricture was mid-body of the sleeve (54.5%). The average time from the primary surgery to diagnosis and first pneumatic dilation was 5.6 months (± 6.8) and 5.9 months (± 6.6) respectively. We successfully used pneumatic dilation in 31 (93.9%) of these patients to relieve the stricture. CONCLUSION: We conclude that pneumatic dilation is an effective procedure in patients with post sleeve gastrectomy stricture.

Does Bismuth Subgallate Affect Smell and Stool Character? A Randomized Double-Blinded Placebo-Controlled Trial of Bismuth Subgallate on Loop Duodenal Switch Patients with Complaints of Smelly Stools and Diarrhea.

BACKGROUND: Loop duodenal switch (LDS) can result in fat and starch malabsorption. In a small percentage of patients, a relevant qualitative and quantitative change in stools happens usually characterized by steatorrhea-like diarrhea. Bismuth subgallate (BS) has been marketed as a way to eliminate the odor associated with flatulence and bowel movements. The objective of this study is to see the efficacy and effect of BS on the quality of life (QOL) in patients undergoing LDS. METHODS: A prospective, randomized, double-blinded, placebo-controlled, crossover study was designed. Thirty-six patients who reported flatus and/or stool odor changes and have completed at least 6 months post-LDS were included. Patients participated in two treatment periods, each lasting for 1 week, separated by 1-week washout. Patients received 200 mg BS, 2 capsules per meal, or placebo for 1 week each. The Gastrointestinal Quality of Life Index (GIQLI) questionnaire was used to compare the QOL before the initiation of the therapy and after each treatment completion. RESULTS: Of 36 patients, 5 patients were lost to follow-up and 2 were withdrawn from the study. And 29 patients were included for final analysis. GIQLI scores obtained with BS treatment completion were significantly higher both overall (P = 0.007) and in the digestive domain (P < 0.001) than those obtained before the treatment. GIQLI scores obtained from the other domains were also higher compared to the pre-treatment as well as placebo treatment but not statistically significant. CONCLUSION: In our double-blinded trial, treatment with BS after LDS statistically improves GIQLI score and steatorrhea-like symptoms.

Laparoscopic stomach intestinal pylorus-sparing surgery as a revisional option after failed adjustable gastric banding: a report of 27 cases with 36-month follow-up.

BACKGROUND: Inadequate weight loss, weight recidivism, and device-related complications after an adjustable gastric banding (AGB) can be treated by a laparoscopic conversion to stomach intestinal pylorus-sparing surgery (SIPS). OBJECTIVE: The aim of the study was to analyze the midterm outcomes of revision SIPS surgery after failed AGB. SETTING: Private practice, United States. METHODS: This is a retrospective review of our prospectively collected data of patients who underwent laparoscopic conversion from AGB to SIPS surgery from June 2013 and February 2017 by a single surgeon in a single institution. RESULTS: Twenty-seven patients (1 stage: 22 and 2 stage: 5) underwent a laparoscopic revision of AGB to SIPS surgery. The mean ± standard deviation preoperative body mass index (BMI) before AGB was 47.5 ± 6.8 kg/m2, while the mean nadir BMI after AGB was 36 ± 7.7 kg/m2. The overall time to reoperation was 9.3 ± 8.7 and 5.6 ± 2.5 years in 1- and 2-stage conversion patients, respectively. The mean preoperative BMI before revision SIPS surgery was 46.7 ± 7 kg/m2. At 36 months, the patients had an average change in BMI of 20.9 units with 90% excess weight loss. A major complication occurred in 4 patients. Postoperatively, the fasting blood glucose, insulin, low-density lipoprotein, triglyceride, and most of the co-morbidities were resolved or improved. CONCLUSION: This study demonstrates that conversion of failed AGB to SIPS surgery is an effective approach to AGB failure.

Mid-term 4-Year Outcomes with Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy Surgery at a Single US Center.

BACKGROUND: Single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) is a modification of Roux-en-Y duodenal switch (RYDS). Long-term data on this operation is lacking in the literature. We reviewed our mid-term data of this RYDS modification. PURPOSE: To analyze the outcomes with SADI-S at 4 years. METHODS: Data from patients who underwent a primary SADI-S procedure performed by three surgeons at a single institution from June 2013 through February 2018 were retrospectively reviewed. All revision bariatric surgeries were excluded. Regression analyses were performed for all follow-up weight loss data. RESULTS: There were 437 patients in our database. The pre-operative mean body mass index (BMI) was 49.8 ± 8.8 kg/m2. The 30-day complication rate was 7.7%. The 30-day readmission, reoperation, and mortality rates were 1.8, 1.3, and 0.2%, respectively. The long-term complication rate was 10.9%. Seventy-nine patients were 4 years post SADI-S surgery and follow-up was possible for 44 patients (55.7%). At 4 years, patients had an average change in BMI of 18.1 ± 6 units with an excess weight loss (EWL) of 85.7 ± 27.3%. At 4 years, 97.6% patients were able to maintain HbA1c < 6% with or without the use of diabetic medication. There was a statistically significant difference between most of the pre-operative and post-operative nutritional data. CONCLUSIONS: SADI-S is a safe and effective procedure in both short- and mid-term data points. Diabetes resolution and weight loss appear similar to traditional RYDS and better than RYGB.

An Analysis of Mid-Term Complications, Weight Loss, and Type 2 Diabetes Resolution of Stomach Intestinal Pylorus-Sparing Surgery (SIPS) Versus Roux-En-Y Gastric Bypass (RYGB) with Three-Year Follow-Up.

BACKGROUND: For many years, the Roux-en-Y Gastric Bypass (RYGB) was considered a good balance of complications and weight loss. According to several short-term studies, single anastomosis duodenal switch or stomach intestinal pylorus sparing surgery (SIPS) offers similar weight loss to RYGB with fewer complications and better diabetes resolution. No one has substantiated mid-term complication and nutritional differences between these two procedures. This paper seeks to compare complication and nutritional outcomes between RYGB and SIPS. METHODS: A retrospective analysis of 798 patients who either had SIPS or RYGB from 2010 to 2016. Complications were gathered for each patient. Nutritional outcomes were measured for each group at 1, 2, and 3 years. Regression analysis was applied to interpolate each patient's weight at 3, 6, 9, 12, 18, 24, and 36 months. These were then compared with t tests, Fisher's exact tests, and chi-squared tests. RESULTS: RYGB and SIPS have statistically similar weight loss at 3, 6, 9, 12, and 36 months. They statistically differ at 18 and 24 months. At 36 months, there is a trend for weight loss difference. There were only statistical differences in nutritional outcomes between the two procedures with calcium at 1 and 3 years and vitamin D at 1 year. There were statistically significantly more long-term class IIIb-V complications, class I-IIIa complications, reoperations, ulcers, small bowel obstructions, nausea, and vomiting with the RYGB than the SIPS. CONCLUSION: With comparable weight loss and nutritional outcomes, SIPS has fewer short- and long-term complications than RYGB and better type 2 diabetes resolution rates.

The incidence of complications associated with loop duodeno-ileostomy after single-anastomosis duodenal switch procedures among 1328 patients: a multicenter experience.

BACKGROUND: The single-anastomosis duodenal switch procedure is a type of duodenal switch that involves a loop anastomosis rather than traditional Roux-en-Y reconstruction. To date, there have been no multicenter studies looking at the complications associated with post-pyloric loop reconstruction. OBJECTIVES: The aim of the study was to report the incidence of complications associated with loop duodeno-ileostomy (DI) following single-anastomosis duodenal switch (SADS) procedures. SETTING: Mixed of private and teaching facilities. METHODS: The medical records of 1328 patients who underwent primary SADS procedure (single-anastomosis duodeno-ileal bypass with sleeve gastrectomy or stomach intestinal pylorus-sparing surgery) by 17 surgeons from 3 countries (United States, Spain, and Australia) at 9 centers over a 6-year period were retrospectively reviewed, and their results were compared with articles in the literature. RESULTS: Mean preoperative body mass index was 51.6 kg/m2. Of 1328 patients, 123 patients received a linear stapled duodeno-ileostomy (DI) and 1205 patients a hand-sewn DI. In the overall series, the anastomotic leak, ulcer, and bile reflux occurred in .6% (9/1328), .1% (2/1328), and .1% (2/1328), respectively. None of our patients experienced volvulus at the DI or an internal hernia. Overall, 5 patients (.3%) (3/123 [2.4%] with linear stapled DI versus 2/1205 [.1%] with hand-sewn DI [P<.05]) experienced stricture at the DI in this series. CONCLUSIONS: The overall incidence of complications associated with loop DI was lower than the reported incidence of anastomotic complications after Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch. SADS procedures may cause much fewer anastomotic complications compared with Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch.

A Matched Cohort Analysis of Stomach Intestinal Pylorus Saving (SIPS) Surgery Versus Biliopancreatic Diversion with Duodenal Switch with Two-Year Follow-up.

BACKGROUND: In bariatric surgery, the procedure with the highest average weight loss is the biliopancreatic diversion with duodenal switch (BPDDS). A new simplified duodenal switch called the stomach intestinal pylorus sparing (SIPS) surgery with less malabsorption and one fewer anastomosis claims to have similar outcomes when compared to the BPDDS. METHODS: A retrospective matched cohort analysis of SIPS versus BPDDS patients in a single private practice was obtained by matching every BPDDS to a SIPS patient of the same gender and BMI. Excess weight loss percentage (EWL), BMI, and percentage total weight loss (%TWL) were compared. Additionally, comorbidity resolution, nutritional data, and complications were also compared. Data was analyzed using both descriptive and comparative statistics. RESULTS: Over 2 years, there was no statistical difference in weight loss between BPDDS and SIPS. There also was no difference in nutritional data between the two procedures pre- and post-op. Complication rates were lower in SIPS however, due to the small sample sizes this is not statistically significant. CONCLUSION: Weight loss and nutritional results between SIPS and BPDDS are similar at 2 years. However, there are fewer complications with SIPS.