Single anastomosis duodeno-ileal bypass with sleeve gastrectomy in the United States: has increased volume impacted safety?

BACKGROUND

Originally described in 2007, the single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) was only endorsed by the American Society for Metabolic and Bariatric Surgery in 2020. Since then, the procedure has grown exponentially in popularity.

OBJECTIVES

Assess whether broader adoption of SADI-S has led to a change in practice patterns or complications.

SETTING

University hospital, US national database.

METHODS

This was a retrospective, observational cohort study of SADI-S entries in the 2020 through 2023 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program databases. χ2 and analysis of variance were applied to determine differences between years for categorical and continuous variables, respectively. Bonferroni correction was applied to adjust for degrees of freedom, and hence a P value < .008 was considered significant.

RESULTS

From the years 2020 to 2023, operative SADI-S volume in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database increased over 4-fold from 488 cases to 1963 cases. Utilization of the robotic platform increased from 33.4% to 41.0% (P < .0001). Complication rate decreased significantly in 2021-2022. There was no significant difference between the years in rates of readmission, reintervention, or reoperation. The most common complications following SADI-S include skin and soft tissue infection, transfusion, and unplanned intensive care unit admission.

CONCLUSIONS

Despite increased volume of SADI-S in recent years, rates of unadjusted, short-term, composite complications have not increased significantly and are not significantly different from those of Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch.