Revisional single anastomosis duodeno-ileal bypass with sleeve gastrectomy after failed adjustable gastric band or sleeve gastrectomy: a meta-analysis of efficacy and safety.

Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) demonstrates a high safety profile and consistent weight loss efficiency, increasingly used as a revisional procedure. However, while mid- and long-term outcomes for primary SADI-S are established, evidence on its effectiveness as a revisional technique remains limited. This study aims to address that gap by assessing the efficacy and safety of revisional SADI-S after failed primary adjustable gastric banding (AGB) or sleeve gastrectomy (SG) procedures. A systematic search was conducted in PubMed, Embase, Web of Science, and Scopus to identify articles on the efficacy and safety of SADI-S as a revisional surgery after failed primary AGB or SG. A meta-analysis was conducted, coupled with subgroup analyses on comparing revisional SADI-S, Roux-en-Y gastric bypass (RYGB), one anastomosis gastric bypass (OAGB), and duodenal switch (DS). Eighteen articles with 1641 revisional cases were included in the current study. BMI change after SADI-S was 11.01 (1.51), 9.57 (1.75), and 11.04 (.86) kg/m2 after 12, 36, and 60 months, respectively. Furthermore, total weight loss (TWL) after SADI-S was 23.78% (2.50), 21.03% (4.95), and 22.11% (8.69) after 12, 36, and 60 months, respectively. SADI-S was associated with 69%, 41%, 47%, and 69% rates of diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea remission, respectively. Leak (2.9%), gastroesophageal reflux disease (GERD) (5.1%), anemia (5.7%), diarrhea (8.7%), nutritional deficiency (4.2%), and steatorrhea (11.2%) were the most common reported complications after revisional SADI-S. In subgroup analysis, revisional SADI-S, OAGB, and RYGB had comparable weight loss, obesity related comorbidity resolution, and complications, except for a higher rate of stenosis/obstruction in RYGB and bile reflux in OAGB. Revisional SADI-S is a safe and effective option for patients with failed primary AGB or SG.