Obesity surgery · 2026
Long-Term Effects of Biliopancreatic Diversion (BPD), Biliopancreatic Diversion with Duodenal Switch (BPD-DS), and Single Anastomosis Duodeno‑Ileal Bypass with Sleeve Gastrectomy (SADI‑S) in Patients with Obesity: A Meta-Analysis.
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Azizi Shahriar, Zare Mohammad Mehdi, Nadir Sherko Abbas, Anari Moghadam Hengameh, Esparham Ali
Аннотация
INTRODUCTION: The long-term outcomes of biliopancreatic diversion (BPD), BPD with duodenal switch (BPD-DS), and single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) in patients with obesity are not well established.
METHODS: A systematic search of PubMed, Embase, Scopus, and Web of Science was conducted until October 11, 2025, following PRISMA guidelines. Studies reporting outcomes at ≥ 10 years following the specified procedures were included.
RESULTS: A total of 22 studies with 2156 patients were included. BPD and BPD-DS were associated with a mean BMI reduction of 19.02 kg/m². BPD-DS achieved total weight loss (TWL) of 36.34% and an excess weight loss (EWL) of 75.22%. Resolution rates for diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea were 78%, 63%, 83%, and 89%, respectively. Major long-term complications included revision surgery (3%), anemia (19%), iron deficiency (34%), and bone disorders (25%). Compared with RYGB, BPD and BPD-DS achieved greater BMI reduction (mean difference 6.31 kg/m², 95% CI: 3.16, 9.47) and higher diabetes resolution (OR 3.49, 95% CI: 1.11, 10.91), but with a higher rate of cholecystectomy. Diabetes relapse after BPD and BPD-DS occurred in 15% of patients, with significant reductions in fasting blood sugar and HbA1c. Limited data from two studies on SADI-S showed sustained weight loss (TWL 34.4%, EWL 80.4%) but notable rates of reoperation due to nutritional complications.
CONCLUSION: Overall, BPD and BPD-DS provide lasting weight loss and metabolic benefits, but careful patient selection and ongoing multidisciplinary care are important because of the risk of malnutrition. Long-term data on SADI-S appear promising but remain limited.
METHODS: A systematic search of PubMed, Embase, Scopus, and Web of Science was conducted until October 11, 2025, following PRISMA guidelines. Studies reporting outcomes at ≥ 10 years following the specified procedures were included.
RESULTS: A total of 22 studies with 2156 patients were included. BPD and BPD-DS were associated with a mean BMI reduction of 19.02 kg/m². BPD-DS achieved total weight loss (TWL) of 36.34% and an excess weight loss (EWL) of 75.22%. Resolution rates for diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea were 78%, 63%, 83%, and 89%, respectively. Major long-term complications included revision surgery (3%), anemia (19%), iron deficiency (34%), and bone disorders (25%). Compared with RYGB, BPD and BPD-DS achieved greater BMI reduction (mean difference 6.31 kg/m², 95% CI: 3.16, 9.47) and higher diabetes resolution (OR 3.49, 95% CI: 1.11, 10.91), but with a higher rate of cholecystectomy. Diabetes relapse after BPD and BPD-DS occurred in 15% of patients, with significant reductions in fasting blood sugar and HbA1c. Limited data from two studies on SADI-S showed sustained weight loss (TWL 34.4%, EWL 80.4%) but notable rates of reoperation due to nutritional complications.
CONCLUSION: Overall, BPD and BPD-DS provide lasting weight loss and metabolic benefits, but careful patient selection and ongoing multidisciplinary care are important because of the risk of malnutrition. Long-term data on SADI-S appear promising but remain limited.