Both the one anastomosis gastric bypass (OAGB-MGB) and single anastomosis duodeno-ileal bypass (SADI-S) have shown efficacy as revisional procedures for weight regain following SG, SADI-S exhibits superior outcomes compared to the OAGB-MGB with regard to weight loss, resolution of comorbidities, complication rates, and reoperation rates, according to researchers from Hamad Medical Corporation, Doha, Qatar. The outcomes were reported in the paper, ‘Comparative analysis of 5-year efficacy and outcomes of single anastomosis procedures as revisional surgery for weight regain following sleeve gastrectomy’, published in Surgical Endoscopy.
The investigators noted that both SADI-S and OAGB-MGB have been proposed as technically simpler yet equally effective alternatives to the Roux-en-Y procedures - biliopancreatic diversion with duodenal switch (BPD-DS) and the Roux-en-Y Gastric bypass (RYGB), respectively.
Therefore, they examined the comparative effectiveness of the SADI-S and the OAGB-MGB as revisional procedures, with respect to their impact on weight loss, resolution of comorbidities, incidence of complications, and rates of reoperation in patients who had weight regain after SG with up to or more than five years of follow-up. The study retrospectively analysed a database of 91 patients who underwent SADI-S (n=42) or OAGB-MGB (n=49).
All patients who underwent the SADI-S or OAGB-MGB procedures were provided with the same postoperative bariatric protocol, which encompassed dietary instructions, protein supplements, multivitamins, proton pump inhibitors (PPIs) and scheduled outpatient follow-up appointments.
Outcomes
The mean pre-SG weight was 133±29.1kg in the OAGB-MGB group and 141.5±27.8 kg in the SADI-S group. The mean pre-SG BMI was 52±11kg/m2 for the OAGB-MGB group and 50±8kg/m2 for the SADI-S group. The mean pre-revisional procedure BMI was 43.0±6.8 for the OAGB-MGB group and 45.9±10.3 in the SADI-S group.
Significant weight loss was observed at five-years follow-up for the SADI-S group compared to the OAGB-MGB group (30.0±18.4 vs. 19.4±16.3, p=0.008) and a marked reduction in BMI in SADI-S patientys from an average of 45.9 ± 10.3 to 33.7 ± 5.8 (p<0.001).
Also at five years of follow-up, patients who underwent the SADI-S procedure demonstrated significant enhancements in serum lipids profile, including triglycerides, cholesterol, LDL, and HDL, when compared to those who underwent OAGB-MGB. Conversely, there were no statistically significant differences in A1C values, serum protein, serum albumin, INR, serum zinc, and Hb levels between the two groups, indicating comparable outcomes.
In the OAGB-MGB group, 14 out of 49 patients (28.6%) experienced complications, with five cases (10.2%) requiring conversion to another procedure. Within the SADI-S group, nine out of 42 patients (21.42%) experienced complications following surgery.
“Our study is subject to several limitations. Notably, its retrospective design, despite the use of prospectively collected data from electronic medical records”, they noted. “Furthermore, there is a dearth of information regarding quality of life following revisional procedures. However, our study boasts several strengths, including a comparatively larger sample size for revisional procedures than previous studies and a longer follow-up duration of five years post-surgery.”
Although SADI-S procedure exhibited superior outcome, the researchers stated OAGB-MGB still serves as an effective and safe alternative for patients experiencing weight regain following SG.
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