title: Single-anastomosis duodenoileal bypass as a second step after sleeve gastrectomy.
abstract: BACKGROUND
  After sleeve gastrectomy, many surgical options are available in patients with insufficient weight loss. Duodenal switch is typically considered the operation that results in higher weight loss, although it is, perhaps unjustly, considered technically difficult and may be accompanied by severe side effects. Single-anastomosis duodenoileal bypass with sleeve gastrectomy is a simplification of the duodenal switch that may behave as a standard biliopancreatic diversion but is easier and quicker to perform. Given its effectiveness as a primary surgery we hypothesized that it would be successful as a second-step operation. The objective of this study was to analyze the weight loss and co-morbidities resolution after a single-anastomosis duodenoileal bypass (SADI) performed as a second step after sleeve gastrectomy.
  
  
  METHODS
  Sixteen patients with an initial body mass index of 56.4 kg/m(2) and a mean excess weight loss of 39.5% after a sleeve gastrectomy were submitted to a single-anastomosis duodenoileal bypass with a 250-cm common channel.
  
  
  RESULTS
  There were no postoperative complications. The mean excess weight loss was 72% 2 years after the second-step surgery. The complete remission rate was 88% for diabetes, 60% for hypertension, and 40% for dyslipidemia. The mean number of daily bowel movements was 2.1. One patient suffered an isolated episode of clinical hypoalbuminemia.
  
  
  CONCLUSIONS
  SADI is a safe operation that offers a satisfactory weight loss for patients subjected to a previous sleeve gastrectomy. The side effects are well tolerated, and complications are minimal.
authors.affiliation: Department of Surgery, Hospital Clínico San Carlos, Madrid, Spain. Electronic address: pernaute@yahoo.com.
authors.forename: Andrés
authors.initials: A
authors.lastname: Sánchez-Pernaute
authors.affiliation: Department of Endocrinology, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Rubio
authors.affiliation: Department of Surgery, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Conde
authors.affiliation: Department of Surgery, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Emmy
authors.initials: E
authors.lastname: Arrue
authors.affiliation: Department of Surgery, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Elia
authors.initials: E
authors.lastname: Pérez-Aguirre
authors.affiliation: Department of Surgery, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Torres
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D015992:Body Mass Index; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D007082:Ileum / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult
keywords: Duodenoileal bypass; Sleeve gastrectomy; Staged surgery; Weight loss