title: Single-anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) for obese diabetic patients.
abstract: BACKGROUND
  Bariatric operations achieve a high remission rate of type 2 diabetes in patients with morbid obesity. Malabsorptive operations usually are followed by a higher rate of metabolic improvement, though complications and secondary effects of these operations are usually higher.
  
  
  OBJECTIVE
  Analyze the results of a simplified duodenal switch, the single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) on patients with obesity and type 2 diabetes mellitus (T2 DM).
  
  
  METHODS
  University Hospital, Madrid, Spain.
  
  
  METHODS
  Ninety-seven T2 DM patients with a mean body mass index (BMI) of 44.3 kg/m(2) were included. Mean preoperative glycated hemoglobin was 7.6%, and mean duration of the disease was 8.5 years. Forty patients were under insulin treatment. SADI-S was completed with a sleeve gastrectomy performed over a 54 French bougie and a 200 cm common limb in 28 cases and 250 cm in 69.
  
  
  RESULTS
  Follow up was possible for 86 patients (95.5%) in the first postoperative year, 74 (92.5%) in the second, 66 (91.6%) in the third, 46 (86.7%) in the fourth and 25 out of 32 (78%) in the fifht postoperative year. Mean glycemia and glycated hemoglobin decreased immediately. Control of the disease, with HbA1c below 6%, was obtained in 70 to 84% in the long term, depending on the initial antidiabetic therapy. Most patients abandoned antidiabetic therapy after the operation. Absolute remission rate was higher for patients under oral therapy than for those under initial insulin therapy, 92.5% versus 47% in the first postoperative year, 96.4% versus 56% in the third and 75% versus 38.4% in the fifth. A short diabetes history and no need for insulin were related to a higher remission rate. Three patients had to be reoperated for recurrent hypoproteinemia.
  
  
  CONCLUSIONS
  SADI-S is an effective therapeutic option for obese patients with diabetes mellitus.
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 Endocrinology, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Lucio
authors.initials: L
authors.lastname: Cabrerizo
authors.affiliation: Department of Endocrinology, Hospital "La Princesa," Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Ramos-Levi
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: D000714:Anastomosis, Surgical / Q000379:methods; D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods; D001786:Blood Glucose / Q000032:analysis*; D015992:Body Mass Index; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006785:Hospitals, University; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D009767:Obesity, Morbid / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology
chemical_list: D001786:Blood Glucose
keywords: Biliopancreatic diversion; Diabetes; Duodenal switch; Malabsorptive surgery; Metabolic surgery; One loop; SADI-S