title: Mid-Term Results and Responsiveness Predictors After Two-Step Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy.
abstract: In patients with insufficient weight loss after sleeve gastrectomy (SG) or in super obese individuals, among many surgical options available, a single-anastomosis duodeno-ileal bypass (SADI) after SG (SADI-S) could be considered. Due to the limited information available about the use of SADI as a second-step procedure, the objective of this study was to evaluate the mid-term results and responsiveness of SADI after sleeve gastrectomy.
  
  
  
  We present prospective data from 30 consecutive patients with a mean BMI of 40.1 kg/m2, a mean excess weight of 44.7 kg, and a mean excess weight loss (EWL) of 37.5%, who were submitted to a SADI as a second-step revisional procedure.
  
  
  
  There were no intraoperative complications. Four early complications (13.34%) occurred within the first 24 postoperative hours. Six, 12, and 24-month follow-up number of patients available was 30 (100%), 22 (73.3%), and 16 (53.34%), respectively. Percent total weight loss (%WL) was 28.1 at the time of revision and 46.26% 24 months after SADI. Global %EWL was 78.93 ± 35.5. The complete remission rate after SG was 50% for diabetes, 33.3% for dyslipidemia, and 25% for hypertension, and 71.4%, 31.2%, and 27.7%, respectively, after SADI. Three (10%) patients required revisional surgery due to hypoalbuminemia.
  
  
  
  SADI as a second-step strategy in super obese patients or after failed SG offers a more than satisfactory ponderal weight loss and an acceptable comorbidities resolution. However, the risk of severe malnutrition after distal SADI-S makes necessary a careful patient selection.
authors.affiliation: Metabolic and Bariatric Surgery Unit, EAC-BS Center of Excellence, Vall d'Hebron University Hospital, Barcelona, Spain. balibrea@gmail.com.|Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain. balibrea@gmail.com.
authors.forename: José M
authors.initials: JM
authors.lastname: Balibrea
authors.affiliation: Metabolic and Bariatric Surgery Unit, EAC-BS Center of Excellence, Vall d'Hebron University Hospital, Barcelona, Spain.|Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: Vilallonga
authors.affiliation: Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Hidalgo
authors.affiliation: Department of Endocrinology, Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: Andreea
authors.initials: A
authors.lastname: Ciudin
authors.affiliation: Metabolic and Bariatric Surgery Unit, EAC-BS Center of Excellence, Vall d'Hebron University Hospital, Barcelona, Spain.|Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Óscar
authors.initials: Ó
authors.lastname: González
authors.affiliation: Metabolic and Bariatric Surgery Unit, EAC-BS Center of Excellence, Vall d'Hebron University Hospital, Barcelona, Spain.|Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Enric
authors.initials: E
authors.lastname: Caubet
authors.affiliation: Department of General Surgery, Clínico San Carlos Hospital, Madrid, Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: Sánchez-Pernaute
authors.affiliation: Metabolic and Bariatric Surgery Unit, EAC-BS Center of Excellence, Vall d'Hebron University Hospital, Barcelona, Spain.|Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Fort
authors.affiliation: Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain.|Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: Manel
authors.initials: M
authors.lastname: Armengol-Carrasco
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D004386:Duodenum / Q000601:surgery; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007082:Ileum / Q000601:surgery; D009767:Obesity, Morbid / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Duodeno-ileal bypass; Obesity; SADI-S; Sleeve gastrectomy; Weight loss