IBC Oxford University Poster Abstract 13 - Single anastomosis duodeno-ileal bypass with gastric plication

Abstract Background Gastric plications and SADI. are new procedures for which authors describe benefits, results, and complications throughout their studies for patients with high BMI. Objectives The aim is to demonstrate the technique we are performing (SADI—P) and to describe its standardization implemented at our bariatric unit and to evaluate safety, efficacy, as well as complications. Methods From May 2016 until January 2019, 118 patients underwent Single Anastomosis Duodeno-Ileal Bypass (SADI) of which 84 with primary gastric plication. The procedure was first described by Youssef Andraos M.D. FACS. (the author) and presented as a video presentation at the 24th IFSO WORLD CONGRESS 2019 (V-123). Technical steps presented consist of 1. Gastric Greater Curvature Plication (GGCP) is performed using two rows of running non-absorbable 2/0 sutures starting at the GE Junction to 4 cm from the pylorus, in multiple bites (standard steps of this procedure were presented at the Clinical Congress 2019 of the American College of Surgeons in San Francisco, CA by the author (Session Code: VE303)) 2. GGCP is calibrated over a 40 French Faucher tube. 3. SADI is performed at 3.5 meters from the ileocecal valve. 4. Terminal-lateral hand-sewn duodenal-ileal anastomosis is performed by two anterior and two posterior running absorbable 3/0 sutures. 5. Patent and leak test are performed at the end of the surgery. Data was prospectively collected and analysed. Results 52 patients were males, mean age being 39.4 ± 11 years, mean operative time duration being 80 ± 13.2 minutes, mean pre-operative BMI. being 46.5 ± 9.75 kg/m2 (36.75 kg/m2–56.25 kg/m2), mean pre-operative weight being 134 ± 26.75 kg (107.25 kg–160.75 kg). Among the 84 patients who underwent SADI—P, there were 21 with type 2 diabetes and 20 with arterial blood hypertension. The mean excess weight loss percentages (%EWL) at 1, 3, 6, 18, 32 months were 24.4 ± 14.07%, 71.1 ± 22.8%, 84.5 ± 23.3%, 85 ± 18.4% , 88 ± 19.52% respectively with a total weight loss (TWL) 11.17 ± 1.9%, 19.65 ± 4%, 30.2 ± 8.3%, 35.2 ± 10.9%, 38.4 ± 10.2% respectively. Obesity-related comorbidities showed favourable resolution: 18 of the diabetic patients as well as 14 of the hypertensive patients became off-treatment. All patients were discharged 56 hours post-operatively. There were no deaths, transfusion, or leak. 2 cases of severe hypo-albuminemia were reversed to normal anatomy at 6 and 26 post-operatively. Conclusion SADI-P is a standardized, safe, and efficient procedure at our bariatric unit for high BMI. patients with severe comorbidities. Nevertheless, severe hypo-albuminemia is still an issue to be considered. Longer follow-up and deeper studies are necessary to assess the long-term effect of this procedure.