IBC Oxford University Oral Abstract 30 - Laparoscopic single anastomosis duodeno–ileal bypass (SADI) <i>versus</i> one anastomosis gastric bypass (OAGB) as revisional procedures after sleeve gastrectomy: meta-analysis and systematic review

Abstract Introduction It has been observed that 5–8% of primary bariatric procedures result in treatment failure, necessitating the need for revisional surgery. Single anastomosis duodeno-ileal bypass (SADI) and one anastomosis gastric bypass (OAGB) have been suggested as technically less complex but equally efficient substitutes for the Roux-en-Y procedures. In this systematic review and meta-analysis, our aim is to compare the effectiveness of SADI and OAGB in addressing weight regain following sleeve gastrectomy. Methods We systematically searched PubMed, Scopus, Web of Science and Cochrane Central Register of Controlled Trials databases. Studies were considered eligible if compared SADI with OAGB as revisional surgeries following sleeve gastrectomy. Weight loss parameters included total weight loss percentage (TWL%) and excess weight loss percentage (EWL%). Results Our search strategy yielded 4 articles with a total of 309 patients. 151 patients were assigned to SADI group, on the other hand 158 patients were assigned to OAGB group. For weight loss parameters comparing both procedures at 1 year, the results were in favor of SADI with an EWL% (95% c.i. 3.90 to 17.66; P &amp;lt; 0.01) and a TWL% (95% c.i. 2.43 to 6.17; P &amp;lt; 0.01). At 2 years of follow-up EWL% did not show a statistically significant difference between both operations (95% c.i. −1.18 to 25.86; P = 0.07). In contrast, TWL% was significantly higher in SADI compared to OAGB (95% c.i. 0.96 to 9.68; P = 0.02) at 2 years of follow-up. Regarding post-operative bile reflux, OAGB group had a significantly higher incidence of biliary reflux (OR 0.15; 95% c.i. 0.04 to 0.53; P = 0.003). Patients enrolled in SADI did not develop anastomotic ulcers according to the 4 studies included in the analysis. In contrast, 7 patients in OAGB group did develop anastomotic ulcers but the difference was not statistically significant (OR 0.23; 95% c.i. 0.05 to 1.10; P = 0.07). Conclusion SADI is a feasible procedure with a favorable outcome compared to OAGB as a revisional surgery following sleeve gastrectomy regarding weight loss at 1 year with a lower incidence of post-operative biliary reflux.