IBC Oxford University Oral Abstract 9 - Reversal of SADI bypass to normal anatomy

Abstract Background Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) or with Gastric Sleeve Plication (SADI-GSP) are technically highly demanding hypo-absorbtive bariatric procedures generally indicated in high BMI patients (>50 kg/m2) with or without a metabolic syndrome. Data from the literature prove the procedure to be safe and effective. However, hypoproteinemia is a major concern as a severe long-term complication that may need re-operation to elongate the common loop or to reverse it to normal anatomy. Methods Among 1,204 patients who underwent bariatric procedures at our institution from May 3rd 2016 till February 14th 2024, 303 patients underwent SADI-S or SADI-GSP as primary procedure, or revisional procedure after sleeve gastrectomy, or gastric sleeve plication (GSP). Early and late post-operative nutritional complications were analysed. Albumin level under normal value at one year was noticed in 21 patients (6.9%). Results Hypoalbuminemia was corrected in 8 patients (38.09%) using medical management, parenteral nutrition and IV albumin. 13 others were re-operated at 5 years. 6 of them were reversed to normal anatomy (The common loop length was initially performed at 2.5 m from the ileocaecal junction and at 3 m from the ileocaecal junction in 2 cases.) One patient among the 6 presented with peritonitis on day 2 without evidence of anastomotic leak (second look, washing, and drainage were performed along with antibiotics). 7 patients underwent lengthening of the common loop. The choice of technique was guided by local anatomical changes (adhesions, bleeding, and tension), the surgeon’s conviction, and the patient’s preference. Both techniques achieve normal level of albumin at 3 months. Conclusion Our data, coherently with the literature, confirms that SADI-S and SADI-GSP are safe and effective procedures with acceptable complications rate. The hypoproteinemia rate was related to lack of data about gastric sleeve capacity and common loop length. Currently, 3.5 m is the adopted length at our institution with wide sleeve gastrectomy. More data is needed to draw definitive conclusions.