IBC Oxford University Oral Abstract 10 - Single anastomosis duodeno-ileal bypass: single centre 2-year outcomes

Abstract Introduction Single-Anastomosis Duodeno-Ileal bypass (SADI) with Sleeve Gastrectomy (SADI-S) is an emerging tool in the treatment of morbid obesity. We report our experience, outcomes and challenges in our first 2 years of SADI in order to evaluate the safety, efficacy and applicability of this operation. Methods Cases were performed at a single institution in San Diego California, with SADI and SADI-S. Body composition and metabolic parameters were measured before and after surgery. Resolution or improvement of obesity-related comorbidities was documented. Our indication for SADI was a BMI > 50 kg/m2 or recurrent morbid obesity following previous sleeve gastrectomy. With more experience, the operation was offered to patients with a BMI > 40 and poorly controlled diabetes (A1c of >9).Our technique utilizes a 300 cm common channel, sleeve gastrectomy over a 42 Fr bougie, dividing the duodenum 3–5 cm distal to the pylorus finishing with a hand sewn duodeno-intestinal anastomosis. Patients who were at risk of poor nutritional compliance or smoking were offered a staged approach with a sleeve followed by a SADI, while most had the surgery completed in one stage. A history of prior open cholecystectomy or right hemicolectomy was also a relative indication for a two-stage operation. Results There were 177 operations. Approaches were robotic (74/177) and laparoscopic (103/177) with no conversions to open. Single stage SADI was performed in 139 of 177 cases, the remaining 38 performed in a two-stage fashion (SADI-S). Median operative time was 118 minutes. Median blood loss was 5 ml. Median length of stay was 1 day. There were 10 Clavien-dindo classification >III complications in 10 patients. This included a common bile duct injury that was recognized intraoperatively, repaired over a T Tube with no long term sequalae. All ten patients recovered fully at final follow up. There were no mortalities.With median follow up of 174 days (range 7–727), median body mass index lost was 12.2 kg/m2. Resolution of Diabetes Mellitus II, Hypertension and Hyperlipidemia were 81%, 71% and 57% respectively. Insulin was stopped in 64% of patients who required it pre-surgery. Eleven patients were followed beyond 18 months; with median weight loss of 122 lbs, median BMI lost was 21 kg/m2. Discussion SADI and SADI-S was safely incorporated into a multi-disciplinary bariatric surgical setting. Operative times were efficient, blood loss & complications minimal, and post-operative course expeditious. Rates of metabolic comorbidity resolution were underestimated due to co-management by primary care physicians outside of our system. Nonetheless, there was excellent resolution of metabolic illness, particularly diabetes mellitus. Sarcopenia was uncommon SADI has the potential of superior resolution of co morbidities than sleeve or bypass, avoidance of the nutritional deficiencies associated with the duodenal switch and a lower likelihood of dumping, anastomotic stricture and internal herniation than gastric bypass. As the burden of metabolic diseases continues to worsen worldwide, this option needs to be further evaluated for mainstream adoption.