SADI-S: personal experience after 8 years

Aim: Biliopancreatic diversion with duodenal switch (BPD-DS) was simplified by the single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). It reduces the surgical duration and postoperative complications while maintaining effectiveness in weight loss and mitigating comorbidities. Methods: This study aims to report personal experiences regarding short- and medium-term outcomes 8 years after the introduction of SADI-S in clinical practice and compare these with the current literature evidence. Results: At our center, 4,854 bariatric procedures were executed from July 2016 to October 2024, with 157 (3.2%) patients undergoing SADI-S/SADI. This included 104 (66.2%) primary SADI-Ss, 8 (5.1%) conversions to SADI-S, and 45 (28.7%) SADI procedures. Conversion to SADI-S was planned in eight out of 157 after adjustable gastric banding (6 cases) and Roux-en-Y gastric bypass (2 cases). Median age and preoperative body mass index (BMI) were 46 (40-53) years and 51.6 (46.7-56.7) kg/m<sup>2</sup>, respectively. The median surgical duration was 120 min, with an interquartile range of 100 to 160 min. Reoperation was required for two of the four patients (2.5%) who experienced early postoperative complications. Furthermore, 5 (3.1%) patients developed late complications. At a median follow-up of 23 (12-31) months, the median %TWL, %EWL, and BMI were 42 (29.3-52.4), 82 (59.1-99.4), and 27.3 (21.2-33) kg/m<sup>2</sup>, respectively. Seven years of follow-up were eligible in 13 out of 157 patients: median %TWL, %EWL and BMI were 43 (40.1-52.7), 69 (66.4-85.6), and 31.1 (26.2-32.2) kg/m<sup>2</sup>, respectively. Conclusion: SADI-S is regarded as an effective primary and conversion operation, balancing bariatric and metabolic outcomes with early and late complications.