Robotic single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S): adverse outcomes compared to gastric sleeve and Roux-en-Y gastric bypass from a high-volume bariatric center

Aim: The single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) is the most recent procedure to be endorsed by the American Society for Metabolic and Bariatric Surgery. It is gaining popularity due to its combined restrictive and malabsorptive properties, and a single anastomosis may theoretically decrease operative time and risk of enteric leak compared to alternative options such as the biliopancreatic diversion duodenal switch or Roux-en-Y gastric bypass (RNY). However, because SADI-S has only recently been adopted, outcomes data remain limited. Here, we present our single-center adverse outcome data after incorporating the SADI-S into our bariatric practice to compare its safety profile with that of other common bariatric procedures. Methods: We retrospectively analyzed the data of patients who underwent robotic-assisted laparoscopic SADI-S, vertical sleeve gastrectomy (VSG), or RNY at Saint Joseph Hospital in Denver, Colorado. Postoperative adverse events after SADI-S were compared to those following VSG and RNY, respectively. We evaluated complications occurring within a 30-day follow-up period, including superficial surgical site infection (SSI), organ space infection, deep vein thrombosis (DVT), gastrointestinal bleeding, and anastomotic staple line leak. Additionally, we assessed rates of readmission, reoperation, or any procedural intervention within 30 days postoperatively. Length of hospital stay and operative time were also compared as indirect indicators of cost and procedural efficiency. Results: In this retrospective data review from January 2023 to August 2024, 35 patients underwent SADI-S, 592 patients underwent VSG, and 200 patients underwent RNY. Compared to VSG, SADI-S demonstrated no significant difference in adverse outcomes with respect to SSI, DVT, gastrointestinal bleeding, readmission, reoperation, and interventions within 30 days. Length of stay was also similar. Compared to RNY, SADI-S also demonstrated no significant differences in adverse outcomes or length of hospital stay. Additionally, there was no significant difference in operative time. (P < 0.05). Conclusion: When compared individually to VSG and RNY, SADI-S was not associated with a higher incidence of early postoperative complications, including SSI, DVT, gastrointestinal bleeding, readmission, reoperation, or need for additional interventions within 30 days, nor with prolonged hospital stay. These findings support the safe implementation of SADI-S in a high-volume bariatric practice without an increased risk of early adverse outcomes.