Conversion for Severe Malnutrition After Single Anastomosis Duodeno-Ileostomy with Sleeve Gastrectomy (SADI-S) to Duodenojejunal Bypass (DJB): a Case Series and Literature Review

Single Anastomosis Duodeno-ileostomy with Sleeve Gastrectomy (SADI-S) is an emerging bariatric procedure that can sometimes lead to severe malnutrition. This report describes two cases of conversion surgery for post-SADI-S malnutrition and reviews management strategies. Both patients, who had undergone sleeve gastrectomy followed by SADI-S for weight recurrence, developed severe protein-energy malnutrition with hypoalbuminemia (1.6-1.8 g/dL) requiring parenteral nutrition, which normalized following conversion surgery. They underwent laparoscopic conversion to Roux-en-Y duodenojejunal bypass with common channel lengthening (Case 1: 200→550 cm, Case 2: 250→750 cm). Postoperatively, both recovered without needing parenteral support. Our technique provides significant clinical advantages through reduced operative complexity and avoidance of challenging duodenal stump management while achieving excellent nutritional outcomes. While this demonstrates the potential of surgical intervention in managing severe post-SADI-S malnutrition, the current absence of standardized protocols for post-SADI-S conversional surgery underscores the clear necessity for evidence-based treatment algorithms through multicenter research.