Physiological Impact of Right Gastric Artery Ligation During SADI-S: A Prospective Randomized Exploratory Study

INTRODUCTION: Single-anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) was developed as a simplified alternative to biliopancreatic diversion with duodenal switch but remains technically demanding. Ligation of the right gastric artery (RGA) may facilitate duodenal mobilization and reduce anastomotic tension; however, concerns persist regarding anastomotic perfusion and vagal fiber disruption. This study aimed to assess the safety and physiological effects of RGA ligation, including its potential impact on vagal function, using pancreatic polypeptide (PP) as an indirect marker, as well as gastric and gallbladder emptying. METHODS: In this prospective double-blind randomized exploratory trial conducted at a single public bariatric center, patients undergoing SADI-S were randomized to RGA ligation (n = 10) or no ligation (n = 9). Participants underwent clinical evaluation, liquid mixed-meal tolerance tests to assess glucose and PP dynamics, gastric emptying scintigraphy, and hepatobiliary scintigraphy before and 12 months after surgery. RESULTS: Clinical outcomes were comparable between groups, with no differences in postoperative morbidity or mortality. After surgery, both groups exhibited similar rates of symptoms consistent with dumping syndrome during the mixed meal test, along with reduced PP secretion. No correlation was observed between dumping symptoms and PP levels. Gastric emptying and hepatobiliary scintigraphy revealed no significant differences between groups before or after surgery. No symptoms suggestive of biliary reflux were reported. CONCLUSION: In this prospective randomized study, no significant differences were observed between groups across the evaluated outcomes. RGA ligation was not associated with adverse clinical or physiological effects compared to no ligation within the limitations of this cohort. However, the small sample size limits statistical power and the ability to exclude clinically meaningful differences; therefore, these findings should be considered exploratory and require confirmation in larger studies.