Long-term Outcomes of RYGB vs SADI-S as Revision Surgeries After Sleeve Gastrectomy

Overview

This retrospective cohort study compared 7-year outcomes of Roux-en-Y gastric bypass (RYGB) and single-anastomosis duodeno-ileal bypass (SADI-S) as revisional surgeries for weight regain after sleeve gastrectomy. Both procedures demonstrated sustained weight loss, but differed in reflux symptom control and nutritional safety profiles.

Background

Obesity is a chronic disease with significant health and economic burdens. Sleeve gastrectomy (SG) is the most common primary bariatric surgery but often requires revision due to inadequate weight loss or weight regain. Roux-en-Y gastric bypass (RYGB) is the standard revisional surgery, especially for patients with severe gastroesophageal reflux disease (GERD), while single-anastomosis duodeno-ileal bypass (SADI-S) has emerged as an alternative with strong metabolic effects. Long-term comparative data beyond five years are limited, necessitating studies to guide individualized revisional procedure selection.

Data Highlights

Key Findings

• Both RYGB and SADI-S provided durable weight loss up to 7 years post-revision, with SADI-S showing slightly greater %TWL and %EWL.
• RYGB was more effective in managing severe GERD symptoms following sleeve gastrectomy.
• SADI-S was associated with higher rates of micronutrient deficiencies, particularly vitamin D and B12, raising concerns about long-term nutritional safety.
• Operative times were longer for SADI-S compared to RYGB, though hospital stays were comparable.
• Complication profiles differed, with RYGB patients experiencing fewer nutritional complications but more marginal ulcers, while SADI-S patients had increased risk of malnutrition.

Clinical Implications

When selecting revisional surgery after sleeve gastrectomy failure, clinicians should consider patient-specific factors such as predominant symptoms and nutritional risk. RYGB remains preferable for patients with severe GERD due to superior reflux control, whereas SADI-S may be favored for patients prioritizing maximal weight loss but requires vigilant long-term nutritional monitoring. Individualized counseling and follow-up are essential to balance efficacy and safety.

Conclusion

Both RYGB and SADI-S are effective revisional procedures after sleeve gastrectomy with distinct advantages and limitations. Long-term data support tailored surgical choices based on weight loss goals, reflux symptoms, and nutritional considerations to optimize patient outcomes.

References

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2. Peterli et al. 2017 -- Sleeve Gastrectomy Versus Roux-en-Y Gastric Bypass
3. Felsenreich et al. 2017 -- Revisional Bariatric Surgery After Sleeve Gastrectomy
4. Chahal-Kummen et al. 2019 -- Gastroesophageal Reflux Disease After Sleeve Gastrectomy
5. Himpens et al. 2015 -- Weight Regain After Sleeve Gastrectomy
6. Mahawar et al. 2020 -- Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy
7. Brethauer et al. 2019 -- Revisional Bariatric Surgery: Indications and Outcomes
8. Gagner et al. 2018 -- Revisional Surgery for Weight Regain
9. Kular et al. 2021 -- Nutritional Safety of SADI-S Versus RYGB
10. ASMBS 2015 -- Bariatric Surgery Guidelines
11. Mechanick et al. 2013 -- Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient