Comparative Study of SADI-S and OAGB-MGB as Revisional Surgeries Post-Sleeve Gastrectomy

Overview

This study compares the efficacy and outcomes of Single Anastomosis Duodeno-ileostomy (SADI-S) and One Anastomosis Gastric Bypass (OAGB-MGB) as revisional procedures for patients experiencing weight regain after laparoscopic sleeve gastrectomy (LSG). Both procedures demonstrated significant weight loss and improvement in metabolic parameters over a minimum 1-year follow-up.

Background

Bariatric surgery is the primary treatment for obesity and related comorbidities, but weight regain after laparoscopic sleeve gastrectomy (LSG) is common, especially in patients with higher baseline BMI. Revisional bariatric surgeries such as SADI-S and OAGB-MGB are increasingly performed to address weight recidivism. SADI-S is a technically simpler alternative to the classic duodenal switch with promising weight loss outcomes, while OAGB-MGB is recognized for its long-term efficacy and tolerability. Comparative data between these two revisional procedures remain limited.

Data Highlights

The study included patients undergoing SADI-S or OAGB-MGB as revisional surgeries post-LSG with at least 1 year follow-up. Weight loss was assessed by BMI, excess weight loss percentage (EWL%), and total weight loss percentage (TWL%). Secondary outcomes included remission rates of type 2 diabetes and hypertension, GERD symptom resolution, blood marker changes, and postoperative complications.

Key Findings

• Both SADI-S and OAGB-MGB resulted in significant weight loss at 1-year follow-up, measured by BMI reduction, EWL%, and TWL%.
• SADI-S showed comparable efficacy to OAGB-MGB in terms of excess weight loss and total weight loss percentages.
• Remission of type 2 diabetes and hypertension was observed in both groups, with defined criteria for remission based on A1C, glucose levels, and blood pressure.
• GERD symptoms improved or resolved in many patients postoperatively, assessed by symptom scores and medication use.
• Postoperative complications were monitored, including bleeding, anastomotic leaks, ulcers, and nutritional deficiencies, with no routine use of drains in either procedure.
• Both procedures required similar postoperative management including liquid diet, proton pump inhibitors, and multivitamin supplementation.

Clinical Implications

SADI-S and OAGB-MGB are effective revisional bariatric surgeries for patients with weight regain after LSG, offering significant weight loss and metabolic improvements. Clinicians should consider patient-specific factors and surgical expertise when selecting the revisional procedure. Routine postoperative monitoring for nutritional deficiencies and GERD symptoms is essential to optimize outcomes.

Conclusion

SADI-S and OAGB-MGB are both viable and effective revisional surgical options for managing weight regain after sleeve gastrectomy, demonstrating favorable short-to-medium term weight loss and metabolic outcomes. Further studies with longer follow-up are warranted to confirm durability and safety.

References

1. Various Authors/Multiple Years -- Bariatric Surgery and Revisional Procedures