Mid-term Outcomes of SADI-S Versus Sleeve Gastrectomy in Obesity Management

Overview

This retrospective study compared mid-term outcomes of single anastomotic duodeno-ileal bypass with sleeve gastrectomy (SADI-S) and sleeve gastrectomy (SG) in obese patients using propensity score matching. Results demonstrated that SADI-S achieved superior weight loss and metabolic disease remission but carried higher risks of postoperative malnutrition compared to SG.

Background

Obesity prevalence in China exceeds 50% among adults, contributing to increased rates of diabetes, cardiovascular disease, and nonalcoholic fatty liver disease. Metabolic surgery, particularly sleeve gastrectomy (SG), is widely used due to its safety and efficacy. Single anastomotic duodeno-ileal bypass with sleeve gastrectomy (SADI-S) offers enhanced metabolic benefits but is less commonly performed due to technical complexity and nutritional concerns. Comparative medium-term data between these procedures remain limited, especially in Asian populations.

Data Highlights

Key Findings

• SADI-S patients had higher baseline BMI and more severe metabolic comorbidities prior to matching.
• After propensity score matching, SADI-S resulted in significantly greater percent excess weight loss (%EWL) and total weight loss (%TWL) compared to SG.
• SADI-S showed superior remission rates of type 2 diabetes, hypertension, hyperuricemia, dyslipidemia, and nonalcoholic fatty liver disease relative to SG.
• Postoperative complications related to malnutrition were more frequent in the SADI-S group, necessitating careful nutritional monitoring.
• SG remains the predominant procedure in China due to its technical simplicity and lower complication rates.

Clinical Implications

Clinicians should consider SADI-S for patients with higher BMI and severe metabolic syndrome due to its enhanced efficacy in weight loss and metabolic remission. However, the increased risk of postoperative malnutrition requires rigorous nutritional follow-up and patient adherence to dietary recommendations. SG remains a safe and effective option for a broader patient population with fewer nutritional concerns.

Conclusion

SADI-S offers superior mid-term metabolic and weight loss outcomes compared to SG but at the cost of increased nutritional risks. Personalized surgical selection and comprehensive postoperative care are essential to optimize patient outcomes in obesity management.

References

1. Chinese Obesity Prevalence Data 2023
2. ASMBS and IFSO 2022 Guidelines
3. China Bariatric Surgery Annual Report 2023
4. SADI-S Efficacy Studies 2019-2022
5. T2D Diagnostic Criteria 2023
6. Hyperuricemia Diagnostic Criteria 2023