Clinical Scorecard: Comparative Outcomes of One-Anastomosis Gastric Bypass (OAGB) and Single Anastomosis Duodeno-Ileal Bypass (SADI) as Revisional Surgeries After Sleeve Gastrectomy: Findings from a Multicenter Analysis

At a Glance

Key Highlights

• Sleeve Gastrectomy is the most common bariatric procedure but 15-50% of patients may experience weight regain or suboptimal response long term.
• OAGB and SADI are feasible revisional options after SG, with OAGB offering good weight loss but risks of bile reflux and ulcers, and SADI being simpler with potentially fewer complications.
• This multicenter retrospective study compares perioperative and postoperative outcomes, complications, and weight loss efficacy between OAGB and SADI after SG.

Guideline-Based Recommendations

Diagnosis

• Perform esophagogastroduodenoscopy prior to revisional surgery.
• Use 24-h pH-metry if GERD is suspected.
• Define recurrence of weight (RoW) as ≥50% weight regain from nadir post-SG weight.
• Define suboptimal clinical response (SCR) as %EWL < 50% at nadir weight.

Management

• Consider OAGB or SADI as revisional procedures after SG based on patient factors and surgeon preference.
• Select surgical approach considering limb lengths: SADI common channel ~300 cm; OAGB biliopancreatic limb 150-250 cm.
• Follow national bariatric surgery guidelines (e.g., SICOb) for patient selection and surgical planning.

Monitoring & Follow-up

• Conduct multidisciplinary outpatient follow-up at 30 days, 3, 6, 12, and 24 months post-revisional surgery.
• Monitor weight loss using %EWL and %TWL metrics.
• Assess for early and mid-term complications up to 2 years post-surgery.

Risks

• OAGB may be associated with bile reflux (7.8-55.5%) and anastomotic ulcers (0.47-7.35%).
• BPD/DS carries higher risk of long-term nutritional deficiencies compared to simpler revisional procedures.
• SADI may reduce operative time and surgical complications compared to BPD/DS.

Patient & Prescribing Data

Patients undergoing revisional bariatric surgery after Sleeve Gastrectomy with weight regain or suboptimal weight loss

Both OAGB and SADI provide effective weight loss and metabolic improvements; choice depends on surgical preference and patient-specific factors.

Clinical Best Practices

• Use propensity score matching to compare outcomes between revisional procedures in observational studies.
• Adhere to ethical standards and obtain institutional review board approval for clinical research.
• Employ standardized definitions for weight regain and suboptimal response to guide revisional surgery decisions.
• Ensure multidisciplinary follow-up for comprehensive postoperative care and monitoring.

References

• Italian Society of Bariatric Surgery and Metabolic Disorders (SICOb) Guidelines