Single Anastomosis Duodenal Switch: 1-Year Outcomes

Category	Detail
Condition	Class II and III obesity with obesity-related comorbidities
Key Mechanisms	Combination of calibrated vertical sleeve gastrectomy with a single duodeno-ileostomy anastomosis 300 cm from ileocecal valve to optimize weight loss and minimize malnutrition
Target Population	Adults aged 18–65 with BMI 35–40 kg/m2 plus one comorbidity or BMI 40–60 kg/m2, no prior bariatric surgery
Care Setting	Multicenter surgical centers with postoperative nutritional and clinical follow-up

SADS offers superior weight loss and diabetes resolution compared to RYGB and VSG at 1 year
Nutritional supplementation protocol includes multivitamins, calcium citrate, iron, and protein intake to mitigate malnutrition risks
Comorbidities such as type 2 diabetes, hypertension, sleep apnea, and hyperlipidemia were assessed for resolution postoperatively

Inclusion criteria: BMI 35–40 kg/m2 with comorbidity or BMI 40–60 kg/m2
Exclude pregnant or breastfeeding women, vulnerable populations, prior bariatric surgery, life expectancy <6 months

Perform laparoscopic single-anastomosis duodenal switch with sleeve gastrectomy over 40–46 French sizing tube
Transect proximal duodenum 3 cm distal to pylorus and create duodeno-ileostomy 300 cm from ileocecal valve
Postoperative liquid diet for 1 month followed by supplementation with ADEK multivitamins, calcium citrate 1800–2400 mg/day, iron 65 mg/day, and protein 60–80 g/day

Assess weight loss via % excess weight loss, % total weight loss, and BMI at baseline and 1 year
Monitor vitamin levels (A, B1, B12, D, folic acid), minerals (iron, copper, zinc, calcium), and metabolic labs preoperatively and at 1, 6, and 12 months
Evaluate comorbidity resolution using standardized criteria for diabetes, hypertension, sleep apnea, and lipid profiles
Use SF-36 and GERD-HRQL questionnaires preoperatively and at 6 and 12 months to assess quality of life

Potential for protein calorie malnutrition despite supplementation
Surgical risks including anastomotic complications; Petersen’s defect not closed in this procedure
Need for close nutritional and clinical follow-up to detect and manage deficiencies or adverse events

Adults with class II/III obesity undergoing SADS surgery

Standardized postoperative supplementation and dietary protocols are critical to minimize nutritional deficiencies and optimize outcomes

Strict adherence to patient selection criteria to optimize safety and efficacy
Standardized surgical technique with hand-sewn duodeno-ileostomy anastomosis
Comprehensive multidisciplinary follow-up including nutritional, metabolic, and quality of life assessments
Routine use of validated questionnaires (SF-36, GERD-HRQL) to monitor patient-reported outcomes
Proactive supplementation with multivitamins, calcium, iron, and protein to prevent deficiencies

Clinical Scorecard: Outcomes After One Year of Single Anastomosis Duodenal Switch Surgery