Clinical Scorecard: Evaluation of Mid-term Results from Two Bariatric Surgical Approaches for Obesity Management Using Propensity Score Matching

At a Glance

Key Highlights

• Sleeve gastrectomy (SG) is the most common bariatric surgery in China due to simplicity and lower complication rates.
• Single anastomotic duodeno-ileal bypass with sleeve gastrectomy (SADI-S) shows higher efficacy but limited by complex anatomy and malnutrition risks.
• Propensity score matching was used to balance baseline characteristics for a credible comparison of mid-term outcomes between SG and SADI-S.

Guideline-Based Recommendations

Diagnosis

• Obesity diagnosis and surgical indications should follow ASMBS and IFSO 2022 guidelines.
• T2DM diagnosis: FPG ≥ 7.0 mmol/L or HbA1c ≥ 6.5%.
• Hypertension diagnosis: BP ≥ 140/90 mmHg without medication, graded by severity.
• Hyperuricemia diagnosis: serum uric acid > 416.36 µmol/L (men) or > 356.88 µmol/L (women).
• Dyslipidemia diagnosis: lipid abnormalities per defined thresholds or lipid-lowering therapy use.

Management

• SG involves gastric sleeve resection guided by a 34F Bougie tube.
• SADI-S includes sleeve gastrectomy plus duodeno-ileal bypass with anastomosis at 300 cm from ileum.
• Surgical choice should consider BMI, metabolic comorbidities, and patient preference.
• Postoperative nutritional and lifestyle adherence is critical for successful outcomes.

Monitoring & Follow-up

• Regular follow-up to assess weight, BMI, waist circumference, %EWL, %TWL.
• Monitor metabolic parameters: HbA1c, FPG, blood pressure, serum uric acid, lipid profile.
• Evaluate remission or alleviation of diabetes, hypertension, hyperuricemia, dyslipidemia, and NAFLD.
• Annual assessment of adherence to dietary and lifestyle modifications over 3 years.

Risks

• SADI-S carries higher risk of postoperative malnutrition due to complex duodenal anatomy.
• Non-adherence to postoperative recommendations increases risk of suboptimal outcomes.
• Potential postoperative complications require monitoring and management.

Patient & Prescribing Data

Patients with obesity undergoing SG or SADI-S surgery at a tertiary hospital in China

SADI-S is typically recommended for patients with higher BMI and more severe metabolic comorbidities; SG is more commonly performed due to lower complexity and complication rates.

Clinical Best Practices

• Use propensity score matching to balance baseline characteristics when comparing surgical outcomes.
• Ensure strict adherence to postoperative nutritional and lifestyle modifications to optimize results.
• Select surgical procedure based on individual patient metabolic profile and surgical risk.
• Monitor metabolic disease remission using standardized diagnostic criteria.
• Adjust surgical techniques (e.g., Bougie size) based on follow-up outcomes to improve patient safety.

References

• Obesity prevalence in Chinese adults
• Metabolic surgery reduces mortality in obesity-related diseases
• Bariatric surgery statistics in China 2023
• Efficacy of SADI-S procedure
• ASMBS and IFSO 2022 surgical guidelines
• T2D diagnostic criteria
• Hyperuricemia diagnostic criteria