Comparison of two revisional procedures after failed sleeve gastrectomy: SADI versus RYGB

Sleeve gastrectomy (SG) is the most performed bariatric procedure to induce weight loss worldwide. However, a significant part of the patients experiences inadequate weight loss or even weight regain after a few years. For those patients, revisional surgery is advised. However, comparative research on which revisional bariatric procedure to perform had not been done prior to this study. Two available options include single anastomosis duodenoileal (SADI) bypass and the Roux-en-Y gastric bypass (RYGB).

Revisional surgery: SADI versus RYGB

In a retrospective cohort study, the effectiveness of SADI versus RYGB as a revisional surgery was assessed. Health outcomes of 140 morbidly obese SG patients were collected, with up to 2 years of follow-up. Patients had revisional surgery because of insufficient weight loss or SG-related functional problems. WLS Forte (RYGB patients) or WLS Maximum (SADI patients) was advised to all patients after their revisional operation.

Effectiveness in weight loss

Patients after a revisional SADI operation achieved significantly more total body weight loss during the 2-year follow-up period compared to RYGB. Complication rates and nutritional deficiencies were similar for both groups. Although tailored supplements were advised to all patients, deficiencies were found in 64% of all SADI patients, and 62% of all RYGB patients. Since this specific bariatric group is known to have very low compliance, this is likely to relate to the high deficiency rate.

Average percentage total body weight loss (TBWL) after SG and revision to SADI or RYGB.

Weight loss efficacy graph

RYGB solves functional complications

Revisional surgery following SG into RYGB or SADI both have similar risks for complications and nutritional deficiencies. Looking into functional problems after SG, conversion into RYGB shows lower complaints almost directly after surgery, and would therefore be recommended as revisional surgery when functional problems are the main indication.

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Dijkhorst, P.J., Boerboom, A.B., Janssen, I.M.C. et al. Failed Sleeve Gastrectomy: Single Anastomosis Duodenoileal Bypass or Roux-en-Y Gastric Bypass? A Multicenter Cohort Study. OBES SURG 28, 3834–3842 (2018).

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