Original articleThe incidence of complications associated with loop duodeno-ileostomy after single-anastomosis duodenal switch procedures among 1328 patients: a multicenter experience
Section snippets
Methods
The medical records of 1328 patients who had undergone primary SADS procedure by 17 surgeons at 9 centers over a 6-year period were retrospectively reviewed from each institution’s prospectively collected database. The centers are as follows: center 1—Bariatric Medicine Institute in the United States, performed by DC; center 2—Hospital Clínico San Carlos in Spain, performed by ASP and A. Torres; center 3—Roller Weight Loss & Advanced Surgery in the United States, performed by JR, YK, and JM;
Results
For analysis, 1328 patients were identified from 2010 to 2017. This equated to 2064 patient-years. The mean preoperative body mass index and weight were 51.6 kg/m2 and 146.5 kg, respectively. The preoperative characteristics can be seen in Table 1. Anastomotic leak, ulcer, stricture at the DI, and bile reflux occurred in .6%, .1%, .3%, and .1% patients, respectively. None of our patients experienced volvulus at the DI or internal hernia (Table 2). The comparison of the incidence rate of
Discussion
The single-anastomosis techniques have flourished in many places around the world over the past decade [14]. There are certain advantages and disadvantages of SADS over RYGB [6]. The benefits of post-pyloric reconstruction in SADS procedures over prepyloric reconstruction in RYGB include a reduction in marginal ulcers, dumping syndrome, strictures, and internal hernias [15], [16]. In this study, we have reported the incidence of complications associated with loop DI after SADS and have also
Conclusions
The overall incidence of complications associated with loop DI was lower than the reported incidence of anastomotic complications after RYGB and BPD-DS. This paper suggests that practitioners who perform SADS may experience fewer small bowel complications than those who use Roux techniques.
Additionally, in our limited experience, using a linear stapled technique has resulted in differing rates of DI stricture. This is not to say that intuitions might develop expertise in the stapled approach
Disclosures
DC is the corresponding author reports personal fees and other from Medtronic, outside the submitted work. PE reports personal fees and other from Medtronic and Intuitive. JB reports personal fees and other from J&J and Endo 360. MR reports personal fees and others from Medtronic and J &J. All other authors have no conflicts of interest to declare.
References (66)
- et al.
Comparative analysis of the single anastomosis duodenal switch 300 cm common channel to established bariatric procedures: an assessment of one year postoperative data illustrating weight loss, risk profile, and nutritional status
Surg Obes Relat Dis
(2016) - et al.
A step-by-step surgical technique video with two reported cases of common channel lengthening in patients with previous stomach intestinal pylorus sparing surgery to treat chronic diarrhea
Surg Obes Relat Dis
(2017) - et al.
Radiographic manifestations of normal postoperative anatomy and gastrointestinal complications of bariatric surgery, with emphasis on CT imaging findings
Semin Ultrasound CT MR
(2004) - et al.
Radiologic evaluation following Roux–en–Y gastric bypass surgery for morbid obesity
Eur J Radiol
(2005) - et al.
Is biliopancreatic diversion with duodenal switch indicated for patients with body mass index<50 kg/m2?
Surg Obes Relat Dis
(2010) - et al.
Roux-en-Y divided gastric bypass results in the same weight loss as duodenal switch for morbid obesity
Am J Surg
(2004) - et al.
Roux-en-Y gastric bypass: hyperamylasemia is associated with small bowel obstruction
Surg Obes Relat Dis
(2015) - et al.
Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up
Surg Obes Relat Dis
(2011) - et al.
Perioperative complications in a consecutive series of 1000 duodenal switches
Surg Obes Relat Dis
(2013) - et al.
Long-term outcomes after biliopancreatic diversion with and without duodenal switch: 2-, 5-, and 10-year data
Surg Obes Relat Dis
(2016)
Ulcer disease after gastric bypass surgery
Surg Obes Relat Dis
Stomal ulcer after gastric bypass
J Am Coll Surg
Bile reflux after Roux-en-Y gastric bypass: an unrecognized cause of postoperative pain
Surg Obes Relat Dis
Retrograde filling of the afferent limb as a cause of chronic nausea after single anastomosis loop duodenal switch
Surg Obes Relat Dis
Single-anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) for obese diabetic patients
Surg Obes Relat Dis
The single anastomosis duodenal switch modifications: a review of the current literature on outcomes
Sug Obes Relat Dis
Proximal duodeno-ileal end-to-side bypass with sleeve gastrectomy: proposed technique
Obes Surg
Novel metabolic surgery for type II diabetes mellitus: loop duodenojejunal bypass with sleeve gastrectomy
Surg Laparosc Endosc Percutan Tech
Laparoscopic single-anastomosis duodenal-jejunal bypass with sleeve gastrectomy (SADJB-SG): short-term result and comparison with gastric bypass
Obes Surg
Single anatomosis duodeno-ileal bypass with sleeve gastectomy. One to three-year follow-up
Obes Surg
A matched cohort analysis of single anastomosis loop duodenal switch versus Roux-en-Y gastric bypass with 18-month follow-up
Surg Endosc
Stomach Intestinal Pylorus Sparing (SIPS) surgery for morbid obesity: retrospective analyses of our preliminary experience
Obes Surg
Managing complications associated with laparoscopic Roux-en-Y gastric bypass for morbid obesity
Can J Surg
Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings
Radiology
Gastrojejunal anastomosis complications and their management after laparoscopic Roux-en-Y gastric bypass
J Obes
Early surgical complications after gastric by-pass: a literature review
Arq Bras Cir Dig
Late surgical complications after gastric by-pass: a literature review
Arq Bras Cir Dig
Exploring the role of single anastomosis bariatric surgery
Bariatric Times
Pylorus preserving loop duodeno-enterostomy with sleeve gastrectomy—preliminary results
BMC Surg
Biliopancreatic diversion with a duodenal switch
Obes Surg
Anastomotic leaks after laparoscopic gastric bypass
Obes Surg
Management of anastomotic leaks after laparoscopic Roux-en-Y gastric bypass
Obes Surg
Experience with over 3,000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality
Surg Endosc
Cited by (62)
Loop versus Roux-en-Y duodenojejunal bypass with sleeve gastrectomy for type 2 diabetes: short-term outcomes of a single-center randomized controlled trial
2022, Surgery for Obesity and Related DiseasesBile reflux after one anastomosis gastric bypass surgery: A review study
2021, Annals of Medicine and SurgeryCitation Excerpt :Finally, considering available data, bile reflux incidence after OAGB operation varies from 7.8 to 55.5%. This relatively wide span of postoperative bile reflux after OAGB may due to different reasons including sample size, subjects’ demographic characteristics, preoperative BMI, applying surgical technique, size of gastric pouch, diameter of anastomosis site, length of biliopancreatic limb, time of surgery, time of follow up and condition of other concurrent metabolic disorders at the time of surgery [23–38]. Hence, it is highly recommended to design studies with greater sample size and more isolated consideration specifically for surgical technique characteristics to have more precise decision while bile reflux after OAGB is considered.
Single-Anastomosis Duodenal Ileostomy with Sleeve Gastrectomy “Continued Innovation of the Duodenal Switch”
2021, Surgical Clinics of North AmericaSingle Anastomosis Duodenoileostomy with Sleeve: A Comprehensive Review of Anatomy, Surgical Technique, and Outcomes
2024, Current Obesity Reports