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Single Anastomosis Duodenal Switch versus Classic Duodenal Switch: Long-term Outcomes from a Prospective Comparative Cohort Study

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Abstract

Purpose

The literature on long-term outcomes of duodenal switch (DS) compared to single anastomosis duodenal switch (SADI-S) procedures is lacking. We evaluated the long-term outcomes of SADI-S compared to those after the classic DS procedure.

Methods

This is a follow-up report from a single-institution prospective cohort study comparing long-term outcomes of SADI-S versus DS both as one- and two-stage procedures (ClinicalTrials.gov: NCT02792166). Data is depicted as count (percentage) or median (interquartile range).

Results

Forty-two patients underwent SADI-S, of whom 11 had it as a second-stage procedure (26%). Of 20 patients who underwent DS, twelve had it as a second-stage procedure (60%). Both groups were similar at baseline. Median follow-up times for one-stage SADI-S and DS were 57 (24) and 57 (9) months, respectively (p = 0.93). Similar BMI reductions were observed after one-stage SADI-S (16.5 kg/m2 [8.5]) and DS (18.9 kg/m2 [7.2]; p = 0.42). At median follow-up of 51 (21) and 60 (15) months after second-stage SADI-S and DS, respectively (p = 0.60), surgical procedures yielded reductions in BMI of 20.5 kg/m2 (14.0) and 24.0 kg/m2 (13.9), respectively (p = 0.52). Follow-up rates were similar for one-stage (≥ 88%; p = 0.29) and second-stage procedures (≥ 83%; p = 0.16). Similar diabetes and hypertension remissions were found (p = 0.77; P = 0.54, respectively). Despite fat-soluble vitamin deficiencies at baseline, after supplementation, they were either eliminated or less prevalent long-term after SADI-S. Daily bowel movements were also less frequent.

Conclusions

Long-term weight and comorbidity outcomes after SADI-S are similar to those of DS both as one- and two-stage surgeries. SADI-S procedure may allow for similar beneficial outcomes with less burden from gastrointestinal symptoms and fat-soluble vitamin deficiencies.

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Funding

This work was supported by an unrestricted institutional award named Herbert S Lang Award in Oncology and Surgery provided to the corresponding author from the Research Institute of McGill University Health Center. The funding entity had no role in the design of the study, data collection, analysis, or interpretation of the results, writing of the manuscript or the decision to submit the manuscript for publication.

Author information

Author notes

  1. Amin Andalib, Ali Safar, Philippe Bouchard, Sebastian Demyttenaere and Olivier Court have contributed equally to this work.

Authors and Affiliations

  1. Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, QC, Canada

    Amin Andalib, Ali Safar, Philippe Bouchard, Sebastian Demyttenaere & Olivier Court

  2. McGill University Health Center, Montreal General Hospital, 1650 Cedar Avenue, Room: E16-165A, Montreal, QC, H3G 1A4, Canada

    Amin Andalib

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Correspondence to Amin Andalib.

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Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. In addition, the study was approved by the institutional Research Ethics Board.

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Informed consent was obtained from all individual participants included in the study.

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Key Points.

• At long-term follow-up, SADI-S (as either one- or two-stage procedure) is equally effective for weight loss as compared to classic DS.

• At long-term follow-up, SADI-S showed comparable resolution of weight-related comorbidities (especially for T2D) as compared to classic DS.

• SADI-S demonstrated fewer nutritional deficiencies (especially fat-soluble vitamins) and GI symptoms (daily bowel movements) as compared to classic DS.

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Andalib, A., Safar, A., Bouchard, P. et al. Single Anastomosis Duodenal Switch versus Classic Duodenal Switch: Long-term Outcomes from a Prospective Comparative Cohort Study. OBES SURG 33, 3951–3961 (2023). https://doi.org/10.1007/s11695-023-06900-z

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