Single Anastomosis Duodeno-Ileal Bypass (SADI) as a Second Step After Failed Sleeve Gastrectomy: Systematic Review and Meta-analysis

Purpose: Our aim in this study is to assess single anastomosis duodeno-ileal bypass (SADI) as a salvage procedure following sleeve gastrectomy (SG), examining its technical feasibility, outcomes, and potential complications. Materials and Methods:A systematic review and meta-analysis were conducted, drawing data from PubMed, Medline, and the Cochrane library.The analysis encompassed 14 studies, involving 1,066 patients.We evaluated operative time, comorbidity resolution (hypertension, dyslipidemia, diabetes), post-operative diarrhea incidence, excess weight loss (EWL) at six, twelve, and twenty-four months, and post-operative leak rates.Results: SADI as a salvage procedure following SG yielded positive outcomes.Mean operative time was 125.98 minutes (95% CI 102.50-149.46,I 2 =99%).Importantly, SADI led to comorbidity resolution in a notable proportion of cases: hypertension in 48% (95% CI 38-57%, I 2 =44%), dyslipidemia in 55% (95% CI 40-69%, I 2 =30%), and diabetes in 63% (95% CI 53-72%, I 2 =30%) of patients.Post-operative diarrhea incidence was relatively low at 2% (95% CI 1-9%, I 2 =75%).In terms of weight loss, SADI patients exhibited substantial EWL: 47.73% (95% CI 37.86-57.61,I 2 =95%) at six months, 59.39% (95% CI 51.18-67.61,I 2 =95%) at twelve months, and 23.84% (95% CI 5.76-41.92,I 2 =100%).At twenty-four months.Furthermore, post-operative leak rate was relatively low, reported in only 1% (95% CI 0-5%, I 2 =80%) of cases.Conclusion: SADI as a salvage procedure post-SG demonstrates technical feasibility and marked effectiveness.It offers substantial comorbidity resolution, significant weight loss, and low post-operative complication rates, notably post-operative leaks.Further research should investigate the long-term impact of SADI on patient nutritional status to facilitate its broader adoption.