Comparative outcomes of single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) versus sleeve gastrectomy and Roux-en-Y gastric bypass: a propensity-matched analysis using the MBSAQIP data registry

Abstract

Background

Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a procedure that is being performed more commonly. Despite its growing adoption, limited data exist comparing its short-term safety to established bariatric operations.

Objectives

To compare 30-day postoperative outcomes of SADI-S with those of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) using a national clinical registry.

Setting

Analysis of data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), encompassing accredited bariatric centers across the United States and Canada.

Methods

The MBSAQIP database was queried for adult patients (≥18 years) undergoing primary laparoscopic SADI-S, SG, or RYGB between 2021 and 2023. Propensity score matching (1:1) was performed to adjust for 19 preoperative demographic and comorbidity variables, yielding matched cohorts for SADI-S versus SG (n = 4017 each) and SADI-S versus RYGB (n = 4017 each). Thirty-day postoperative outcomes were compared between matched groups.

Results

Compared with SG, SADI-S was associated with a higher overall complication rate (3.7% vs 2.4%, P < .01) including higher rates of pneumonia, bowel obstruction, emergency department visits, reintervention, readmission, and reoperation. In contrast, overall complication rates were similar between SADI-S and RYGB (3.7% vs 4.3%, P = .14). SADI-S demonstrated higher pulmonary embolism rates, whereas RYGB had more reinterventions and emergency department visits.

Conclusions

SADI-S is associated with higher 30-day morbidity compared to SG but demonstrates short-term safety comparable to RYGB. These findings support SADI-S as a safe bariatric surgery option when performed in appropriately selected patients at accredited centers.