Single-anastomosis duodenoileal bypass with sleeve in the United States: a first comparative safety analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database

Background: The single-anastomosis duodenoileal bypass with sleeve (SADI-S) is a relatively new bariatric procedure. In 2020, the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) started reporting outcomes for SADI-S.

Objectives: We aimed to study the perioperative safety of SADI-S and compare it with other established bariatric procedures utilizing the MBSAQIP database.

Setting: Academic hospital, United States.

Methods: The 2020 MBSAQIP Participant Use File was used to evaluate SADI-S outcomes. We included SADI-S primary cases and excluded revisions and concurrent operations. A 5:1 propensity matched analysis (PMA) for 20 variables was performed to compare the outcomes of the SADI-S with the Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) and a 2:1 PMA to the biliopancreatic diversion with duodenal switch (BPD/DS).

Results: There were 255 primary SADI-S reported in 2020. After PMA, the only significant complications between the RYGB and SADI-S cohorts were Clavien-Dindo grade IVa and IVb (.1% and 1.4% versus 1.6% and 7.1%, respectively). SADI-S had more Clavien-Dindo grade II, IVa, and IVb complications than the SG cohort (1.3% versus 3.5%, P = .03; .2% versus 1.6%, P = 0; 1.% versus 7.1%, P = 0). When compared with BPD/DS, outcomes including readmission, reoperation, and intervention were not statistically significant.

Conclusion: SADI-S, in its early adoption stage, has a higher incidence of perioperative complications than RYGB and SG. It has comparable 30-day outcomes to BPD/DS.