Perioperative safety profile of single anastomosis duodeno-ileal bypass and Roux-en-Y gastric bypass after sleeve gastrectomy.

Background: Although metabolic and bariatric surgery (MBS) is highly effective for weight management, revisional procedures are often needed after sleeve gastrectomy (SG). While Roux-en-Y gastric bypass (RYGB) has historically been the most commonly performed revisional procedure, single anastomosis duodeno-ileal bypass (SADI) is a more recently endorsed alternative.

Objective: To compare the safety profile of revisional RYGB and SADI after SG in the first postoperative 30 days.

Setting: United States of America.

Methods: Using the 2022-2023 MBSAQIP database, patients undergoing revisional RYGB or SADI after SG were identified and matched using propensity scores. Demographic, medical, and perioperative variables were analyzed, including length of stay, operative time, complications, and 30-day readmission, reoperation, and mortality rates.

Results: After propensity score matching, a total of 6108 patients were included; 4581 (75.0%) to RYGB group and 1527 (25.0%) to SADI group. Operative times were longer for RYGB (P = .03). Mean length of stay was 1.57 ± 1.84 days for RYGB and 1.44 ± 1.28 days for SADI (P < .01) Postoperative bowel obstruction was more common after RYGB (.9% vs .3%, P = .01). RYGB 30-day readmission rate was 5.5% and reoperation rate was 1.8%. SADI 30-day readmission rate was 4.3% and reoperation rate was 2.2% (P = .06 for readmission rates; P = .3 for reoperation rates). Thirty-day mortality was similarly low in both groups (Group 1: .2%, Group 2: .1%, P > .7).

Conclusion: Revisional RYGB and SADI after SG are both safe and associated with low morbidity in a short-term period. However, SADI may offer advantages over RYGB for its lower risk of postoperative bowel obstruction.