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Background <p>Recurrent weight gain (RWG) and Suboptimal Clinical Response (SCR) after primary metabolic and bariatric surgery (MBS) are common, often necessitating revisional procedures. Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) has emerged as a promising conversion option.</p> Methods <p>We retrospectively reviewed patients who underwent laparoscopic conversion to SADI-S for RWG/SCR between 2018 and 2024. Eligible patients had prior MBS after meeting national guidelines. Data included demographics, weight-loss outcomes, complications and nutritional/metabolic markers. The primary outcomes were percent of total weight loss (%TWL) and excess weight loss (%EWL). Long-term complications and need for revisional surgery were also assessed.</p> Results <p>Sixty-nine patients (mean age 42.7 ± 9.8 years; 66.7% female) were included. Most (65.2%) were converted from sleeve gastrectomy. Mean follow-up was 2.2 ± 1.4 years. Mean %TWL was 36.4%, 37.8%, and 34.5% at 1, 3, and 5 years, respectively, and %EWL exceeded 90% at all time points. Major complications (Clavien-Dindo ≥ 3b) occurred in 5.8% within 90 days, with 4 reoperations in the perioperative period. No conversional surgeries were required during the follow-up period.</p> Conclusions <p>Conversion to SADI-S is a safe and effective option for RWG/SCR following primary MBS, yielding durable weight loss and metabolic improvement with low complication rates. These findings support its use as a conversion strategy, warranting further prospective validation.</p>

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SADI-S as a Conversion for Suboptimal Clinical Response and Recurrent Weight Gain Following Bariatric Surgery: A Retrospective Cohort Study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月26日

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  • Reut El-On,
  • Adi Litmanovich,
  • Adam Abu-Abeid,
  • Idan Carmeli,
  • Shlomi Rayman,
  • Shai Meron Eldar,
  • Andrei Keidar

摘要

Background

Recurrent weight gain (RWG) and Suboptimal Clinical Response (SCR) after primary metabolic and bariatric surgery (MBS) are common, often necessitating revisional procedures. Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) has emerged as a promising conversion option.

Methods

We retrospectively reviewed patients who underwent laparoscopic conversion to SADI-S for RWG/SCR between 2018 and 2024. Eligible patients had prior MBS after meeting national guidelines. Data included demographics, weight-loss outcomes, complications and nutritional/metabolic markers. The primary outcomes were percent of total weight loss (%TWL) and excess weight loss (%EWL). Long-term complications and need for revisional surgery were also assessed.

Results

Sixty-nine patients (mean age 42.7 ± 9.8 years; 66.7% female) were included. Most (65.2%) were converted from sleeve gastrectomy. Mean follow-up was 2.2 ± 1.4 years. Mean %TWL was 36.4%, 37.8%, and 34.5% at 1, 3, and 5 years, respectively, and %EWL exceeded 90% at all time points. Major complications (Clavien-Dindo ≥ 3b) occurred in 5.8% within 90 days, with 4 reoperations in the perioperative period. No conversional surgeries were required during the follow-up period.

Conclusions

Conversion to SADI-S is a safe and effective option for RWG/SCR following primary MBS, yielding durable weight loss and metabolic improvement with low complication rates. These findings support its use as a conversion strategy, warranting further prospective validation.