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

Published:September 05, 2022DOI:


      • SADI-S has more complications than RYGB and SG, although similar to BPD/DS.
      • The current early experience of SADI-S may correlate with the complication profile found.



      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.


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


      Academic hospital, United States.


      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).


      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.


      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.

      Graphical abstract


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery for Obesity and Related Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kallies K.
        • Rogers A.M.
        American Society for Metabolic and Bariatric Surgery updated statement on single-anastomosis duodenal switch.
        Surg Obes Relat Dis. 2020; 16: 825-830
        • Shoar S.
        • Poliakin L.
        • Rubenstein R.
        • Saber A.A.
        Single anastomosis duodeno-ileal switch (SADIS): a systematic review of efficacy and safety.
        Obes Surg. 2018; 28: 104-113
        • Yashkov Y.
        • Bordan N.
        • Torres A.
        • Malykhina A.
        • Bekuzarov D.
        SADI-S 250 vs Roux-en-Y Duodenal Switch (RY-DS): results of 5-year observational study.
        Obes Surg. 2021; 31: 570-579
        • Surve A.
        • Cottam D.
        • Sanchez-Pernaute A.
        • et al.
        The incidence of complications associated with loop duodeno-ileostomy after single-anastomosis duodenal switch procedures among 1328 patients: a multicenter experience.
        Surg Obes Relat Dis. 2018; 14: 594-601
        • Zaveri H.
        • Surve A.
        • Cottam D.
        • et al.
        Mid-term 4-year outcomes with single anastomosis duodenal-ileal bypass with sleeve gastrectomy surgery at a single US center.
        Obes Surg. 2018; 28: 3062-3072
        • Sánchez-Pernaute A.
        • Herrera M.A.R.
        • Pérez-Aguirre M.E.
        • et al.
        Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). One to three-year follow-up.
        Obes Surg. 2010; 20: 1720-1726
        • Surve A.
        • Cottam D.
        • Medlin W.
        • et al.
        Long-term outcomes of primary single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S).
        Surg Obes Relat Dis. 2020; 16: 1638-1646
        • Clapp B.
        • Badaoui J.N.
        • Gamez J.A.
        • Vivar A.
        • Ghanem O.M.
        Reluctance in duodenal switch adoption: an international survey among bariatric surgeons.
        Surg Obes Relat Dis. 2021; 17: 1760-1765
        • Liagre A.
        • Martini F.
        • Anduze Y.
        • et al.
        Efficacy and drawbacks of single-anastomosis duodeno-ileal bypass after sleeve gastrectomy in a tertiary referral bariatric center.
        Obes Surg. 2021; 31: 2691-2700
        • Sang Q.
        • Wang L.
        • Wuyun Q.
        • et al.
        Retrospective comparison of SADI-S versus RYGB in Chinese with diabetes and BMI< 35kg/m2: a propensity score adjustment analysis.
        Obes Surg. 2021; 31: 5166-5175
        • Surve A.
        • Cottam D.
        • Belnap L.
        • Richards C.
        • Medlin W.
        Long-term (> 6 years) outcomes of duodenal switch (DS) versus single-anastomosis duodeno-ileostomy with sleeve gastrectomy (SADI-S): a matched cohort study.
        Obes Surg. 2021; 31: 5117-5126
        • Wang L.
        • Jiang T.
        • Zhao Y.H.
        One-year outcomes of laparoscopic single-anastomosis duodenal-ileal bypass with sleeve gastrectomy versus laparoscopic sleeve gastrectomy for the treatment of obesity and obesity-related metabolic diseases [in Chinese].
        Zhonghua Wei Chang Wai Ke Za Zhi. 2021; 24: 1058-1064
        • Pereira A.M.
        • Guimarães M.
        • Pereira S.S.
        • Ferreira de Almeida R.
        • Monteiro M.P.
        • Nora M.
        Single and dual anastomosis duodenal switch for obesity treatment: a single-center experience.
        Surg Obes Relat Dis. 2021; 17: 12-19
        • Mocanu V.
        • Dang J.
        • Ladak F.
        • Switzer N.
        • Birch D.W.
        • Karmali S.
        Predictors and outcomes of leak after Roux-en-Y gastric bypass: an analysis of the MBSAQIP data registry.
        Surg Obes Relat Dis. 2019; 15: 396-403
        • Marshall J.S.
        • Srivastava A.
        • Gupta S.K.
        • Rossi T.R.
        • DeBord J.R.
        Roux-en-Y gastric bypass leak complications.
        Arch Surg. 2003; 138: 520-524
        • Warner D.L.
        • Sasse K.C.
        Technical details of laparoscopic sleeve gastrectomy leading to lowered leak rate: discussion of 1070 consecutive cases.
        Minim Invasive Surg. 2017; 20174367059
        • Cirera De Tudela A.
        • Vilallonga R.
        • Ruiz-Úcar E.
        • et al.
        Management of leak after single anastomosis duodeno-ileal bypass with sleeve gastrectomy.
        J Lapareoendosc Adv Surg Tech A. 2021; 31: 152-160