Single-anastomosis duodenoileal bypass as a revisional or second-step operation after sleeve gastrectomy

Background: One-loop duodenal switch leads to weight loss and improvement or resolution of co-morbidities similar to standard duodenal switch, and it is technically less demanding. Objectives: To analyze the weight loss and metabolic improvement after conversion of sleeve gastrectomy to single-anastomosis duodenoileal bypass. Setting: University Hospital, Madrid, Spain. Methods: This was a retrospective cohort study. Patients submitted to sleeve gastrectomy with insufficient weight loss or programmed for a 2-step surgical approach were included. Single-anastomosis duodenoileostomy was completed if there was no stricture in the stomach and no severe symptoms of gastroesophageal reflux. Results: Fifty-one patients with a mean initial body mass index of 52 kg/m2 were included. Maximum excess weight loss after the sleeve procedure was 63%. Mean time to the second operation was 36 months. The common channel was 250 cm in 41 patients and 300 cm in 10 patients. The follow-up rate was 77% at 5 years. Excess weight loss and total weight loss were 79% and 39%, respectively, at 1 year from the second surgery and 79% and 41%, respectively, at 5 years. Furthermore, 47% of the patients with diabetes achieved complete remission after sleeve gastrectomy, and 94% achieved remission after conversion to single-anastomosis duodenoileal bypass. Final weight loss was significantly higher in those patients who achieved better weight loss after the sleeve gastrectomy than those who did not. Conclusions: Single-anastomosis duodenoileal bypass is a beneficial procedure after sleeve gastrectomy for those who fail to lose weight or those with co-morbidities or as a planned second step. (C) 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.