Single-Anastomosis Duodenal Switch: Conceptual Difference between East and West

Area of Science:

• Bariatric and Metabolic Surgery
• Surgical Gastroenterology

Background:

• Single-anastomosis duodenal switch (SADS) is a growing bariatric procedure.
• Regional variations in SADS application and outcomes exist between Eastern and Western countries.

Purpose of the Study:

• To compare the conceptual differences between Eastern (SADS-E) and Western (SADS-W) approaches to SADS.
• To analyze patient selection, surgical techniques, and outcomes associated with SADS-E and SADS-W.

Main Methods:

• Systematic review of PubMed and high-impact journal articles on SADS.
• Analysis of 19 articles encompassing 2280 patients.

Main Results:

• SADS-W is typically for high BMI patients without type 2 diabetes mellitus (T2DM), using larger bougies and shorter common channels, resulting in superior weight loss and T2DM remission.
• SADS-E is preferred for T2DM patients with lower BMI, involving less bowel bypass and smaller bougies.
• Distinct patterns of postoperative complications, nutritional deficiencies, and gastrointestinal issues were observed between SADS-E and SADS-W.

Conclusions:

• SADS is an effective bariatric and metabolic procedure with favorable outcomes.
• SADS-W demonstrates greater efficacy in weight loss and T2DM remission compared to SADS-E.
• Tailoring SADS based on regional patient demographics and metabolic status is crucial for optimizing results.