Five-Year Outcomes of Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy: A Systematic Review

Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) has gained increasing popularity in bariatric surgery due to its promising weight loss and metabolic outcomes. However, long-term evidence remains limited. This systematic review aimed to assess the 5-year outcomes of SADI-S performed as a primary bariatric procedure, focusing on weight loss, morbidity, mortality, and complications.

A systematic literature search was conducted in accordance with PRISMA guidelines. Out of 13 studies identified, four met the inclusion criteria. These studies reported outcomes of SADI-S as a primary bariatric procedure with follow-up at 5 years.

The included studies comprised 1088 patients across four centers. The mean preoperative BMI was 49.66 kg/m², with women representing 64% of the cohort. At 5 years, follow-up data were available for 326 patients. The procedure demonstrated sustained weight loss, with a mean total weight loss (TWL) of 33.67% and excess weight loss (EWL) of 72.88%, resulting in a mean BMI of 31.7 kg/m². Short-term complication rates ranged from 5.4% to 11.6%, while long-term complications ranged from 8.7% to 17.9%. Malnutrition-related reoperations were associated with a common channel length of 200 cm. Mortality rates were consistently low.

SADI-S appears to be an effective bariatric procedure, providing sustained weight loss and acceptable complication rates at 5 years. Its safety profile is comparable to other bariatric techniques. Nonetheless, nutritional risks-particularly those related to protein malnutrition-highlight the importance of structured postoperative monitoring. Further prospective studies are needed to validate these findings and guide surgical decision-making.