Long-Term Outcomes of Single and Dual Anastomosis Duodenal Switch

Single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) offers a streamlined alternative to biliopancreatic diversion with duodenal switch (BPD/DS), potentially with a lower risk of complications in patients with obesity grade III, although long-term comparative studies are lacking.

To compare long-term outcomes of patients undergoing SADI-S and BPD/DS.

A cohort of 114 patients with a body mass index (BMI) equal to or greater than 45 kg/m² who underwent BPD/DS or SADI-S in a single bariatric public center as a primary intervention between 2015 and 2019 was evaluated for a follow-up period of at least 60 months.

After ≥ 60 months of follow-up, patients submitted to BPD/DS and SADI-S achieved a total weight loss (TWL) > 20% (96% vs 91%, p = 0.67) and similar remission rates of associated medical problems. Transient vitamin and micronutrient deficiencies during follow-up were observed in 44.8% of BPD/DS patients and 63.5% of SADI-S patients, anemia in 44.8% and 42.4%, and iron deficiency in 58.6% and 48.2%, respectively. Quality of life (QoL) scores were not significantly different between the groups (BPD/DS: 2.00 ± 0.22 vs. SADI-S: 2.15 ± 0.19, p = 0.08). After propensity score matching (n = 28 per group), differences in weight loss outcomes became more pronounced, favoring BPD/DS, while SADI-S was associated with significantly greater improvement in quality-of-life.

The long-term outcomes of BPD/DS and SADI-S in terms of obesity-related comorbidities remission and complication rates do not seem to differ, despite BPD/DS inducing greater weight loss and SADI-S being associated with greater improvements in quality of life.