One-Stage Vs. Two-Step One Anastomosis Duodenal Switch (OADS/SADI-S): A Safety and Efficacy Single-Center Propensity-Score Matched Analysis

Javier Osorio; Víctor Admella; David Merino; Lucía Sobrino; Carlota Tuero; Núria Vilarrasa; Claudio Lazzara

doi:10.1007/s11695-024-07280-8

One-Stage Vs. Two-Step One Anastomosis Duodenal Switch (OADS/SADI-S): A Safety and Efficacy Single-Center Propensity-Score Matched Analysis

Obes Surg. 2024 May 17. doi: 10.1007/s11695-024-07280-8. Online ahead of print.

Authors

Javier Osorio¹, Víctor Admella², David Merino², Lucía Sobrino², Carlota Tuero², Núria Vilarrasa³, Claudio Lazzara²

Affiliations

¹ Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, Carrer de La Feixa Llarga, S/N. 08907 L'Hospitalet de Llobregat, Barcelona, Spain. javier_osorio2003@yahoo.es.
² Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, Carrer de La Feixa Llarga, S/N. 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
³ Department of Endocrinology, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain.

PMID: 38758514
DOI: 10.1007/s11695-024-07280-8

Abstract

Introduction: One Anastomosis Duodenal Switch (OADS/SADI-S) is used both as a one stage and a second-step procedure, either planned or revisional after a failed sleeve gastrectomy. However, there is lack of adjusted comparative evidence validating its use.

Material and methods: Propensity-score matched comparison between patients submitted to one-stage vs. two-step OADS, adjusted by age, gender, and initial body mass index (BMI).

Results: One hundred ninety-five patients (130 one-stage and 65 two-step OADS) were included, with mean initial BMI 52.4 kg/m². Overall complication rate was 6.6% in the short-term (3.3% Clavien-Dindo ≥ III), and 7.3% in the long-term, with no differences between groups. Follow-up at 1 and 3 years was 83.6% and 61.5%. After one-stage OADS, total weight loss was 36.6 ± 8.2% at 1 year and 30.4 ± 10.3% at 3 years, vs. 30.2 ± 9.4% and 25.6 ± 10.2% after two-steps OADS (p = 0.021). Resolution rates of diabetes mellitus, hypertension, dyslipidemia, and obstructive sleep apnea were 86.4%, 80.4%, 78.0%, and 73.3%, with no differences between groups.

Conclusion: One-stage OADS is a safe and effective bariatric technique for patients with grade III and IV obesity. The two-step strategy does not reduce postoperative risks and may compromise weight loss results at mid-term.

Keywords: Bariatric surgery; Hypoabsorptive surgery; OADS; SADI-S; Obesity; Revisional bariatric surgery.