Single and dual anastomosis duodenal switch for obesity treatment: a single centre experience (Reviewer #1, Comment #3)

Abstract Background Biliopancreatic diversion with duodenal switch (BPD/DS) is the most effective bariatric surgery in super-obese patients, although technically complex and time consuming. Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) as a primary surgery, is similar to BPD/DS, at short term outcomes but long term and comparative data is lacking. Objectives The aim of this study was to compare the outcomes of patients submitted to SADI-S and BPD/DS. Setting Public hospital. Methods Obese patients (n=112) submitted to SADI-S (n=83) and BPD/DS (n=29) for obesity treatment were prospectively compared. Results Mean preoperative body mass index (BMI) was 53.41±0.93 for BPD/DS and 50.61±0.52 kg/m2 for SADI-S. Follow-up of 48 months was achieved in 18% (n=21) of patients with a non-significant difference in percentage of excess BMI loss (%EBMIL) of 81.20±3.71 for BPD/DS and 74.82±3.45 for SADI-S. Operative time (164.30±7.78 vs 132.70±7.19 minutes, BPD/DS vs SADI-S; p=0.006) and hospital stay (4.90±1.10 vs 4.35±0.70 days, BPD/DS vs SADI-S; p=0.006) were significantly shorter for SADI-S. . There was no significant difference in 30-days post-operative complication rate. No mortality was reported. After surgery, significant improvements were observed in glucose and lipid profile for both groups. Type 2 diabetes (T2D) remission rate was 100% for BPD/DS and ranged from 60 to 80% for SADI-S across follow-up times. Dyslipidemia remission followed a similar pattern. Protein deficiency was observed in up to 50% of patients after BPD/DS and 20% after SADI-S, without statistically significances. Conclusion SADI-S and BPD/DS as primary surgery for obesity treatment results in no significant differences in %EBMIL, obesity related diseases improvement, nutritional deficiencies and post-operative morbidity. Nevertheless, there was greater total weight loss after BPD/DS. SADI-S being less time consuming and technically simpler, can be represent an advantage over BPD/DS.