O-223 - UNICENTRIC COMPARATIVE ANALYSIS WITH PROPENSITY SCORE MATCHING: DIRECT SADI-S VERSUS TWO-STEP PROCEDURE
Hospital Universitari de Bellvitge, L´Hospitalet de Llobregat.
Introduction: Single anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) is a simplification of the standard duodenal switch (DS) procedure and has excellent results in weight control and comorbidities resolution. Sleeve gastrectomy was firstly conceived as part of the DS procedure. In patients with a high grade of obesity, it was proposed as a stand-alone procedure as a first step to minimize the surgical risks of the complete surgery.
Objectives: The aim of this study was to assess the effectiveness and safety of SADI-S, comparing its results as a direct or two-step procedure.
Methods: Unicentric cohort analysis of a prospective maintained database including 406 patients that underwent direct SADI-S versus 65 patients with a two-step procedure. To compare outcomes between the two groups, we performed a propensity score matching. The matching was 2:1, 130 patients in direct SADI-S group versus 65 patients in two-step group.
Results: After matching there were no statistical differences. Patients in two-step SADI-S group were younger (46.9 vs. 45.2 y, p = 0.264), and with a higher body mass index (BMI 53 vs. 51.4 kg/m2, p = 0.172) than the direct SADI-S group. One year after surgery %TWL was 37 versus 31% in the direct and two-step groups, respectively (p < 0.001). At three years follow-up, %TWL was still better in direct SADI-S group (33.3 versus 24.8%, p < 0.001 respectively). The mean BMI loss in the first three months after surgery was higher in two-step SADI-S group (34.7 vs. 37.5 kg/m2, p = 0.056). However, after one year of surgery direct SADI-S could maintain a better BMI loss reaching statistical significance (p IIIa) was 3.1% in direct SADI-S and 3.8% in two-step SADI-S. There was no mortality. Nutritional supplementation needs were similar for both groups with no cases of diarrhea or malnutrition requiring protein supplementation or revisional surgery.
Conclusions: In mid and long term, direct SADI-S is a safe and effective technique that offers a satisfactory weight loss and remission of comorbidities. Two-step strategy does not reduce postoperative risks and may compromise weight loss results at mid-term.
