Comparison between single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) and roux-en-y gastric bypass (RYGB) in terms of weight loss, comorbidities remission and complications. A Systematic Review with Meta-analysis.

Purpose Evaluate and compare the results of weight loss outcomes, comorbidities resolution and complications in the short and long-term between SADI-S and RYGB. Material and methods A systematic review was conducted following PRISMA guidelines. Studies comparing SADI-S and RYGB as primary surgery were included if they reported weight loss (total weight loss (TWL), excess weight loss (EWL), or body mass index (BMI) changes), comorbidity remission (diabetes and hypertension), and postoperative outcomes (complications, hospital stay, and operative time). A meta-analysis of mean differences (MD) was conducted to assess continuous outcomes and a meta-analysis of odds ratios (OR) was performed to evaluate the categorical variables, random effects model was used. Results Nine studies, including 51,634 patients (2,126 SADI-S; 49508 RYGB), were analysed. Six studies with over one year of follow-up [Mean 3.93 years (1.79)] were included for long-term outcomes, while all nine were considered for short-term outcomes. SADI-S resulted in a statistically significant higher total weight loss (MD 10.02; 95% CI 4.21–15.82; p < 0.001), excess weight loss (MD 10.3; 95% CI 6.9–13.7; p < 0.001) and diabetes remission (OR 3.48; 95% CI 2.02–6.02; p < 0.001). Short-term complications (OR 0.95; 95% CI 0.45–1.97; p = 0.89) and severe complications (OR 0.65; 95% CI 0.22–1.91; p = 0.43) were similar between groups, but SADI-S had fewer long-term complications (OR 0.17; 95% CI 0.04–0.66; p = 0.01). Operative time (MD 9.2; 95% CI -26.3–44.8; p = 0.6), and hospital stay (MD 0.06; 95% CI -0.69–0.82; p = 0.86) were comparable. Conclusion This meta-analysis suggests that SADI-S may offer advantages over RYGB in terms of weight loss and diabetes remission, with a similar safety profile regarding short-term complications and potentially fewer long-term complications.