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COMPARATIVE STUDY BETWEEN SINGLE ANASTMOSIS DUODENO-ILEAL BYPASS-SLEEVE AND MINI-GASTRIC BYPASS AFTER FAILED SLEEVE GASTRECTOMY IN MORBIDLY OBESE PATIENTS

Background: About 10-30% of the SG patients are associated with long-term failure, due either to inadequate weight loss or to renewed weight gain. Objective: To compare weight loss as well as the metabolic effects of 2 types of bariatric surgery after failure of primary SG; Single Anastomosis Duodeno-ileal Bypass-Sleeve (SADI-S) and MiniGastric bypass (MGB), in the first year postoperative follow up. Patients and Methods: This study is a prospective controlled study which included 30 patients underwent bariatric and metabolic surgeries at Ain-Shams University El-Demerdash Hospital, Cairo, Egypt from July 2017 to July 2018 with one year of postoperative follow up till July 2019. A comprehensive assessment program was carefully structured so that a disciplined routine is followed in each patient. All patients were preoperatively evaluated with provision of extensive information and consented to participate in the study. Results: According to our results, the SADI-S group presented markedly higher percentage of EWL of 91.4% vs 71.6% in MGB after one year. Control of DM, with HbA1c below 6%, was obtained in 86.6% in both groups with more decrease in mean HbA1c of SADIS being 5.44 vs 5.815% in MGB after one year. Most patients abandoned antidiabetic therapy or at least were controlled by less medications and lower doses. The SADI-S group presented remission of hypertension by 81.8% of patients vs 80% in MGB with far less medications. Lipid profile improvement was noticed in both groups with slightly higher resolution in SADIS group by 93.3% vs 86.6% for total cholesterol, 86.6% vs 80% for T.G, 80% vs 86.6% for LDL, 60% vs 67.6% for HDL in SADIS and MGB patients respectively. Although the nutritional deficiency is still a considerable concern after SADIS, ours study didn’t show intense difference from MGB provided that proper vitamin supplementation and patient compliance are maintained postoperatively. Conclusion: When compared to gastric bypass, SADI-S appears to be an effective and safe therapeutic technique as a revisional surgery for failed primary SG with excellent short-term results for treating morbid obesity and its associated comorbidities with a low rate of nutritional complications. Proving its safety and efficacy by further studies and long term follow up will grant it more popularity in the future.