Comparative Outcomes of Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy Versus Roux-en-Y Gastric Bypass in Adults with Severe Obesity: A Systematic Review and Meta-Analysis.
Ali Altwaheih, Feras W Atieh, Ibrahim Abdel-Jaleel et al.
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In 30 seconds
This systematic review and meta-analysis compared single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) and Roux-en-Y gastric bypass (RYGB) in adults with severe obesity. It included 12 comparative studies involving 3,317 patients. Random-effects analyses suggested that SADI-S may provide greater weight loss at selected follow-up points, but found no clear differences in remission of type 2 diabetes, hypertension, or dyslipidemia, or in HbA1c reduction. Operative outcomes and early complications were also similar. Overall certainty was predominantly low or very low.
Key findings
- Across 12 comparative studies (3,317 patients), SADI-S showed a potential weight-loss benefit over RYGB at selected follow-up points.
- No clear differences were observed in remission of type 2 diabetes, hypertension, or dyslipidemia, or in HbA1c reduction.
- Operative outcomes and early complications showed no clear differences; analyses suggested potential reductions in reoperations and selected late surgical complications with SADI-S.
- A nonsignificant trend toward greater calcium deficiency was observed with SADI-S; comparative mortality could not be assessed.
Why it matters
The review brings together comparative evidence on two operations used for severe obesity and suggests that possible weight-loss advantages may not translate into clearly different metabolic outcomes. Its findings on reoperations, late complications, and calcium deficiency also highlight outcomes relevant to weighing potential benefits and harms. However, low or very low evidence certainty limits confidence in these comparisons.
What to keep in mind
Evidence certainty was predominantly low or very low because of methodological limitations and heterogeneity. Mortality could not be compared because no included study provided suitable data for pooling.