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Pennestrì et al. Mini-invasive Surg. 2025;9:16 https://dx.doi.org/10.20517/2574-1225.2025.03 Page 3 of 13

Furthermore, the increasing availability of novel robotic platforms has enhanced its appeal by offering
outcomes similar to laparoscopy while reducing some of the technical difficulties associated with the
[20]
procedure .

Our study aims to present our experiences regarding short- and medium-term outcomes over an eight-year
period since the introduction of SADI-S in clinical practice, and to compare these results with the existing
literature.

METHODS
A retrospective cross-sectional study was conducted at our referral center for bariatric and endocrine
surgery, involving patients who underwent SADI-S as either a primary or conversion procedure between
July 2016 and October 2024.

Data from each patient scheduled for bariatric surgery were prospectively collected and stored in a de-
identified database, after obtaining informed consent for scientific studies. Clinical and demographic
information was obtained from patient records and electronic databases.

The inclusion criteria encompassed all patients who underwent SADI-S, whether as a primary or conversion
procedure from a previous bariatric surgery. No exclusion criteria were applied.

The primary endpoint was the incidence of early postoperative complications, occurring within 30 days.
Secondary endpoints included late complications and overall clinical outcomes. Moreover, the learning
curve has been assessed.

This research complied with the ethical standards of the Helsinki Declaration. We secured ethical approval
from our Local Ethical Committee (Comitato Etico Territoriale Lazio Area 3, ID: 5538), and each
participant provided informed consent.

For this retrospective analysis, the follow-up ended on 30th November 2024.

The indications for bariatric surgery and for SADI-S/SAD, including details of the preoperative workup,
have been previously described [6,20] . Any identified nutritional deficiencies were addressed and corrected
prior to surgery.

The technical aspects of the surgical procedures - laparoscopic/robot-assisted SADI-S/SADI- have also been
thoroughly described in previous reports [6,20] . Nonetheless, certain information still needs to be documented.
SADI-S is performed as a primary bariatric procedure: beginning with a SG, followed by the duodenum
transition and concluding with the duodenum-ileal anastomosis. In contrast, SADI is a conversion surgery
for patients who have previously undergone a SG; thus, only the duodenum transition and duodenum-ileal
anastomosis are performed. In all cases, the common channel length was standardized to 300 cm [Figure 1].
All robot-assisted procedures in this series were performed using the DaVinci Xi platform. Since January
2024, a robotic stapler device has been routinely introduced into our clinical practice. All procedures
included in the present study were carried out by the same experienced surgeon (M.R.).

The postoperative protocol management, including discharge criteria and follow-up strategy, has also been
previously described [6,20] .