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Pennestrì et al. Mini-invasive Surg. 2025;9:16 https://dx.doi.org/10.20517/2574-1225.2025.03 Page 7 of 13

Malnutrition (yes/no) 3 (1.9%) / 154 (98.1%)
Other events (yes/no)
Wernicke-Korsakoff syndrome 1 (0.7%) / 156 (99.3%)
Toxic megacolon 1 (0.7%) / 156 (99.3%)
BMI: Body mass index; HBP: high blood pressure; OSAS: obstructive sleep apnea syndrome; IGT: impaired glucose tolerance; T2DM: type 2
diabetes mellitus; SADI-S: single anastomosis duodeno-ileal bypass with sleeve gastrectomy; SADI: single anastomosis duodeno-ileal bypass in
previously sleeve gastrectomy; SG: sleeve gastrectomy; OT: operative time; ICU: intensive care unit.

adopted DeMeester’s duodenal switch for bariatric surgery to prevent the common occurrence of marginal
ulcers associated with the Scopinaro procedure. Many authors indicate that BPD-DS offers significantly
better bariatric outcomes than other procedures, along with longer-lasting benefits in resolving
comorbidities. Nonetheless, BPD-DS is regarded as a procedure that requires significant technical expertise.
Although complications are rare, the occurrence of a leakage, bleeding, or obstruction/stenosis can lead to
severe effects, including prolonged hospitalization, intrabdominal infections, reinterventions, or even
mortality [6,25] . Due to the considerations mentioned above, Sánchez-Pernaute et al. attempted to simplify the
[7]
surgical technique without compromising the procedure’s results . Similar to its predecessor procedure, the
restrictive component of SADI-S is achieved through SG, followed by the addition of a malabsorptive
element through a single anastomosis between the duodenum and the ileum . Both mechanisms enhance
[7]
the efficacy of SADI-S: the restrictive component facilitates initial weight reduction during the first year,
whereas prolonged weight loss after one year is mainly attributed to the malabsorptive aspect . Regarding
[28]
the primary endpoint of our study, our results show an early postoperative complication rate of 2.5%.
Delving deeper, we reported two cases of pneumonia, one case of bleeding (intrabdominal collection), one
case of acute pancreatitis, and one case of trocar site hernia. Thus, 2 out of 157 patients required surgical re-
[29]
exploration. Our most recent systematic review analyzing data from seventeen studies reported an overall
early postoperative complication rate ranging from 0% to 6.7% , describing the following postoperative
[29]
complications: leakage (15 patients), bleeding (12 patients), incisional hernia (8 patients), and reoperations
(14 patients). Therefore, considering this systematic review, we can conclude that our experience is
consistent with those of other authors. Aiming to understand the safety of bariatric procedures, we also
focused on the late complications, reporting a rate of 3.1%. More in detail, we described 4 cases of chronic
diarrhoea, 3 cases of malnutrition, 1 case of Wernicke-Korsakoff syndrome, and 1 case of toxic megacolon
(2 years after the bariatric procedure, due to new-onset ulcerative colitis). Concerning long-term follow-up,
Sánchez-Pernaute et al. reported a rate of 7.3% for reoperation due to severe malnutrition . Upon further
[30]
investigation of their preliminary experience, they reported seven such cases: two with a 2-m common
channel, five with a 250-cm channel, and none among those with a 3-m common limb. Therefore, the
length of the common channel plays a pivotal role in the malnutrition rate, balancing outcomes and
complications. Postoperative malnutrition has been a subject of several researchers, including Shoar et al.,
who performed a systematic review of 12 studies and found a lower incidence of nutrient deficiencies when
the common channel is at least 3 m long . Our results are similar to those reported by Cottam et al. .
[31]
[32]
The other side of the coin is the bariatric outcomes. When interpreting the clinical response, two critical
covariates should be considered: time and patient adherence to diet therapy. Regarding this point, after 23
months of median follow-up, we observed median values of 27.3 kg/m for BMI, 82% for %EWL, and 42%
2
for %TWL. Palmieri et al. analyzed 17 studies that provide bariatric outcomes . These data, however,
[29]
might be impacted by the fact that most studies have an average follow-up period of two years, while only a
few describe clinical outcomes beyond five years. Notably, SADI-S outcomes after ten years have been
reported in only one study . In all evaluated studies, the median %TWL was ≥ 25% (ideal clinical
[30]
response ) at the 1-year follow-up, rising to 44% after 2 years and stabilizing at 3 and 5 years. Moreover,
[33]
[33]
EWL ≥ 50% (the standard criterion for optimal clinical response ) has been recorded three months after