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Page 8 of 13 Pennestrì et al. Mini-invasive Surg. 2025;9:16 https://dx.doi.org/10.20517/2574-1225.2025.03

Table 2. Description of early and late complications

Age BMI
Gender 2 Complication Grade Treatment
(years) (kg/m )
Early Male 51 52.3 Severe acute necrotising pancreatitis IV Debridement and necrosectomy, anastomotic breakdown, gastrostomy and
complications jejunostomy for feeding, open abdomen technique and vacuum-assisted therapy;
conversion to one anastomosis gastric bypass 4 months later
Female 41 54.6 Trocar site hernia IIIb Surgical revision: reduction of the herniated intestinal loop and defect closure
Female 62 51.4 Pneumonia II Intravenous antimicrobial therapy
Female 57 57.0 Intra-abdominal collection (haematoma) adjacent to stomach II Intravenous antimicrobial therapy
suture
Late Male 19 58.1 Wernicke-Korsakoff syndrome and severe malnutrition developed IIIb Conversion to Roux-en-Y gastric bypass
complications as a result of his noncompliance with the dietary plan and the
vitamin and trace element supplement
Male 50 43.4 Chronic diarrhoea not associated with Clostridium difficile II Oral antibiotic therapy and supplementation with pre/probiotics
Female 48 46.0 Electrolyte imbalance and initial malnutrition from rapid weight II Intravenous supplementation
loss
Female 48 51.8 Newly developed ulcerative colitis with toxic megacolon and bowel IV Urgent total colectomy and end ileostomy
perforation
Female 42 53.1 Sepsis brought on by pneumonia, malnutrition V Intravenous antimicrobial therapy, refusal to accept supplements and nutritional
guidance, uncontactable during follow-up

Complications grade is reported according to the Clivien-Dindo classification. BMI: Body mass index.

surgery, thereafter increasing to 81.8%, 88%, 86%, and 83.4% at the 6 months, 1 year, 2 years, 3 years, and 5 years follow-ups, respectively. Nevertheless, the
substantial reduction in BMI after 3 months, 6 months, 1 year, and 2 years (37.4, 33.7, 29.9, and 29.3 kg/m , respectively) exhibited a slight increase at 3 and 5
2
years. Furthermore, if we examine our analysis in more detail, the follow-up data [Table 3] show a nadir of bariatric results two years after the procedure.
There is a plateau between 3 and 5 years, and finally, after 7 years, we see a slight weight gain. However, the number of patients eligible for different years of
follow-up may partially influence these results. On the other hand, Sánchez-Pernaute et al. reported a similar trend, but the data should be interpreted taking

into account the eligibility criteria for the study population . At the same time, Surve et al. reported data consistent with ours, focusing on patients with more
[30]
similar preoperative BMI values . These discrepancies may be due to the different lengths of the common limb and the specific surgical indications for this
[13]
procedure. Indeed, Sánchez-Pernaute et al. used a 200 cm long common channel at the beginning of their experience, which was later adjusted to 250 cm
(occasionally 300 cm) [7,30] . By contrast, both our clinical practice [6,20] and the experience of Surve et al. [13,34] consistently employ a 300 cm common limb.

Furthermore, according to current guidelines, there are no indications for specific bariatric procedures in different obesity classes , as can be observed in the
[35]
different preoperative characteristics of the patients in the current literature. Nonetheless, to summarize, clinical outcomes associated with SADI-S are
[14]
comparable to those following BPD-DS , and are significantly better than those of other surgeries such as gastric bypasses [36,37] , particularly in patients with
obesity classes IV and V.