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Pennestrì et al. Mini-invasive Surg. 2025;9:16 https://dx.doi.org/10.20517/2574-1225.2025.03 Page 11 of 13

In conclusion, SADI-S is an effective bariatric treatment that can be employed as both a primary and
conversion operation for weight gain or suboptimal clinical response. It integrates restrictive and
malabsorptive elements, resulting in fewer malnutrition-related complications compared to BPD-DS. Much
attention must be paid to postoperative follow-up, especially for patients not adhering to their supplement
regimen. Further studies with extended follow-up, larger sample sizes, and randomized controlled designs
remain essential to corroborate these findings.

DECLARATIONS
Acknowledgments
Ministero della Salute - Ricerca Corrente 2025. Thanks to Ilda Hoxhaj for the language editing assistance
provided.

Authors’ contributions
Conceptualization: Pennestrì F, Palmieri L, Raffaelli M
Methodology: Pennestrì F, Palmieri L, Procopio PF, Sessa L, Marincola G, Capristo E, Laurino A, Perrone G
Validation: Procopio PF, Sessa L, Salvi G, Iaconelli A, Aquilanti B, Giustacchini P, Laurino A, Martullo A
Formal analysis: Gallucci P, Prioli F, Greco F, Ciccoritti L, Marincola G, Guidone C, Capristo E, Martullo A,
Perrone G
Investigation: Gallucci P, Greco F, Ciccoritti L, Salvi G, Iaconelli A, Aquilanti B, Guidone C
Data curation: Pennestrì F, Palmieri L, Giustacchini P
Writing - original draft preparation: Pennestrì F, Palmieri L, Prioli F, Raffaelli M
Writing - review and editing: Pennestrì F, Palmieri L, Procopio PF, Mingrone G, De Crea C, Raffaelli M
Supervision: Pennestrì F, Mingrone G, De Crea C, Raffaelli M
All authors have read and agreed to the published version of the manuscript.

Availability of data and materials
The data supporting the findings of this study are available from the corresponding author upon reasonable
request. The data are not publicly available due to privacy and ethical restrictions.

Financial support and sponsorship
None.

Conflicts of interest
Pennestrì F, Procopio PF, Gallucci P, Laurino A, Greco F, Ciccoritti L, Giustacchini P, and Raffaelli M are
advisory consultants for Medtronic (Minneapolis, Minnesota, USA). Additionally, Raffaelli M serves as an
advisory consultant for Intuitive Surgical (Sunnyvale, California, USA) and AbMedica (Cerro Maggiore,
Milano, Italy). All the authors declared that they received no funding for this study. The other authors
declared they have no conflicts of interest.

Ethical approval and consent to participate
This study was conducted in accordance with the ethical guidelines of the Helsinki Declaration. Ethical
approval was obtained from Comitato Etico Territoriale Lazio Area 3 (ID: 5538). Written informed
consent for publication was obtained from all participants.

Consent for publication
Not applicable.