Introduction

The SADI was introduced in the hope to reduce complication rates of the traditional Roux-en-Y. Bariatric surgery is always striving to reduce complications whilst maintaining weight loss. The SADI involves a sleeve gastrectomy and a duodeno-ileostomy with a common channel of 250-300cm. Optimal length for the common channel (CC) and biliary-pancreatic (BP) limb remains contested. The SDJB is similar to the SADI other than the BP limb is shortened to 150cm. Our aim was to confirm a reduction in malabsorptive complications and maintain weight loss over time by shortening BP limb length.

Methods

A 5-year retrospective cohort study was performed at a single surgeon institute. 78 SADI, 57 SDJB patients and a BMI matched cohort of 135 SG patients were identified. Inclusions: BMI 35-70, operation December 2015 – December 2021. Exclusions: revisional ring procedures. Data was collected pre and post operative. Outcomes were EWL% at 5 years, Biochemistry, stool habit and complications.

Results:

Shortening limb length was not significantly different to SADI regarding EWL% at 5 years (p=0.137) yet SADI and SDJB were superior to SG alone in EWL% at 3 and 4 years (p=<0.001 and p=0.017). SDJB was similar to SADI at remission of T2DM with both groups significantly reducing HbA1c compared to SG group (p=0.006, p=0.009 respectively). All groups significantly reduced use of CPAP, Statins and antihypertensives post operative. SDJB group significantly improved post operative daily stool count and consistency compared to SADI group (p=0.03 and p=0.001). SDJB complication rate was comparative to SADI 5.2% and 6.4% respectively with no significant difference between the two groups (p=0.189). SDJB had significantly improved levels of selenium, corrected calcium, cholesterol and B12 stores compared to SADI (p=0.041, p=0.001, p=<0.001, p=<0.001).

Conclusion

Shortening limb length (SDJB) proved equal to SADI regarding EWL% over 5 years. With SADI and SDJB groups having significantly higher long term EWL% compared to SG alone. SDJB was significantly better then SADI at reducing bowel motions per day and improving stool consistency. SDJB had significantly improved biochemical markers of malabsorption compared to SADI. Overall, SDJB has similar disease resolution and weight loss to SADI and significantly improved bowel habits. Thus, shortening BPL reduced malabsorptive complications whilst maintaining long term EWL%.