Surgery for obesity and related diseases : official journal of the American Society for Bariatric SurgeryDec 10, 2025

Effectiveness and safety of revising weight loss surgery by connecting the stomach to the lower intestine after failed gastric band or sleeve gastrectomy

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗

Updated Apr 4, 2026

Abstract

Eighteen articles with 1641 revisional cases indicate that single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a safe and effective option for patients with failed primary procedures.

BMI change after SADI-S was 11.01 kg/m² at 12 months, 9.57 kg/m² at 36 months, and 11.04 kg/m² at 60 months.
Total weight loss after SADI-S was 23.78% at 12 months, 21.03% at 36 months, and 22.11% at 60 months.
SADI-S was associated with remission rates of 69% for diabetes, 41% for hypertension, 47% for hyperlipidemia, and 69% for obstructive sleep apnea.
Reported complications included leaks (2.9%), gastroesophageal reflux disease (5.1%), anemia (5.7%), diarrhea (8.7%), nutritional deficiency (4.2%), and steatorrhea (11.2%).
In subgroup analysis, SADI-S, one anastomosis gastric bypass, and Roux-en-Y gastric bypass showed comparable outcomes in weight loss and resolution of obesity-related comorbidities.

Simplified

Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) demonstrates a high safety profile and consistent weight loss efficiency, increasingly used as a revisional procedure. However, while mid- and long-term outcomes for primary SADI-S are established, evidence on its effectiveness as a revisional technique remains limited. This study aims to address that gap by assessing the efficacy and safety of revisional SADI-S after failed primary adjustable gastric banding (AGB) or sleeve gastrectomy (SG) procedures. A systematic search was conducted in PubMed, Embase, Web of Science, and Scopus to identify articles on the efficacy and safety of SADI-S as a revisional surgery after failed primary AGB or SG. A meta-analysis was conducted, coupled with subgroup analyses on comparing revisional SADI-S, Roux-en-Y gastric bypass (RYGB), one anastomosis gastric bypass (OAGB), and duodenal switch (DS). Eighteen articles with 1641 revisional cases were included in the current study. BMI change after SADI-S was 11.01 (1.51), 9.57 (1.75), and 11.04 (.86) kg/m2 after 12, 36, and 60 months, respectively. Furthermore, total weight loss (TWL) after SADI-S was 23.78% (2.50), 21.03% (4.95), and 22.11% (8.69) after 12, 36, and 60 months, respectively. SADI-S was associated with 69%, 41%, 47%, and 69% rates of diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea remission, respectively. Leak (2.9%), gastroesophageal reflux disease (GERD) (5.1%), anemia (5.7%), diarrhea (8.7%), nutritional deficiency (4.2%), and steatorrhea (11.2%) were the most common reported complications after revisional SADI-S. In subgroup analysis, revisional SADI-S, OAGB, and RYGB had comparable weight loss, obesity related comorbidity resolution, and complications, except for a higher rate of stenosis/obstruction in RYGB and bile reflux in OAGB. Revisional SADI-S is a safe and effective option for patients with failed primary AGB or SG.

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Effectiveness and safety of revising weight loss surgery by connecting the stomach to the lower intestine after failed gastric band or sleeve gastrectomy

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