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Background Standardization of the laparoscopic sleeve gastrectomy procedure is needed to improve patient outcomes. A single-fire 23 cm stapler was developed to streamline the operation. Comparative testing conducted on excised human tissue has demonstrated the superiority of the novel Titan SGS stapler to two commonly utilized commercial devices in both staple line integrity and burst pressure. We hypothesized that the stapler would be safe and effective in creating longitudinal gastric resections in human patients. Methods 61 patients were enrolled to undergo gastric resection with the Titan SGS stapler. Perioperative interventions and post-operative adverse events were recorded. Upper GI study was completed on post-operative day 1, and patients were followed for 6 weeks post-operatively to determine any subacute device-related adverse events. Results Surgeon feedback for intraoperative device utilization and post-operative gastric pouch shape were positive. Adverse events were found to be mild, limited, and generally well-known effects of bariatric surgery. One episode of post-operative hemorrhage required surgical takeback, with no criminal bleeding vessel identified. Conclusion The Titan SGS stapler is both safe and effective in sleeve gastrectomy pouch creation.

Introduction Single-anastomosis duodenal switch has been suggested to be an effective bariatric procedure that offers excellent weight loss and by lengthening the common channel the potential to reduce micronutrient deficiencies. Purpose To evaluate the weight loss, comorbidity resolution and the 1-year nutritional outcomes of the single-anastomosis duodenal switch (SADS) procedure. Setting Multiple US Hospitals. Methods From October 2014 to January 2017, 120 patients were enrolled at six sites across the USA and underwent the SADS procedure. Weight loss, comorbidities, quality of life, and adverse events were followed post-procedure for 12 months. Results At 1, 6, and 12 months, 98.3%, 85.5%, and 77.1% of the patients were available for assessment, respectively. At 12 months, patients showed significantly reduced body mass index when compared to baseline (46.8 ± 5.8 vs 29.8 ± 4.4, P P Conclusions SADS is a highly efficacious weight loss procedure with significant comorbidity reduction at 1 year. At 1 year, complications and vitamin and mineral deficits appear to be consistent with other malabsorption operations. Long-term follow-up is needed, especially around complications and vitamin deficiencies.

Recently, a single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) has become increasingly popular for patients with BMI > 50 as a primary or staged surgery. Staging allows surgeons to do the sleeve gastrectomy (SG) first with the conversion only happening when a failure or technical challenge is identified. We present the mid-term outcomes of SADI bypass surgery after SG. A retrospective analysis was performed on a prospective database from four institutions. Ninety-six patients were identified from 2013 to 2018. Patients were divided into two groups: one had two-stage SADI because of insufficient weight loss, the second had planned two-stage SADI because of super obesity (BMI > 50 kg/m2). Incidence of complications was divided into 30 days. Of 96 patients, 3 patients were completely lost to follow-up. The mean age was 44.8 ± 11.3 years. There were no deaths or conversion to open surgery. The postoperative early complication and late complication rate was 5.3% and 6.4% respectively. At 24 months, group 2 had higher %weight loss (WL) and change in BMI units compared to group 1 with statistically significant difference. The average WL and change in BMI for entire patient’s population at 24 months after 2nd stage SADI was 20.5% and 9.4 units respectively. The remission rate for DM was 93.7% with or without the use of medication. The two-stage approach to SADI-S appears technically simpler than a single compromised operation. However, this approach needs more patients to understand its limitations.

Background The sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and single-anastomosis duodenal-ileal bypass with SG (SADI-S) are recognized bariatric procedures. A comparison has never been made between these 3 procedures and especially in different body mass index (BMI) categories. Objective The study aimed to analyze a large cohort of patients undergoing either laparoscopic (L) SG, LRYGB, or LSADI-S to evaluate and compare weight loss and glycosylated hemoglobin level. The secondary aim was to compare the nutritional outcomes between LRYGB and LSADI-S. Setting Private practice, United States. Methods This is a retrospective review of 878 patients who underwent LSG, LRYGB, or LSADI-S from April 2014 through October 2015 by 5 surgeons in a single institution. For weight loss analysis, the patients were categorized into 4 different categories as follows: patients regardless of their preoperative BMI, patients with preoperative BMI 55 kg/m2. Results A total of 878 patients were identified for analysis. Of 878 patients, 448 patients, 270 patients, and 160 patients underwent LSG, LRYGB, and LSADI-S, respectively. Overall, at 12 and 24 months, the weight loss was highest with LSADI-S, followed by LRYGB and LSG in all 4 categories. At 2 years, the patients lost 19.5, 16.1, and 11.3 BMI points after LSADI-S, LRYGB, and LSG, respectively. In addition, the weight loss was highest in patients with preoperative BMI 55 kg/m2 at 12 and 24 months. Also, there were no statistically significant differences between the nutritional outcomes between LRYGB and LSADI-S. The LSADI-S had significantly lower rates of abnormal glycosylated hemoglobin than LRYGB and LSG at 12 months (P Conclusions The weight loss outcomes and glycosylated hemoglobin rates were better with LSADI-S than LRYGB or LSG. The nutritional outcomes between LRYGB and LSADI-S were similar.

Background The single-anastomosis duodenal switch procedure is a type of duodenal switch that involves a loop anastomosis rather than traditional Roux-en-Y reconstruction. To date, there have been no multicenter studies looking at the complications associated with post-pyloric loop reconstruction. Objectives The aim of the study was to report the incidence of complications associated with loop duodeno-ileostomy (DI) following single-anastomosis duodenal switch (SADS) procedures. Setting Mixed of private and teaching facilities. Methods The medical records of 1328 patients who underwent primary SADS procedure (single-anastomosis duodeno–ileal bypass with sleeve gastrectomy or stomach intestinal pylorus-sparing surgery) by 17 surgeons from 3 countries (United States, Spain, and Australia) at 9 centers over a 6-year period were retrospectively reviewed, and their results were compared with articles in the literature. Results Mean preoperative body mass index was 51.6 kg/m 2 . Of 1328 patients, 123 patients received a linear stapled duodeno-ileostomy (DI) and 1205 patients a hand-sewn DI. In the overall series, the anastomotic leak, ulcer, and bile reflux occurred in .6% (9/1328), .1% (2/1328), and .1% (2/1328), respectively. None of our patients experienced volvulus at the DI or an internal hernia. Overall, 5 patients (.3%) (3/123 [2.4%] with linear stapled DI versus 2/1205 [.1%] with hand-sewn DI [ P Conclusions The overall incidence of complications associated with loop DI was lower than the reported incidence of anastomotic complications after Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch. SADS procedures may cause much fewer anastomotic complications compared with Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch.