Safety of single anastomosis duodeno-ileal bypass with sleeve gastrectomy adoption in a statewide collaborative using performance monitoring
In brief
SADI-S shows 2.7% serious complication rate, under 1% after 20 cases
In a Michigan statewide registry of 330 primary SADI-S operations by 13 surgeons, serious complications occurred in 2.7% of patients and there were no deaths. The rate fell from 5.2% to 0.9% after each surgeon completed about 20 cases, indicating a rapid learning curve. Ongoing performance monitoring can help safely expand this emerging bariatric technique.
- Journal
- Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery (Q1)
- Published
- 10 August 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 4, Very Low (CEBM 4)
- Authors
- Oliver A Varban, Arthur M Carlin, Hassan Nasser, Michael Kia, Nabeel Obeid, Jonathan F Finks, et al.
- PMID
- 42697761
- DOI
- 10.1016/j.soard.2026.08.009
Why clinicians should know about it
- Picked for Bariatric and Metabolic Surgery (paper of the day, 5 September 2026): Safety outcomes of SADI‑S across statewide registry
Abstract
BACKGROUND: Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is an emerging bariatric procedure with safety data often limited to single centers or single surgeons. OBJECTIVE: To assess complication rates across a broad range of practices. SETTING: Prospective, state-wide bariatric-specific clinical registry. METHODS: We analyzed prospectively collected data from the Michigan Bariatric Surgery Collaborative (41-hospital consortium) for all primary SADI-S procedures between 2016 and 2025. Firth penalized logistic regression was performed to evaluate risk factors for serious complications. Time-series, funnel plot volume-outcome and risk-adjusted cumulative sum (CUSUM) analyses were performed to evaluate surgeon-specific performance and learning curve. RESULTS: Among 330 SADI-S procedures (13 surgeons, 9 sites), serious complication rate, which included major cardiovascular/pulmonary events, anastomotic leak, renal failure, surgical site infection, venous thrombosis and reoperation was 2.7% and there were no deaths. Funnel plot volume-outcome relationship and CUSUM analysis for surgeons performing > 15 cases (6 surgeons), demonstrated no outliers. Serious complication rates trended at or below 2.7% despite an influx of cases in 2022. Learning curve analysis demonstrated that serious complications declined from 5.2% to 0.9% (P = .018) after 20 cases. CONCLUSION: Among experienced mid-career bariatric surgeons, SADI-S achieved acceptable safety with zero mortality and a low serious complication rate (2.7%) despite increased adoption at different hospitals. Surgeon-specific CUSUM monitoring did not demonstrate any outliers and serves as a framework for safe implementation of emerging procedures. Serious complication rates declined significantly after 20 cases among the study cohort.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.