Why One-Anastomosis Gastric Bypass With a Minimizer Ring Is My Procedure of Choice Compared With SADI-S

One anastomosis gastric bypass (OAGB) with Minimizer ring provides excellent weight loss, both in the primary and revisional setting.

A single anastomosis duodeno-ileal bypass with sleeve (SADI-S) also provides excellent weight loss, however there are significant issues with the SADI-S, which determine my preference for a OAGB with Minimizer ring.

Weight loss:

A single-centre cohort study found mean excess weight loss to be around 80% at 2 years, often superior to a Roux-en-Y gastric bypass.  This number can be further improved with a Minimizer ring, which provides durable and further weight loss.

A Minimizer ring intends to decrease pouch dilation, limit weight regain and potentially reduce dumping by providing an additional restrictive component.

A SADI-S provides excellent weight loss also, with similar results to a OAGB with Minimizer ring (improved results with the ring).

Nutritional deficiencies:

The effect on diabetes resolution with both SADI-S and OAGB with Minimizer ring is excellent (slightly better for a SADI-S for severe diabetics), however the concern with SADI-S is the nutritional deficiencies, in particular fat-soluble vitamin and trace elements as well as protein.  This is a draw-back of the SADI-S, and why I favour a OAGB with Minimizer ring.

Safety:

A OAGB with Minimizer is a safe operation, that is reproducible.  The complications of the anastomosis can be managed more effectively and safer, compared to a SADI-S, due to the duodenal anastomosis and duodenal stump.  This is a high risk area to manage if there was an infection, bleeding or a leak.

Reflux:

Reflux with a SADI-S can be an issue, and a bypass would need to be considered.  This can be a significant undertaking, with associated risks involved.  This is compared to a OAGB, which has less risks of acid reflux, and is far easier to convert to a RYGB if bile reflux becomes an issue (low risk).

Diarrhoea:

OAGB patient series tend to report 1-2 bowel motions per day in most patients.  This is compared to a SADI-S which lead to more frequent, looser and foul-smelling stools with urgency.

These are my reasons for providing an OAGB with Minimizer ring for patients, compared to a SADI-S.

This article was written by Dr George Balalis. For further discussion about your options, please arrange for a referral and contact us for an appointment.