Bile Reflux After Single Anastomosis Duodenal-Ileal Bypass with Sleeve (SADI-S): a Meta-analysis of 2,029 Patients

Ray Portela, Katie Marrerro, Ahmet Vahibe, Carlos Galvani, Helmuth Billy, Barham Abu Dayyeh, Benjamin Clapp, Omar M. Ghanem

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background: Single anastomosis duodenal-ileal bypass with sleeve (SADI-S) is a novel bariatric surgery modified from the classic biliopancreatic diversion with duodenal switch (BPD-DS). These surgical modifications address most BPD-DS hurdles, but the risk of bile reflux may hinder SADI-S acceptance. We aimed to evaluate the event rate of bile reflux after SADI-S. Methods: PubMed, ScienceDirect, Cochrane, Web of Science, and Google Scholar were used to search English articles between 2008 and 2021 by two independent reviewers using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). The risk of bias was assessed using Newcastle–Ottawa Scale and the JBI tool. Event rates were meta-analyzed using Comprehensive Meta-Analysis (CME) V3. Results: Out of 3,027 studies analyzed, seven were included. Studies were published between 2010 and 2020. Six out of 7 studies were retrospective. Three studies had a low risk of bias, three studies had a moderate risk of bias, and one had a high risk of bias. The mean follow-up was 10.3 months. The total number of patients was 2,029, with 25 reports of bile reflux, resulting in an incidence of 1.23%, with an event rate of 0.016 (95% CI 0.004 to 0.055). Conclusions: Bile reflux has not been demonstrated to be problematic after SADI-S in this meta-analysis. Further long-term studies are needed. Graphical abstract: [Figure not available: see fulltext.].

Original languageEnglish (US)
Pages (from-to)1516-1522
Number of pages7
JournalObesity Surgery
Issue number5
StatePublished - May 2022
Externally publishedYes


  • Meta-analysis
  • Obesity
  • SADI-S
  • Single anastomosis duodenal-ileal bypass with sleeve
  • Systematic review

ASJC Scopus subject areas

  • Surgery
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics


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