Revisional OAGB Versus SADI-S After Failed Bariatric Surgery: A Comparative Study of Metabolic, Nutritional, and Quality-of-Life Outcomes

Revisional OAGB Versus SADI-S After Failed Bariatric Surgery: A Comparative Study of Metabolic, Nutritional, and Quality-of-Life Outcomes | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Revisional OAGB Versus SADI-S After Failed Bariatric Surgery: A Comparative Study of Metabolic, Nutritional, and Quality-of-Life Outcomes Ivan Kukeev, Yuval Arnon, Sergey Yerep, Illia Vasyliev, Elchanan Quint, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9072993/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background: Revisional bariatric surgery is increasingly performed due to inadequate weight loss, weight regain, or complications following primary bariatric procedures. One anastomotic gastric bypass (OAGB) and single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) are commonly used revisional options, yet comparative data on metabolic, nutritional, and quality-of-life outcomes remain limited. Objective: To compare metabolic, nutritional, perioperative, and quality-of-life outcomes between revisional OAGB and SADI-S. Methods A retrospective comparative cohort study was conducted at a tertiary bariatric center between 2020 and 2025. Adult patients undergoing revisional OAGB or SADI-S after primary failed sleeve gastrectomy were included. Outcomes included weight loss, metabolic and nutritional parameters, perioperative outcomes, complications, and quality of life assessed using BAROS and SF-BARI questionnaires. Results Forty-four patients were included (22 OAGB, 22 SADI-S). At one year, weight loss outcomes were comparable between groups (EWL 43% vs. 37%, p > 0.9; TWL 18% vs. 15%, p = 0.9). SADI-S demonstrated superior lipid profile improvement, including lower total cholesterol (119 vs. 153 mg/dL, p = 0.005) and LDL levels (65 vs. 85 mg/dL, p = 0.032). Vitamin B12 levels were higher after SADI-S (475 vs. 330 pg/mL, p = 0.015), while other nutritional parameters were comparable. Operative time was shorter for OAGB (90 vs. 109 minutes, p = 0.019). Quality-of-life scores were similar between groups. Conclusion Both revisional OAGB and SADI-S are safe and effective procedures with comparable weight loss and quality-of-life outcomes. SADI-S provides greater metabolic benefit, particularly in lipid profile improvement, while OAGB demonstrates a more favorable nutritional profile. Procedure selection should be individualized based on metabolic needs and nutritional risk. Revisional bariatric surgery One-anastomosis gastric bypass Single-anastomosis duodeno-ileal bypass SF-BARI questionnaire Figures Figure 1 Figure 2 Introduction The increasing prevalence of obesity has resulted in a growing number of patients undergoing primary bariatric surgery (PBS). Although these procedures provide effective weight loss and metabolic improvement, a substantial proportion of patients develop inadequate weight loss, weight regain, or procedure-related complications, ultimately requiring revisional bariatric surgery [ 1 ]. As a result, revisional procedures now represent a significant and expanding component of modern metabolic surgery. Following failed restrictive procedures, particularly sleeve gastrectomy, one anastomotic gastric bypass (OAGB) and single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) are increasingly employed revisional options. While both techniques offer favorable metabolic outcomes and technical simplicity, the optimal revisional approach remains debated due to differences in malabsorption, nutritional risk, and long-term patient-centered outcomes [ 2 ]. Most existing studies have focused primarily on weight loss and metabolic parameters, whereas patient-reported outcomes, especially quality of life, remain insufficiently explored in the revisional setting [ 3 ]. Furthermore, reliance on single assessment tools limits the comprehensive evaluation of postoperative patient experience. Recently, the Swiss-Finnish Bariatric Metabolic Outcome Score (SF-BARI) has been introduced as a bariatric surgery–specific instrument designed to more accurately capture postoperative quality of life and functional outcomes, complementing established scoring systems [ 4 ]. This study compares revisional OAGB and SADI-S in terms of perioperative outcomes, weight loss, metabolic and nutritional parameters, and postoperative morbidity. Importantly, quality of life was assessed using two validated instruments—the BAROS score and the newly implemented SF-BARI questionnaire—allowing for a more comprehensive evaluation of patient-reported outcomes following revisional bariatric surgery. This study was conducted in accordance with the STROCSS guidelines. Method This retrospective comparative cohort study was conducted at the Bariatric Surgery Unit, Soroka University Medical Center, a tertiary referral center between January 2020 and December 2025. Adult patients who underwent revisional surgery following failed primary bariatric surgery (PBS) were included. All patients included in the study underwent sleeve gastrectomy as their primary bariatric surgery. Failure of PBS was defined as insufficient weight loss, significant weight regain, or procedure-related complications requiring revision. Patients undergoing revisional OAGB or single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) were eligible. Patients with incomplete follow-up or missing key clinical data were excluded. During the study period, 49 patients underwent revisional surgery. The 5 patients were excluded due to incomplete data ( Fig. 1 ) . -Surgical Technique One anastomotic gastric bypass (OAGB). The procedure was performed laparoscopically with creation of a long, narrow gastric pouch along the lesser curvature. A single antecolic gastrojejunostomy was constructed to a jejunal loop with a biliopancreatic limb length of 200 cm, according to institutional protocol and patient characteristics. The common channel was not divided, resulting in a moderate malabsorptive component. Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). SADI-S was performed laparoscopically as a revisional procedure. A sleeve gastrectomy was present from the primary operation or revised when required. The duodenum was transected distal to the pylorus, and a single end-to-side duodenoileal anastomosis was created, preserving a common channel of approximately 250–300 cm, measured from the ileocecal valve. This configuration provides a greater hypoabsorptive effect while maintaining pyloric function. Demographic data, perioperative variables, and postoperative outcomes were extracted from electronic medical records. Weight-loss outcomes included percentage excess weight loss (EWL%) and total weight loss (TWL%). Metabolic and nutritional parameters were assessed using routine laboratory tests. Postoperative complications were recorded and classified according to the Clavien–Dindo classification. Quality of life was assessed using two validated instruments: the Bariatric Analysis and Reporting Outcome System (BAROS) and the SF-BARI questionnaire, a bariatric surgery–specific patient-reported outcome measure. This study was approved by the Helsinki Committee of Soroka University Medical Center (approval number: 0291-21-SOR). Informed consent was waived due to the retrospective study design. Statistical Analysis Continuous variables were summarized as median and interquartile range (IQR), and categorical variables as counts and percentages. Comparisons between the OAGB and SADI-S groups were performed using the Wilcoxon rank-sum test for continuous variables and Fisher’s exact test for categorical variables. All tests were two-sided, and a p-value < 0.05 was considered statistically significant. All statistical analyses were performed using R software (version 4.5). Results A total of 44 patients undergoing revisional bariatric surgery were included in the analysis, with 22 patients in the OAGB group and 22 patients in the SADI-S group. Baseline demographic characteristics were comparable between groups. Median age was 45 years (IQR 34–55) in the OAGB group and 39 years (IQR 26–48) in the SADI-S group (p = 0.2). Gender distribution did not differ significantly between groups (p = 0.3). Pre-revisional BMI, excess weight loss (EWL), total weight loss (TWL), and time from primary bariatric surgery were similar between cohorts. Hypertension prevalence differed significantly between groups, with a higher proportion of patients with elevated blood pressure in the OAGB group compared with the SADI-S group (52% vs. 18%, p = 0.031). Smoking status showed no statistically significant difference (p = 0.095). Detailed baseline demographic data are presented in Table 1. Variable OAGB, n = 22 SADI-S, n = 22 p-value Age, years 45 (34, 55) 39 (26, 48) 0.2 Male, n (%) 8 (36%) 4 (19%) 0.3 Female, n (%) 14 (64%) 17 (81%) 0.3 Smoker, n (%) 6 (27%) 1 (4.5%) 0.095 BMI after primary surgery, kg/m 2 42 (40, 45) 43 (38, 47) 0.9 EWL (%) after primary surgery 47 (28, 89) 43 (20, 64) 0.3 TWL (%) after primary surgery 18 (13, 31) 16 (9, 28) 0.6 Time from primary surgery, months 48 (37, 81) 60 (47, 86) 0.5 Hypertension, n (%) 11 (52%) 4 (18%) 0.031 Table 1. Baseline demographic and clinical characteristics. Post-primary bariatric surgery metabolic parameters were largely comparable between the two groups. No statistically significant differences were observed in HbA1c, triglycerides, total cholesterol, LDL, HDL, hemoglobin, ferritin, iron, vitamin B12, vitamin D, or albumin levels. Total protein levels were significantly lower in the SADI-S group compared with the OAGB group (median 6.75 vs. 7.30 g/dL, p = 0.001). All other assessed nutritional parameters showed no significant intergroup differences. These findings are summarized in Table 2. Table 2. Metabolic and nutritional parameters after primary bariatric surgery. The primary indication for revisional surgery in both groups was weight regain, accounting for 73% of cases in the OAGB group and 95% in the SADI-S group (p = 0.058). All patients underwent the planned revisional procedure according to group allocation. Median operative time was significantly shorter in the OAGB group compared with the SADI-S group (90 vs. 109 minutes, p = 0.019). Intraoperative complications were rare, with one intraoperative leak reported in the SADI-S group. Length of hospital stay did not differ significantly between groups. Postoperative complication rates were low and comparable, with no statistically significant differences observed. Rehospitalizations and emergency department visits during follow-up were minimal and similar between groups. Operative and postoperative outcomes are detailed in Table 3. Variable OAGB, n = 22 SADI-S, n = 22 p-value Indication for revisional surgery 0.058 Weight regain (± GERD) 16 (72.7%) 22 (100%) GERD / reflux-related 4 (18.2%) 0 Mechanical complications* 2 (9.1%) 0 Operative time (min) 90 (57–105) 109 (88–116) 0.019 Intraoperative complications >0.9 Any intraoperative complication 0 1 (4.5%) Additional procedures 0.072 Any additional procedure 7 (32%) 3 (14%) Length of stay (days) 4.0 (3.0–5.0) 3.5 (3.0–4.0) 0.4 Postoperative complications 0.2 Any postoperative complication 3 (13.6%) 2 (9.1%) Severe nutritional complication** 0 (0%) 1 (4.5%) Rehospitalizations (count) 0 0 0.7 ED visits / hospitalizations (count) 0 0 0.7 Follow-up duration (months) 31 (16–57) 27 (15–39) 0.4 Table 3. Indications, operative details, and short-term outcomes of revisional surgery. * Mechanical complications include twisted sleeve or anastomotic stricture. ** Severe nutritional complications defined as hypoalbuminemia, osteoporosis, or iron-deficiency anemia requiring treatment. Quality of life assessment demonstrated no statistically significant differences between groups. Median BAROS quality-of-life scores and SF-BARI total and subscale scores were comparable between OAGB and SADI-S patients. These results are presented in Table 4 . Table 4. Quality of life outcomes following revisional bariatric surgery. One year after revisional bariatric surgery, weight loss outcomes were comparable between groups (Table 5) . Median excess weight loss (EWL) was 43% (IQR 25–59) in the OAGB group and 37% (20–64) in the SADI-S group (p > 0.9). Similarly, total weight loss (TWL) did not differ significantly (18% [9–23] vs. 15% [9–28], p = 0.9). Body mass index (BMI) at one year was also similar between groups (37 [30–43] vs. 38 [32–40] kg/m², p = 0.9). Regarding lipid profile, patients in the SADI-S group demonstrated significantly lower total cholesterol levels compared with the OAGB group (119 [92–144] vs. 153 [141–169] mg/dL, p = 0.005), as well as lower LDL cholesterol levels (65 [49–85] vs. 85 [72–93] mg/dL, p = 0.032). Triglyceride and HDL cholesterol levels were comparable between groups. Hematologic and nutritional parameters at one year showed no significant differences between groups for hemoglobin, ferritin, iron, total protein, albumin, or vitamin D levels. However, vitamin B12 levels were significantly higher in the SADI-S group compared with the OAGB group (475 [436–700] vs. 330 [268–481] pg/mL, p = 0.015). Glycemic control at one year, assessed by HbA1c, was similar between the two procedures (4.80% [4.45–5.18] vs. 5.35% [4.93–5.95], p = 0.3). Variable OAGB , n = 22 SADI-S , n = 22 p-value EWL (%) 43 (25, 59) 37 (20, 64) >0.9 TWL (%) 18 (9, 23) 15 (9, 28) 0.9 BMI, kg/m 2 37 (30,43) 38 (32,40) 0.9 Triglycerides, mg/dl 90 (70, 133) 70 (54, 130) 0.3 Cholesterol, mg/dl 153 (141, 169) 119 (92, 144) 0.005 LDL, mg/dl 85 (72, 93) 65 (49, 85) 0.032 HDL, mg/dl 44 (40, 54) 43 (37, 51) 0.7 Hb, gr/dl 12.30 (11.08, 13.75) 11.70 (11.08, 12.30) 0.2 Ferritin, ng/ml 21 (9, 129) 27 (14, 150) 0.5 Iron, mcg/dl 40 (21, 62) 57 (44, 65) 0.13 VIT B12, pg/ml 330 (268, 481) 475 (436, 700) 0.015 VIT D, nmol/l 49 (36, 64) 31 (25, 57) 0.13 Total Protein, gr/dl 6.90 (6.60, 7.10) 6.60 (6.28, 6.90) 0.2 Albumin, gr/dl 4.00 (3.70, 4.30) 3.65 (3.25, 3.95) 0.2 HbA1c, % 5.35 (4.93, 5.95) 4.80 (4.45, 5.18) 0.3 Table 5. One-year metabolic and nutritional outcomes after revisional bariatric surgery. Figure 2 presents a two-panel forest plot illustrating between-group differences in metabolic and nutritional parameters at one-year follow-up after revisional bariatric surgery, comparing SADI-S and OAGB. In the metabolic panel, patients undergoing SADI-S demonstrated lower median levels of total cholesterol, LDL cholesterol, and triglycerides compared to OAGB, as reflected by negative median differences. HDL cholesterol levels were also slightly lower in the SADI-S group. In contrast, HbA1c levels were marginally higher following SADI-S compared to OAGB. However, most metabolic parameters showed confidence intervals crossing zero, indicating no statistically significant differences between procedures. In the nutritional panel, SADI-S was associated with lower median levels of hemoglobin, albumin, total protein, and vitamin D, suggesting a greater nutritional impact compared to OAGB. Iron and ferritin levels were also lower after SADI-S. Conversely, vitamin B12 levels were higher in the SADI-S group. Among nutritional parameters, vitamin B12 demonstrated a statistically significant higher level after SADI-S, whereas the remaining variables did not reach statistical significance. Overall, the forest plot demonstrates a trend toward greater metabolic improvement but more pronounced nutritional deficiencies following SADI-S compared to OAGB. Discussion This study represents one of the few direct comparative analyses of revisional OAGB and SADI-S incorporating both metabolic and validated quality-of-life outcomes. Importantly, this study addresses a critical gap in the literature, as direct comparisons between these procedures in the revisional setting remain limited, particularly with respect to nutritional safety and patient-reported outcomes. Our findings demonstrate that both procedures achieve comparable weight loss and quality-of-life outcomes, while SADI-S provides greater lipid profile improvement at the expense of a more pronounced nutritional impact. In our cohort, excess weight loss and total weight loss at one year did not differ significantly between the procedures (EWL 43% vs 37%, TWL 18% vs 15%, p > 0.9), suggesting comparable effectiveness in achieving weight reduction. These findings are consistent with the systematic review by Sorto et al., which demonstrated comparable weight loss but higher nutritional risk following SADI-S. [ 5 ]. Several studies have demonstrated that revisional OAGB achieves EWL ranging between 40% and 70% at one year, with favorable long-term durability [ 2 , 6 ]. Similarly, Sánchez-Pernaute et al. reported that SADI-S achieves substantial weight loss, with excess weight loss exceeding 60% in primary procedures and favorable outcomes in revisional settings as well [ 3 ]. Importantly, some studies suggest that SADI-S may achieve superior weight loss compared with OAGB due to its longer biliopancreatic limb and greater malabsorptive component [ 7 , 8 ]. The absence of significant differences in weight loss between procedures in our study may be explained by the revisional setting. Unlike primary bariatric surgery, revisional procedures are performed in patients with altered gastrointestinal anatomy, prior metabolic adaptation, and potential behavioral factors contributing to weight regain. These factors may attenuate the expected differences in malabsorptive effect between procedures. Additionally, limb lengths in revisional surgery may be adjusted to balance efficacy and safety, potentially reducing differences in weight-loss outcomes. A key finding of our study was the significantly greater improvement in lipid profile following SADI-S, with lower total cholesterol (119 vs 153 mg/dL, p = 0.005) and LDL cholesterol levels (65 vs 85 mg/dL, p = 0.032). These findings are consistent with previous studies demonstrating superior metabolic effects of more hypoabsorptive procedures. Malabsorptive procedures have been shown to produce greater reductions in cholesterol levels through mechanisms including decreased lipid absorption, alterations in bile acid metabolism, and hormonal changes affecting lipid metabolism [ 9 , 10 ]. Specifically, SADI-S has been associated with significant improvement in dyslipidemia and cardiovascular risk factors due to its greater bypassed intestinal length and increased malabsorptive effect [ 3 , 11 ]. The superior lipid profile improvement observed following SADI-S is likely related to its greater hypoabsorptive component, resulting in reduced lipid absorption. In addition, altered bile acid circulation and hormonal changes, including increased GLP-1 secretion, may contribute to improved lipid metabolism. These mechanisms have been previously described following more extensive intestinal bypass procedures and may explain the metabolic advantage observed with SADI-S. Interestingly, glycemic control was comparable between groups in our study, with no significant difference in HbA1c levels. This finding suggests that both procedures provide effective metabolic improvement, consistent with prior studies showing that bariatric surgery improves insulin sensitivity and glycemic control through both weight-dependent and weight-independent mechanisms [ 12 ]. Our study demonstrated a trend toward greater nutritional impact following SADI-S, including lower total protein levels after primary surgery and trends toward lower albumin, hemoglobin, and vitamin D levels at follow-up. These findings are consistent with the known nutritional risks associated with malabsorptive procedures. Previous studies have reported higher rates of protein malnutrition and micronutrient deficiencies following hypoabsorptive procedures such as biliopancreatic diversion and SADI-S [ 11 , 13 ]. Protein malnutrition following hypoabsorptive procedures is primarily related to reduced intestinal absorptive surface and inadequate protein intake [ 14 ]. Similarly, vitamin deficiencies, including iron, vitamin D, and fat-soluble vitamins, are well-documented complications following malabsorptive bariatric procedures [ 15 ]. Importantly, despite these trends, severe nutritional complications were rare in our cohort, suggesting that appropriate follow-up and supplementation can mitigate these risks. Interestingly, vitamin B12 levels were significantly higher in the SADI-S group in our study. This may reflect differences in supplementation protocols, adherence, or follow-up rather than intrinsic procedural differences. The greater nutritional impact observed following SADI-S is consistent with its longer bypassed intestinal segment and greater malabsorptive effect. Although severe complications were rare in our cohort, these findings highlight the importance of careful patient selection, structured postoperative follow-up, and lifelong nutritional supplementation. This consideration is particularly relevant in revisional patients, who may already be at increased nutritional risk due to prior surgery. Operative time was significantly shorter for OAGB compared with SADI-S (90 vs 109 minutes, p = 0.019), reflecting the greater technical complexity of SADI-S. This finding is consistent with prior studies demonstrating that SADI-S requires more extensive dissection and intestinal reconstruction [ 3 ]. Importantly, complication rates were low and comparable between procedures in our study. These findings align with previous reports showing that both OAGB and SADI-S are safe revisional procedures when performed in experienced centers [ 6 , 11 ]. In our study we used two validated quality-of-life instruments, including the newly developed SF-BARI questionnaire [ 4 ]. Our results demonstrated comparable quality-of-life outcomes between procedures, consistent with previous studies showing that bariatric surgery improves quality of life regardless of procedure type [ 16 ]. The absence of significant differences suggests that both procedures provide similar patient-perceived benefits despite physiological differences. This finding is particularly important because patient-reported outcomes are increasingly recognized as essential endpoints in bariatric surgery evaluation. Our findings are consistent with previous studies demonstrating effective weight loss and metabolic improvement following both revisional OAGB and SADI-S. However, most prior studies have focused primarily on weight loss outcomes, with limited evaluation of nutritional parameters and patient-reported quality-of-life outcomes. The inclusion of comprehensive metabolic, nutritional, and quality-of-life assessment in the present study provides a more complete understanding of the comparative benefits and risks of these revisional procedures. These findings have important implications for clinical decision-making. In patients with severe metabolic disease, particularly dyslipidemia, SADI-S may offer greater metabolic benefit. Conversely, in patients at increased risk of nutritional deficiencies, including older patients or those with pre-existing deficiencies, OAGB may represent a safer revisional option. Therefore, revisional procedure selection should be individualized based on patient-specific metabolic needs and nutritional risk profile. This study has several important strengths. It provides a comprehensive evaluation of revisional OAGB and SADI-S, incorporating metabolic, nutritional, perioperative, and patient-reported quality-of-life outcomes. The use of both the established BAROS score and the recently validated SF-BARI questionnaire allows for a more detailed and procedure-specific assessment of postoperative quality of life. Additionally, all procedures were performed in a single high-volume tertiary bariatric center using standardized surgical techniques and follow-up protocols, ensuring consistency in perioperative management and outcome assessment. This multidimensional evaluation provides clinically relevant insight into the balance between metabolic effectiveness and nutritional safety in revisional bariatric surgery. Several limitations should be acknowledged. First, the retrospective design introduces the potential for selection bias and limits the ability to establish causal relationships. Second, the relatively small sample size reduces statistical power and may limit the detection of smaller but clinically relevant differences between procedures. Third, the follow-up duration was limited to one year, which may not fully capture long-term metabolic outcomes, nutritional deficiencies, or durability of weight loss. Finally, as this was a single-center study, the generalizability of the findings to other institutions and patient populations may be limited. No formal sample size calculation was performed due to retrospective design. Conclusion In conclusion, both revisional OAGB and SADI-S are safe and effective revisional bariatric procedures, achieving comparable weight loss and quality-of-life outcomes at one year. SADI-S was associated with superior improvement in lipid profile, whereas OAGB demonstrated a more favorable nutritional profile. These findings support an individualized approach to revisional bariatric surgery, balancing metabolic benefits against potential nutritional risks. Larger prospective studies with longer follow-up are needed to further define the optimal revisional strategy. Abbreviations BMI – Body Mass Index BAROS – Bariatric Analysis and Reporting Outcome System CI – Confidence Interval ED – Emergency Department EWL – Excess Weight Loss GERD – Gastroesophageal Reflux Disease Hb – Hemoglobin HbA1c – Glycated Hemoglobin HDL – High-Density Lipoprotein IQR – Interquartile Range LDL – Low-Density Lipoprotein MGB – Mini-Gastric Bypass OAGB – One-Anastomosis Gastric Bypass PBS – Primary Bariatric Surgery QoL – Quality of Life SADI-S – Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy SF-BARI – Swiss-Finnish Bariatric Metabolic Outcome Score TWL – Total Weight Loss Declarations Declaration of competing interest The authors of this manuscript have no related conflicts of interest to declare. Funding The authors have no funding sources to report. Author Contribution Dr. Ivan Kukeev – conceptualization, investigation, writing and original draft preparation.Mr. Yuval Arnon – data analysis. As agreed at the beginning of the study, Mr. Yuval Arnon should be listed as the second author with an asterisk, indicating equal contribution.Dr. Sergey Yerep - data analysis.Dr. Illia Vasyliev – data analysis.Dr. Elchanan Quint – supervision, resources.Dr. Sofyan Abu Freih - data analysis and editingMrs. Karina Fishman – data analysis.Dr. Anton Osyntsov – formal analysis and editing of the manuscript.Prof. Zvi Perry - supervision, resourcesDr. Oleg Dukhno – critical revision and final approval of the version to be published. References Angrisani L, Santonicola A, Iovino P, Vitiello A, Higa K, Himpens J, Buchwald H, Scopinaro N. IFSO Worldwide Survey 2016: Primary, Endoluminal, and Revisional Procedures. Obes Surg. 2018 Dec;28(12):3783-3794. doi: 10.1007/s11695-018-3450-2. PMID: 30121858. Mahawar KK, Jennings N, Brown J, Gupta A, Balupuri S, Small PK. "Mini" gastric bypass: systematic review of a controversial procedure. Obes Surg. 2013 Nov;23(11):1890-8. doi: 10.1007/s11695-013-1026-8. PMID: 23934271. Sánchez-Pernaute A, Herrera MA, Pérez-Aguirre ME, Talavera P, Cabrerizo L, Matía P, Díez-Valladares L, Barabash A, Martín-Antona E, García-Botella A, Garcia-Almenta EM, Torres A. Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). One to three-year follow-up. Obes Surg. 2010 Dec;20(12):1720-6. doi: 10.1007/s11695-010-0247-3. PMID: 20798995. Bruinsma FFE, Hurme S, Peterli R, Stenberg E, Nienhuijs SW, Grönroos S, Våge V, Bueter M, Ottosson J, Liem RSL, Salminen P. Validation of the Swiss-Finnish Bariatric Metabolic Outcome Score within a large prospective registry cohort. Br J Surg. 2025 May 31;112(6):znaf106. doi: 10.1093/bjs/znaf106. PMID: 40448630. Sorto H, Vilallonga R. SADI-S vs OAGB as a revisional procedure after sleeve gastrectomy: systematic review. BMI J. 2023; doi:10.53435/funj.00890. Parmar C, Abdelhalim MA, Mahawar KK, Boyle M, Carr WRJ, Jennings N, Small PK. Management of super-super obese patients: comparison between one anastomosis (mini) gastric bypass and Roux-en-Y gastric bypass. Surg Endosc. 2017 Sep;31(9):3504-3509. doi: 10.1007/s00464-016-5376-x. Epub 2016 Dec 15. PMID: 27981383. Zaveri H, Surve A, Cottam D, Cottam A, Medlin W, Richards C, Belnap L, Cottam S, Horsley B. Mid-term 4-Year Outcomes with Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy Surgery at a Single US Center. Obes Surg. 2018 Oct;28(10):3062-3072. doi: 10.1007/s11695-018-3358-x. PMID: 29909514. McLennan, S., Verhoeff, K., Mocanu, V. et al. Characteristics and outcomes for patients undergoing revisional bariatric surgery due to persistent obesity: a retrospective cohort study of 10,589 patients. Surg Endosc 37, 4613–4622 (2023). https://doi.org/10.1007/s00464-023-09951-6. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004 Oct 13;292(14):1724-37. doi: 10.1001/jama.292.14.1724. Erratum in: JAMA. 2005 Apr 13;293(14):1728. PMID: 15479938. Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Leccesi L, Nanni G, Pomp A, Castagneto M, Ghirlanda G, Rubino F. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012 Apr 26;366(17):1577-85. doi: 10.1056/NEJMoa1200111. Epub 2012 Mar 26. PMID: 22449317. Surve A, Cottam D, Medlin W, Richards C, Belnap L, Horsley B, Cottam S, Cottam A. Long-term outcomes of primary single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). Surg Obes Relat Dis. 2020 Nov;16(11):1638-1646. doi: 10.1016/j.soard.2020.07.019. Epub 2020 Jul 31. PMID: 32843266. Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A, Brethauer SA, Navaneethan SD, Singh RP, Pothier CE, Nissen SE, Kashyap SR; STAMPEDE Investigators. Bariatric Surgery versus Intensive Medical Therapy for Diabetes - 5-Year Outcomes. N Engl J Med. 2017 Feb 16;376(7):641-651. doi: 10.1056/NEJMoa1600869. PMID: 28199805; PMCID: PMC5451258. Topart P, Becouarn G. The single anastomosis duodenal switch modifications: a review of the current literature on outcomes. Surg Obes Relat Dis. 2017 Aug;13(8):1306-1312. doi: 10.1016/j.soard.2017.04.027. Epub 2017 Apr 27. PMID: 28602793. Scopinaro N, Gianetta E, Friedman D, Adami GF, Traverso E, Vitale B, Castagnola M, Semino G, Summa M, Bachi V. Surgical revision of biliopancreatic diversion. Gastroenterol Clin North Am. 1987 Sep;16(3):529-31. PMID: 3436660. Stein J, Stier C, Raab H, Weiner R. Review article: The nutritional and pharmacological consequences of obesity surgery. Aliment Pharmacol Ther. 2014 Sep;40(6):582-609. doi: 10.1111/apt.12872. Epub 2014 Jul 30. PMID: 25078533. Kolotkin RL, Norquist JM, Crosby RD, Suryawanshi S, Teixeira PJ, Heymsfield SB, Erondu N, Nguyen AM. One-year health-related quality of life outcomes in weight loss trial participants: comparison of three measures. Health Qual Life Outcomes. 2009 Jun 9;7:53. doi: 10.1186/1477-7525-7-53. PMID: 19505338; PMCID: PMC2700089. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9072993","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":609052194,"identity":"0111fead-afff-41b2-97ea-e52d735daeda","order_by":0,"name":"Ivan Kukeev","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIiWNgGAWjYBAC+R4GZiiTsfHABwMGGSDLAK8WNh6EloaDMwwYeEjRwsBwGKieGC1njA0+VBy2W9t+uOGwTYEdD79E8gaGHxXbcGvh7TFOnHHmcPK2M4kNh3MMknkkZ6QVMPacuY1bCz+P8WHetrRkswNgLQd4DG7kGDAzthHQ8vcfUMv5hw2HLYjSAnRYMmODjZ3ZDaAtDERp4TlWbNhzzCbB7MbDhoM9IL/0PCs4iM8v8j3JmyV+1EjYm51Pf/jgxx87OX725I0PflTg1gIDiQ3IvAME1QOBPTGKRsEoGAWjYIQCAN8PV2t6IRGzAAAAAElFTkSuQmCC","orcid":"","institution":"Soroka Hospital","correspondingAuthor":true,"prefix":"","firstName":"Ivan","middleName":"","lastName":"Kukeev","suffix":""},{"id":609052195,"identity":"f7dbc26e-8ad5-44b6-a79a-c34047aa4125","order_by":1,"name":"Yuval Arnon","email":"","orcid":"","institution":"Ben-Gurion University of the Negev","correspondingAuthor":false,"prefix":"","firstName":"Yuval","middleName":"","lastName":"Arnon","suffix":""},{"id":609052196,"identity":"f9354db7-9fb0-4d24-a7be-e8d90b7e7fdc","order_by":2,"name":"Sergey Yerep","email":"","orcid":"","institution":"Soroka Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sergey","middleName":"","lastName":"Yerep","suffix":""},{"id":609052197,"identity":"64792423-35b4-48c1-8a7c-a3b9f43d3582","order_by":3,"name":"Illia Vasyliev","email":"","orcid":"","institution":"Soroka Hospital","correspondingAuthor":false,"prefix":"","firstName":"Illia","middleName":"","lastName":"Vasyliev","suffix":""},{"id":609052198,"identity":"b027c9bc-b333-4e14-a389-d068f1c35188","order_by":4,"name":"Elchanan Quint","email":"","orcid":"","institution":"Soroka Hospital","correspondingAuthor":false,"prefix":"","firstName":"Elchanan","middleName":"","lastName":"Quint","suffix":""},{"id":609052199,"identity":"16a8c6ab-6bda-4416-9963-a1320d1b6fa1","order_by":5,"name":"Sofyan Abu Freih","email":"","orcid":"","institution":"Soroka Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sofyan","middleName":"Abu","lastName":"Freih","suffix":""},{"id":609052200,"identity":"652d2dab-0955-481a-b4cd-dd42440a2dc7","order_by":6,"name":"Karina Fishman","email":"","orcid":"","institution":"Soroka Hospital","correspondingAuthor":false,"prefix":"","firstName":"Karina","middleName":"","lastName":"Fishman","suffix":""},{"id":609052201,"identity":"43c7a014-3ddf-4e12-8554-14216b6bfc32","order_by":7,"name":"Anton Osyntsov","email":"","orcid":"","institution":"Soroka Hospital","correspondingAuthor":false,"prefix":"","firstName":"Anton","middleName":"","lastName":"Osyntsov","suffix":""},{"id":609052202,"identity":"7fad5205-5db4-47cd-8d71-84c55903370b","order_by":8,"name":"Zvi Perry","email":"","orcid":"","institution":"Soroka Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zvi","middleName":"","lastName":"Perry","suffix":""},{"id":609052203,"identity":"9bc7c2c2-4e3c-4ffa-9d9c-8aebd20802e6","order_by":9,"name":"Oleg Dukhno","email":"","orcid":"","institution":"Soroka Hospital","correspondingAuthor":false,"prefix":"","firstName":"Oleg","middleName":"","lastName":"Dukhno","suffix":""}],"badges":[],"createdAt":"2026-03-09 12:38:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9072993/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9072993/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105149562,"identity":"d3f50c0d-e5cd-4fe3-8244-de7fd48813c8","added_by":"auto","created_at":"2026-03-22 14:56:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":56756,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram of patient selection.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9072993/v1/f0fc22a7ff4f8f5773957fa4.png"},{"id":105149563,"identity":"ac5636e6-a9c1-4df3-833a-2e927cf81495","added_by":"auto","created_at":"2026-03-22 14:56:18","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":221931,"visible":true,"origin":"","legend":"\u003cp\u003eTwo-panel forest plot demonstrating between-group differences in metabolic (Panel A) and nutritional (Panel B) parameters following SADI-S versus Mini-Gastric Bypass. Points represent median differences (SADI-S minus Mini-Gastric Bypass), with horizontal bars indicating approximate 95% confidence intervals derived from interquartile ranges. Diamond markers denote statistically significant differences (p \u0026lt; 0.05). Positive values indicate higher levels after SADI-S.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9072993/v1/328f233cbaab6ee76834475f.png"},{"id":105563281,"identity":"2b850197-7b81-4138-9807-916261876e37","added_by":"auto","created_at":"2026-03-27 12:46:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1190710,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9072993/v1/fc2260c8-4bf6-4f77-ba99-d21063ba1ebb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Revisional OAGB Versus SADI-S After Failed Bariatric Surgery: A Comparative Study of Metabolic, Nutritional, and Quality-of-Life Outcomes","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe increasing prevalence of obesity has resulted in a growing number of patients undergoing primary bariatric surgery (PBS). Although these procedures provide effective weight loss and metabolic improvement, a substantial proportion of patients develop inadequate weight loss, weight regain, or procedure-related complications, ultimately requiring revisional bariatric surgery [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. As a result, revisional procedures now represent a significant and expanding component of modern metabolic surgery. Following failed restrictive procedures, particularly sleeve gastrectomy, one anastomotic gastric bypass (OAGB) and single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) are increasingly employed revisional options. While both techniques offer favorable metabolic outcomes and technical simplicity, the optimal revisional approach remains debated due to differences in malabsorption, nutritional risk, and long-term patient-centered outcomes [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Most existing studies have focused primarily on weight loss and metabolic parameters, whereas patient-reported outcomes, especially quality of life, remain insufficiently explored in the revisional setting [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Furthermore, reliance on single assessment tools limits the comprehensive evaluation of postoperative patient experience. Recently, the Swiss-Finnish Bariatric Metabolic Outcome Score (SF-BARI) has been introduced as a bariatric surgery\u0026ndash;specific instrument designed to more accurately capture postoperative quality of life and functional outcomes, complementing established scoring systems [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study compares revisional OAGB and SADI-S in terms of perioperative outcomes, weight loss, metabolic and nutritional parameters, and postoperative morbidity. Importantly, quality of life was assessed using two validated instruments\u0026mdash;the BAROS score and the newly implemented SF-BARI questionnaire\u0026mdash;allowing for a more comprehensive evaluation of patient-reported outcomes following revisional bariatric surgery. This study was conducted in accordance with the STROCSS guidelines.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eThis retrospective comparative cohort study was conducted at the Bariatric Surgery Unit, Soroka University Medical Center, a tertiary referral center between January 2020 and December 2025. Adult patients who underwent revisional surgery following failed primary bariatric surgery (PBS) were included. All patients included in the study underwent sleeve gastrectomy as their primary bariatric surgery. Failure of PBS was defined as insufficient weight loss, significant weight regain, or procedure-related complications requiring revision. Patients undergoing revisional OAGB or single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) were eligible. Patients with incomplete follow-up or missing key clinical data were excluded. During the study period, 49 patients underwent revisional surgery. The 5 patients were excluded due to incomplete data \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e-Surgical Technique\u003c/h2\u003e \u003cp\u003e \u003cb\u003eOne anastomotic gastric bypass (OAGB).\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe procedure was performed laparoscopically with creation of a long, narrow gastric pouch along the lesser curvature. A single antecolic gastrojejunostomy was constructed to a jejunal loop with a biliopancreatic limb length of 200 cm, according to institutional protocol and patient characteristics. The common channel was not divided, resulting in a moderate malabsorptive component.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSingle-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S).\u003c/b\u003e \u003c/p\u003e \u003cp\u003eSADI-S was performed laparoscopically as a revisional procedure. A sleeve gastrectomy was present from the primary operation or revised when required. The duodenum was transected distal to the pylorus, and a single end-to-side duodenoileal anastomosis was created, preserving a common channel of approximately 250\u0026ndash;300 cm, measured from the ileocecal valve. This configuration provides a greater hypoabsorptive effect while maintaining pyloric function.\u003c/p\u003e \u003cp\u003eDemographic data, perioperative variables, and postoperative outcomes were extracted from electronic medical records. Weight-loss outcomes included percentage excess weight loss (EWL%) and total weight loss (TWL%). Metabolic and nutritional parameters were assessed using routine laboratory tests. Postoperative complications were recorded and classified according to the Clavien\u0026ndash;Dindo classification. Quality of life was assessed using two validated instruments: the Bariatric Analysis and Reporting Outcome System (BAROS) and the SF-BARI questionnaire, a bariatric surgery\u0026ndash;specific patient-reported outcome measure. This study was approved by the Helsinki Committee of Soroka University Medical Center (approval number: 0291-21-SOR). Informed consent was waived due to the retrospective study design.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eContinuous variables were summarized as median and interquartile range (IQR), and categorical variables as counts and percentages. Comparisons between the OAGB and SADI-S groups were performed using the Wilcoxon rank-sum test for continuous variables and Fisher\u0026rsquo;s exact test for categorical variables. All tests were two-sided, and a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. All statistical analyses were performed using R software (version 4.5).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 44 patients undergoing revisional bariatric surgery were included in the analysis, with 22 patients in the OAGB group and 22 patients in the SADI-S group. Baseline demographic characteristics were comparable between groups. Median age was 45 years (IQR 34\u0026ndash;55) in the OAGB group and 39 years (IQR 26\u0026ndash;48) in the SADI-S group (p = 0.2). Gender distribution did not differ significantly between groups (p = 0.3). Pre-revisional BMI, excess weight loss (EWL), total weight loss (TWL), and time from primary bariatric surgery were similar between cohorts. Hypertension prevalence differed significantly between groups, with a higher proportion of patients with elevated blood pressure in the OAGB group compared with the SADI-S group (52% vs. 18%, p = 0.031). Smoking status showed no statistically significant difference (p = 0.095). Detailed baseline demographic data are presented in\u003cstrong\u003e\u0026nbsp;Table 1.\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOAGB,\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en = 22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSADI-S,\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en = 22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e45 (34, 55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e39 (26, 48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eMale, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e8 (36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e4 (19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eFemale, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e14 (64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e17 (81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eSmoker, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e6 (27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e1 (4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.095\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eBMI after primary surgery, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e42 (40, 45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e43 (38, 47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eEWL (%) after primary surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e47 (28, 89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e43 (20, 64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eTWL (%) after primary surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e18 (13, 31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e16 (9, 28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eTime from primary surgery, months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e48 (37, 81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e60 (47, 86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eHypertension, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e11 (52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e4 (18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.031\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eBaseline demographic and clinical characteristics.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePost-primary bariatric surgery metabolic parameters were largely comparable between the two groups. No statistically significant differences were observed in HbA1c, triglycerides, total cholesterol, LDL, HDL, hemoglobin, ferritin, iron, vitamin B12, vitamin D, or albumin levels. Total protein levels were significantly lower in the SADI-S group compared with the OAGB group (median 6.75 vs. 7.30 g/dL, p = 0.001). All other assessed nutritional parameters showed no significant intergroup differences. These findings are summarized in\u003cstrong\u003e\u0026nbsp;Table 2.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cimg src=\"https://myfiles.space/user_files/58895_8739fc6c57c1c19a/58895_custom_files/img1774028724.png\" width=\"755\" height=\"696\"\u003e\u003c/strong\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eMetabolic and nutritional parameters after primary bariatric surgery.\u003c/p\u003e\n\u003cp\u003eThe primary indication for revisional surgery in both groups was weight regain, accounting for 73% of cases in the OAGB group and 95% in the SADI-S group (p = 0.058). All patients underwent the planned revisional procedure according to group allocation. Median operative time was significantly shorter in the OAGB group compared with the SADI-S group (90 vs. 109 minutes, p = 0.019). Intraoperative complications were rare, with one intraoperative leak reported in the SADI-S group. Length of hospital stay did not differ significantly between groups. Postoperative complication rates were low and comparable, with no statistically significant differences observed. Rehospitalizations and emergency department visits during follow-up were minimal and similar between groups. Operative and postoperative outcomes are detailed in\u003cstrong\u003e\u0026nbsp;Table 3.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOAGB,\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en = 22\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSADI-S,\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en = 22\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndication for revisional surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight regain (\u0026plusmn; GERD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e16 (72.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e22 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGERD / reflux-related\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4 (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e0\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMechanical complications*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2 (9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e0\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOperative time (min)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e90 (57\u0026ndash;105)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e109 (88\u0026ndash;116)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.019\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntraoperative complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAny intraoperative complication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e1 (4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdditional procedures\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAny additional procedure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e7 (32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e3 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of stay (days)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4.0 (3.0\u0026ndash;5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e3.5 (3.0\u0026ndash;4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAny postoperative complication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e3 (13.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e2 (9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSevere nutritional complication**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e1 (4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRehospitalizations (count)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eED visits / hospitalizations (count)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFollow-up duration (months)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e31 (16\u0026ndash;57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e27 (15\u0026ndash;39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Indications, operative details, and short-term outcomes of revisional surgery. \u003cstrong\u003e*\u003c/strong\u003eMechanical complications include twisted sleeve or anastomotic stricture.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e**\u003c/strong\u003eSevere nutritional complications defined as hypoalbuminemia, osteoporosis, or iron-deficiency anemia requiring treatment.\u003c/p\u003e\n\u003cp\u003eQuality of life assessment demonstrated no statistically significant differences between groups. Median BAROS quality-of-life scores and SF-BARI total and subscale scores were comparable between OAGB and SADI-S patients. These results are presented in \u003cstrong\u003eTable 4\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cimg src=\"https://myfiles.space/user_files/58895_8739fc6c57c1c19a/58895_custom_files/img1774028381.png\" width=\"755\" height=\"274\"\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u0026nbsp;\u003c/strong\u003eQuality of life outcomes following revisional bariatric surgery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOne year after revisional bariatric surgery, weight loss outcomes were comparable between groups \u003cstrong\u003e(Table 5)\u003c/strong\u003e. Median excess weight loss (EWL) was 43% (IQR 25\u0026ndash;59) in the OAGB group and 37% (20\u0026ndash;64) in the SADI-S group (p \u0026gt; 0.9). Similarly, total weight loss (TWL) did not differ significantly (18% [9\u0026ndash;23] vs. 15% [9\u0026ndash;28], p = 0.9). Body mass index (BMI) at one year was also similar between groups (37 [30\u0026ndash;43] vs. 38 [32\u0026ndash;40] kg/m\u0026sup2;, p = 0.9). Regarding lipid profile, patients in the SADI-S group demonstrated significantly lower total cholesterol levels compared with the OAGB group (119 [92\u0026ndash;144] vs. 153 [141\u0026ndash;169] mg/dL, p = 0.005), as well as lower LDL cholesterol levels (65 [49\u0026ndash;85] vs. 85 [72\u0026ndash;93] mg/dL, p = 0.032). Triglyceride and HDL cholesterol levels were comparable between groups. Hematologic and nutritional parameters at one year showed no significant differences between groups for hemoglobin, ferritin, iron, total protein, albumin, or vitamin D levels. However, vitamin B12 levels were significantly higher in the SADI-S group compared with the OAGB group (475 [436\u0026ndash;700] vs. 330 [268\u0026ndash;481] pg/mL, p = 0.015). Glycemic control at one year, assessed by HbA1c, was similar between the two procedures (4.80% [4.45\u0026ndash;5.18] vs. 5.35% [4.93\u0026ndash;5.95], p = 0.3).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOAGB\u003c/strong\u003e,\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;n = 22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSADI-S\u003c/strong\u003e,\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;n = 22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEWL (%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43 (25, 59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37 (20, 64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTWL (%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18 (9, 23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15 (9, 28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37 (30,43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38 (32,40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTriglycerides, mg/dl\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e90 (70, 133)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e70 (54, 130)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCholesterol, mg/dl\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e153 (141, 169)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e119 (92, 144)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLDL, mg/dl\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e85 (72, 93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e65 (49, 85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.032\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHDL, mg/dl\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e44 (40, 54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43 (37, 51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHb, gr/dl\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.30 (11.08, 13.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.70 (11.08, 12.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFerritin, ng/ml\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21 (9, 129)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27 (14, 150)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIron, mcg/dl\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40 (21, 62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e57 (44, 65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVIT B12, pg/ml\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e330 (268, 481)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e475 (436, 700)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.015\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVIT D, nmol/l\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49 (36, 64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31 (25, 57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Protein, gr/dl\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.90 (6.60, 7.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.60 (6.28, 6.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlbumin, gr/dl\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.00 (3.70, 4.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.65 (3.25, 3.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHbA1c, %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.35 (4.93, 5.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.80 (4.45, 5.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5.\u0026nbsp;\u003c/strong\u003eOne-year metabolic and nutritional outcomes after revisional bariatric surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 2\u003c/strong\u003e presents a two-panel forest plot illustrating between-group differences in metabolic and nutritional parameters at one-year follow-up after revisional bariatric surgery, comparing SADI-S and OAGB. In the metabolic panel, patients undergoing SADI-S demonstrated lower median levels of total cholesterol, LDL cholesterol, and triglycerides compared to OAGB, as reflected by negative median differences. HDL cholesterol levels were also slightly lower in the SADI-S group. In contrast, HbA1c levels were marginally higher following SADI-S compared to OAGB. However, most metabolic parameters showed confidence intervals crossing zero, indicating no statistically significant differences between procedures. In the nutritional panel, SADI-S was associated with lower median levels of hemoglobin, albumin, total protein, and vitamin D, suggesting a greater nutritional impact compared to OAGB. Iron and ferritin levels were also lower after SADI-S. Conversely, vitamin B12 levels were higher in the SADI-S group. Among nutritional parameters, vitamin B12 demonstrated a statistically significant higher level after SADI-S, whereas the remaining variables did not reach statistical significance. Overall, the forest plot demonstrates a trend toward greater metabolic improvement but more pronounced nutritional deficiencies following SADI-S compared to OAGB.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study represents one of the few direct comparative analyses of revisional OAGB and SADI-S incorporating both metabolic and validated quality-of-life outcomes. Importantly, this study addresses a critical gap in the literature, as direct comparisons between these procedures in the revisional setting remain limited, particularly with respect to nutritional safety and patient-reported outcomes. Our findings demonstrate that both procedures achieve comparable weight loss and quality-of-life outcomes, while SADI-S provides greater lipid profile improvement at the expense of a more pronounced nutritional impact.\u003c/p\u003e \u003cp\u003eIn our cohort, excess weight loss and total weight loss at one year did not differ significantly between the procedures (EWL 43% vs 37%, TWL 18% vs 15%, p\u0026thinsp;\u0026gt;\u0026thinsp;0.9), suggesting comparable effectiveness in achieving weight reduction. These findings are consistent with the systematic review by Sorto et al., which demonstrated comparable weight loss but higher nutritional risk following SADI-S. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Several studies have demonstrated that revisional OAGB achieves EWL ranging between 40% and 70% at one year, with favorable long-term durability [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Similarly, S\u0026aacute;nchez-Pernaute et al. reported that SADI-S achieves substantial weight loss, with excess weight loss exceeding 60% in primary procedures and favorable outcomes in revisional settings as well [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Importantly, some studies suggest that SADI-S may achieve superior weight loss compared with OAGB due to its longer biliopancreatic limb and greater malabsorptive component [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The absence of significant differences in weight loss between procedures in our study may be explained by the revisional setting. Unlike primary bariatric surgery, revisional procedures are performed in patients with altered gastrointestinal anatomy, prior metabolic adaptation, and potential behavioral factors contributing to weight regain. These factors may attenuate the expected differences in malabsorptive effect between procedures. Additionally, limb lengths in revisional surgery may be adjusted to balance efficacy and safety, potentially reducing differences in weight-loss outcomes.\u003c/p\u003e \u003cp\u003eA key finding of our study was the significantly greater improvement in lipid profile following SADI-S, with lower total cholesterol (119 vs 153 mg/dL, p\u0026thinsp;=\u0026thinsp;0.005) and LDL cholesterol levels (65 vs 85 mg/dL, p\u0026thinsp;=\u0026thinsp;0.032). These findings are consistent with previous studies demonstrating superior metabolic effects of more hypoabsorptive procedures. Malabsorptive procedures have been shown to produce greater reductions in cholesterol levels through mechanisms including decreased lipid absorption, alterations in bile acid metabolism, and hormonal changes affecting lipid metabolism [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Specifically, SADI-S has been associated with significant improvement in dyslipidemia and cardiovascular risk factors due to its greater bypassed intestinal length and increased malabsorptive effect [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The superior lipid profile improvement observed following SADI-S is likely related to its greater hypoabsorptive component, resulting in reduced lipid absorption. In addition, altered bile acid circulation and hormonal changes, including increased GLP-1 secretion, may contribute to improved lipid metabolism. These mechanisms have been previously described following more extensive intestinal bypass procedures and may explain the metabolic advantage observed with SADI-S.\u003c/p\u003e \u003cp\u003eInterestingly, glycemic control was comparable between groups in our study, with no significant difference in HbA1c levels. This finding suggests that both procedures provide effective metabolic improvement, consistent with prior studies showing that bariatric surgery improves insulin sensitivity and glycemic control through both weight-dependent and weight-independent mechanisms [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Our study demonstrated a trend toward greater nutritional impact following SADI-S, including lower total protein levels after primary surgery and trends toward lower albumin, hemoglobin, and vitamin D levels at follow-up. These findings are consistent with the known nutritional risks associated with malabsorptive procedures. Previous studies have reported higher rates of protein malnutrition and micronutrient deficiencies following hypoabsorptive procedures such as biliopancreatic diversion and SADI-S [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Protein malnutrition following hypoabsorptive procedures is primarily related to reduced intestinal absorptive surface and inadequate protein intake [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Similarly, vitamin deficiencies, including iron, vitamin D, and fat-soluble vitamins, are well-documented complications following malabsorptive bariatric procedures [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Importantly, despite these trends, severe nutritional complications were rare in our cohort, suggesting that appropriate follow-up and supplementation can mitigate these risks. Interestingly, vitamin B12 levels were significantly higher in the SADI-S group in our study. This may reflect differences in supplementation protocols, adherence, or follow-up rather than intrinsic procedural differences. The greater nutritional impact observed following SADI-S is consistent with its longer bypassed intestinal segment and greater malabsorptive effect. Although severe complications were rare in our cohort, these findings highlight the importance of careful patient selection, structured postoperative follow-up, and lifelong nutritional supplementation. This consideration is particularly relevant in revisional patients, who may already be at increased nutritional risk due to prior surgery.\u003c/p\u003e \u003cp\u003eOperative time was significantly shorter for OAGB compared with SADI-S (90 vs 109 minutes, p\u0026thinsp;=\u0026thinsp;0.019), reflecting the greater technical complexity of SADI-S. This finding is consistent with prior studies demonstrating that SADI-S requires more extensive dissection and intestinal reconstruction [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Importantly, complication rates were low and comparable between procedures in our study. These findings align with previous reports showing that both OAGB and SADI-S are safe revisional procedures when performed in experienced centers [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In our study we used two validated quality-of-life instruments, including the newly developed SF-BARI questionnaire [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Our results demonstrated comparable quality-of-life outcomes between procedures, consistent with previous studies showing that bariatric surgery improves quality of life regardless of procedure type [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The absence of significant differences suggests that both procedures provide similar patient-perceived benefits despite physiological differences. This finding is particularly important because patient-reported outcomes are increasingly recognized as essential endpoints in bariatric surgery evaluation. Our findings are consistent with previous studies demonstrating effective weight loss and metabolic improvement following both revisional OAGB and SADI-S. However, most prior studies have focused primarily on weight loss outcomes, with limited evaluation of nutritional parameters and patient-reported quality-of-life outcomes. The inclusion of comprehensive metabolic, nutritional, and quality-of-life assessment in the present study provides a more complete understanding of the comparative benefits and risks of these revisional procedures. These findings have important implications for clinical decision-making. In patients with severe metabolic disease, particularly dyslipidemia, SADI-S may offer greater metabolic benefit. Conversely, in patients at increased risk of nutritional deficiencies, including older patients or those with pre-existing deficiencies, OAGB may represent a safer revisional option. Therefore, revisional procedure selection should be individualized based on patient-specific metabolic needs and nutritional risk profile.\u003c/p\u003e \u003cp\u003eThis study has several important strengths. It provides a comprehensive evaluation of revisional OAGB and SADI-S, incorporating metabolic, nutritional, perioperative, and patient-reported quality-of-life outcomes. The use of both the established BAROS score and the recently validated SF-BARI questionnaire allows for a more detailed and procedure-specific assessment of postoperative quality of life. Additionally, all procedures were performed in a single high-volume tertiary bariatric center using standardized surgical techniques and follow-up protocols, ensuring consistency in perioperative management and outcome assessment. This multidimensional evaluation provides clinically relevant insight into the balance between metabolic effectiveness and nutritional safety in revisional bariatric surgery.\u003c/p\u003e \u003cp\u003eSeveral limitations should be acknowledged. First, the retrospective design introduces the potential for selection bias and limits the ability to establish causal relationships. Second, the relatively small sample size reduces statistical power and may limit the detection of smaller but clinically relevant differences between procedures. Third, the follow-up duration was limited to one year, which may not fully capture long-term metabolic outcomes, nutritional deficiencies, or durability of weight loss. Finally, as this was a single-center study, the generalizability of the findings to other institutions and patient populations may be limited. No formal sample size calculation was performed due to retrospective design.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, both revisional OAGB and SADI-S are safe and effective revisional bariatric procedures, achieving comparable weight loss and quality-of-life outcomes at one year. SADI-S was associated with superior improvement in lipid profile, whereas OAGB demonstrated a more favorable nutritional profile. These findings support an individualized approach to revisional bariatric surgery, balancing metabolic benefits against potential nutritional risks. Larger prospective studies with longer follow-up are needed to further define the optimal revisional strategy.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBMI \u0026ndash; Body Mass Index\u003c/p\u003e\n\u003cp\u003eBAROS \u0026ndash; Bariatric Analysis and Reporting Outcome System\u003c/p\u003e\n\u003cp\u003eCI \u0026ndash; Confidence Interval\u003c/p\u003e\n\u003cp\u003eED \u0026ndash; Emergency Department\u003c/p\u003e\n\u003cp\u003eEWL \u0026ndash; Excess Weight Loss\u003c/p\u003e\n\u003cp\u003eGERD \u0026ndash; Gastroesophageal Reflux Disease\u003c/p\u003e\n\u003cp\u003eHb \u0026ndash; Hemoglobin\u003c/p\u003e\n\u003cp\u003eHbA1c \u0026ndash; Glycated Hemoglobin\u003c/p\u003e\n\u003cp\u003eHDL \u0026ndash; High-Density Lipoprotein\u003c/p\u003e\n\u003cp\u003eIQR \u0026ndash; Interquartile Range\u003c/p\u003e\n\u003cp\u003eLDL \u0026ndash; Low-Density Lipoprotein\u003c/p\u003e\n\u003cp\u003eMGB \u0026ndash; Mini-Gastric Bypass\u003c/p\u003e\n\u003cp\u003eOAGB \u0026ndash; One-Anastomosis Gastric Bypass\u003c/p\u003e\n\u003cp\u003ePBS \u0026ndash; Primary Bariatric Surgery\u003c/p\u003e\n\u003cp\u003eQoL \u0026ndash; Quality of Life\u003c/p\u003e\n\u003cp\u003eSADI-S \u0026ndash; Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy\u003c/p\u003e\n\u003cp\u003eSF-BARI \u0026ndash; Swiss-Finnish Bariatric Metabolic Outcome Score\u003c/p\u003e\n\u003cp\u003eTWL \u0026ndash; Total Weight Loss\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eDeclaration of competing interest\u003c/h2\u003e \u003cp\u003eThe authors of this manuscript have no related conflicts of interest to declare.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe authors have no funding sources to report.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eDr. Ivan Kukeev \u0026ndash; conceptualization, investigation, writing and original draft preparation.Mr. Yuval Arnon \u0026ndash; data analysis. As agreed at the beginning of the study, Mr. Yuval Arnon should be listed as the second author with an asterisk, indicating equal contribution.Dr. Sergey Yerep - data analysis.Dr. Illia Vasyliev \u0026ndash; data analysis.Dr. Elchanan Quint \u0026ndash; supervision, resources.Dr. Sofyan Abu Freih - data analysis and editingMrs. Karina Fishman \u0026ndash; data analysis.Dr. Anton Osyntsov \u0026ndash; formal analysis and editing of the manuscript.Prof. Zvi Perry - supervision, resourcesDr. Oleg Dukhno \u0026ndash; critical revision and final approval of the version to be published.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAngrisani L, Santonicola A, Iovino P, Vitiello A, Higa K, Himpens J, Buchwald H, Scopinaro N. IFSO Worldwide Survey 2016: Primary, Endoluminal, and Revisional Procedures. Obes Surg. 2018 Dec;28(12):3783-3794. doi: 10.1007/s11695-018-3450-2. PMID: 30121858.\u003c/li\u003e\n \u003cli\u003eMahawar KK, Jennings N, Brown J, Gupta A, Balupuri S, Small PK. \u0026quot;Mini\u0026quot; gastric bypass: systematic review of a controversial procedure. Obes Surg. 2013 Nov;23(11):1890-8. doi: 10.1007/s11695-013-1026-8. PMID: 23934271.\u003c/li\u003e\n \u003cli\u003eS\u0026aacute;nchez-Pernaute A, Herrera MA, P\u0026eacute;rez-Aguirre ME, Talavera P, Cabrerizo L, Mat\u0026iacute;a P, D\u0026iacute;ez-Valladares L, Barabash A, Mart\u0026iacute;n-Antona E, Garc\u0026iacute;a-Botella A, Garcia-Almenta EM, Torres A. Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). One to three-year follow-up. Obes Surg. 2010 Dec;20(12):1720-6. doi: 10.1007/s11695-010-0247-3. PMID: 20798995.\u003c/li\u003e\n \u003cli\u003eBruinsma FFE, Hurme S, Peterli R, Stenberg E, Nienhuijs SW, Gr\u0026ouml;nroos S, V\u0026aring;ge V, Bueter M, Ottosson J, Liem RSL, Salminen P. Validation of the Swiss-Finnish Bariatric Metabolic Outcome Score within a large prospective registry cohort. Br J Surg. 2025 May 31;112(6):znaf106. doi: 10.1093/bjs/znaf106. PMID: 40448630.\u003c/li\u003e\n \u003cli\u003eSorto H, Vilallonga R. SADI-S vs OAGB as a revisional procedure after sleeve gastrectomy: systematic review. BMI J. 2023; doi:10.53435/funj.00890.\u003c/li\u003e\n \u003cli\u003eParmar C, Abdelhalim MA, Mahawar KK, Boyle M, Carr WRJ, Jennings N, Small PK. Management of super-super obese patients: comparison between one anastomosis (mini) gastric bypass and Roux-en-Y gastric bypass. Surg Endosc. 2017 Sep;31(9):3504-3509. doi: 10.1007/s00464-016-5376-x. Epub 2016 Dec 15. PMID: 27981383.\u003c/li\u003e\n \u003cli\u003eZaveri H, Surve A, Cottam D, Cottam A, Medlin W, Richards C, Belnap L, Cottam S, Horsley B. Mid-term 4-Year Outcomes with Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy Surgery at a Single US Center. Obes Surg. 2018 Oct;28(10):3062-3072. doi: 10.1007/s11695-018-3358-x. PMID: 29909514.\u003c/li\u003e\n \u003cli\u003eMcLennan, S., Verhoeff, K., Mocanu, V. et al. Characteristics and outcomes for patients undergoing revisional bariatric surgery due to persistent obesity: a retrospective cohort study of 10,589 patients. Surg Endosc 37, 4613\u0026ndash;4622 (2023). https://doi.org/10.1007/s00464-023-09951-6.\u003c/li\u003e\n \u003cli\u003eBuchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004 Oct 13;292(14):1724-37. doi: 10.1001/jama.292.14.1724. Erratum in: JAMA. 2005 Apr 13;293(14):1728. PMID: 15479938.\u003c/li\u003e\n \u003cli\u003eMingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Leccesi L, Nanni G, Pomp A, Castagneto M, Ghirlanda G, Rubino F. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012 Apr 26;366(17):1577-85. doi: 10.1056/NEJMoa1200111. Epub 2012 Mar 26. PMID: 22449317.\u003c/li\u003e\n \u003cli\u003eSurve A, Cottam D, Medlin W, Richards C, Belnap L, Horsley B, Cottam S, Cottam A. Long-term outcomes of primary single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). Surg Obes Relat Dis. 2020 Nov;16(11):1638-1646. doi: 10.1016/j.soard.2020.07.019. Epub 2020 Jul 31. PMID: 32843266.\u003c/li\u003e\n \u003cli\u003eSchauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A, Brethauer SA, Navaneethan SD, Singh RP, Pothier CE, Nissen SE, Kashyap SR; STAMPEDE Investigators. Bariatric Surgery versus Intensive Medical Therapy for Diabetes - 5-Year Outcomes. N Engl J Med. 2017 Feb 16;376(7):641-651. doi: 10.1056/NEJMoa1600869. PMID: 28199805; PMCID: PMC5451258.\u003c/li\u003e\n \u003cli\u003eTopart P, Becouarn G. The single anastomosis duodenal switch modifications: a review of the current literature on outcomes. Surg Obes Relat Dis. 2017 Aug;13(8):1306-1312. doi: 10.1016/j.soard.2017.04.027. Epub 2017 Apr 27. PMID: 28602793.\u003c/li\u003e\n \u003cli\u003eScopinaro N, Gianetta E, Friedman D, Adami GF, Traverso E, Vitale B, Castagnola M, Semino G, Summa M, Bachi V. Surgical revision of biliopancreatic diversion. Gastroenterol Clin North Am. 1987 Sep;16(3):529-31. PMID: 3436660.\u003c/li\u003e\n \u003cli\u003eStein J, Stier C, Raab H, Weiner R. Review article: The nutritional and pharmacological consequences of obesity surgery. Aliment Pharmacol Ther. 2014 Sep;40(6):582-609. doi: 10.1111/apt.12872. Epub 2014 Jul 30. PMID: 25078533.\u003c/li\u003e\n \u003cli\u003eKolotkin RL, Norquist JM, Crosby RD, Suryawanshi S, Teixeira PJ, Heymsfield SB, Erondu N, Nguyen AM. One-year health-related quality of life outcomes in weight loss trial participants: comparison of three measures. Health Qual Life Outcomes. 2009 Jun 9;7:53. doi: 10.1186/1477-7525-7-53. PMID: 19505338; PMCID: PMC2700089.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"obesity-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"obsu","sideBox":"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)","snPcode":"11695","submissionUrl":"https://submission.springernature.com/new-submission/11695/3","title":"Obesity Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Revisional bariatric surgery, One-anastomosis gastric bypass, Single-anastomosis duodeno-ileal bypass, SF-BARI questionnaire","lastPublishedDoi":"10.21203/rs.3.rs-9072993/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9072993/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eRevisional bariatric surgery is increasingly performed due to inadequate weight loss, weight regain, or complications following primary bariatric procedures. One anastomotic gastric bypass (OAGB) and single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) are commonly used revisional options, yet comparative data on metabolic, nutritional, and quality-of-life outcomes remain limited.\u003c/p\u003e\u003ch2\u003eObjective:\u003c/h2\u003e \u003cp\u003eTo compare metabolic, nutritional, perioperative, and quality-of-life outcomes between revisional OAGB and SADI-S.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective comparative cohort study was conducted at a tertiary bariatric center between 2020 and 2025. Adult patients undergoing revisional OAGB or SADI-S after primary failed sleeve gastrectomy were included. Outcomes included weight loss, metabolic and nutritional parameters, perioperative outcomes, complications, and quality of life assessed using BAROS and SF-BARI questionnaires.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eForty-four patients were included (22 OAGB, 22 SADI-S). At one year, weight loss outcomes were comparable between groups (EWL 43% vs. 37%, p\u0026thinsp;\u0026gt;\u0026thinsp;0.9; TWL 18% vs. 15%, p\u0026thinsp;=\u0026thinsp;0.9). SADI-S demonstrated superior lipid profile improvement, including lower total cholesterol (119 vs. 153 mg/dL, p\u0026thinsp;=\u0026thinsp;0.005) and LDL levels (65 vs. 85 mg/dL, p\u0026thinsp;=\u0026thinsp;0.032). Vitamin B12 levels were higher after SADI-S (475 vs. 330 pg/mL, p\u0026thinsp;=\u0026thinsp;0.015), while other nutritional parameters were comparable. Operative time was shorter for OAGB (90 vs. 109 minutes, p\u0026thinsp;=\u0026thinsp;0.019). Quality-of-life scores were similar between groups.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eBoth revisional OAGB and SADI-S are safe and effective procedures with comparable weight loss and quality-of-life outcomes. SADI-S provides greater metabolic benefit, particularly in lipid profile improvement, while OAGB demonstrates a more favorable nutritional profile. Procedure selection should be individualized based on metabolic needs and nutritional risk.\u003c/p\u003e","manuscriptTitle":"Revisional OAGB Versus SADI-S After Failed Bariatric Surgery: A Comparative Study of Metabolic, Nutritional, and Quality-of-Life Outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-22 14:56:13","doi":"10.21203/rs.3.rs-9072993/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-02T14:39:25+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-27T03:55:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-20T08:25:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"330332249786065646569451420126219870255","date":"2026-03-20T02:59:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"234627568457823422428058548283411240601","date":"2026-03-19T17:23:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-18T08:02:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"209091534033507699964116338840319406261","date":"2026-03-18T07:42:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-17T19:25:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-13T16:57:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-13T12:39:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"Obesity Surgery","date":"2026-03-09T12:22:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"obesity-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"obsu","sideBox":"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)","snPcode":"11695","submissionUrl":"https://submission.springernature.com/new-submission/11695/3","title":"Obesity Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"e1d08519-f5fb-4b83-a1ba-404ad5501758","owner":[],"postedDate":"March 22nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-13T21:53:24+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-22 14:56:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9072993","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9072993","identity":"rs-9072993","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}