Grant: Project Grant

The number of individuals with severe obesity (i.e. an excess weight of more than 100 pounds) has grown disproportionately in Canada, with a 455% increase between 1985 and 2016. In addition to suffering from the limitations and diseases related to their excess weight, these individuals often experience stigma and have a very low quality of life. The overly simplistic recommendation of eating less and moving more is frequently ineffective in the long term for them, so weight loss surgery has emerged as an integral part of the possibilities for clinical management. The predominant weight loss surgery is called a 'sleeve gastrectomy', accounting for 60% of the weight loss surgeries performed annually. Even though it is associated with good short-term outcomes, it is also associated with a significant risk of weight loss failure or recidivism, ranging between 20 and 40%. In this case, the best surgical option for weight loss and cure of associated diseases is called 'duodenal switch' (DS). The latter is, however, technically challenging and associated with significant side-effects and risks of malnutrition. A modification of this procedure called 'single-anastomosis' DS (SADI-S), has been recently approved (Nov 2019). It is technically easier and could potentially decrease the risk of complications and side-effects, while preserving most metabolic benefits from the 'standard' DS. This new procedure is rapidly gaining in popularity, both as a primary operation or as a revisional surgery, with about 10,000 surgeries performed annually. However, the scientific evidence of its efficacy is based on small case series. The objective of this study is to establish the clinical benefits of the SADI-S as a revisional surgery after sleeve gastrectomy, while also considering the critical issues related to sex and gender.