Robotic Single Anastomosis Duodenal-ileal Bypass With Sleeve Gastrectomy (SADI-S) for Morbid Obesity: A Systematic Review.

Background/aim: The global obesity epidemic has seen a dramatic increase in prevalence since 1975, posing significant health and economic challenges worldwide. Robotic-assisted single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) has emerged as a promising surgical intervention for morbid obesity, offering potential advantages over traditional laparoscopic approaches in terms of precision, safety, and recovery outcomes. This study aimed to evaluate the efficacy and safety of robotic-assisted SADI-S, focusing on perioperative and postoperative outcomes including intraoperative complications, operative time, conversion rates, mortality, length of hospital stay, weight loss, and postoperative complications.

Materials and methods: A comprehensive literature search was conducted on PubMed, Scopus, and Cochrane Library, adhering to inclusion and exclusion criteria focused on obese adult humans undergoing robotic SADI-S. Seven studies, published between 2015 and 2024, involving 204 patients, were ultimately included for analysis.

Results: The analysis revealed a low rate of intraoperative complications (0.49%), no mortality, and varied operative times (138 to 205.7 min). The median hospital stay ranged from 2 to 6.7 days, with minimal readmission rates. Postoperative complications occurred in 6.37% of patients, but no late complications (>30 days) were reported. Notably, significant weight loss outcomes were documented, with mean excess weight loss (EWL) up to 113.74% at 24 months follow-up.

Conclusion: Robotic-assisted SADI-S demonstrates a favourable safety profile with promising weight loss outcomes, highlighting its potential as a primary or revisional treatment for morbid obesity. Further research, including randomized controlled trials, is needed to establish its long-term efficacy and cost-effectiveness compared to traditional laparoscopic methods.