Comparing safety and efficacy of primary single anastomosis duodeno-ileal bypass vs. one anastomosis gastric bypass: 6 months analysis of MBSAQIP database.

BACKGROUND: One-anastomosis gastric bypass (OAGB) and single-anastomosis duodenoileal bypass (SADI) are increasingly performed hypoabsorptive bariatric procedures, yet large-scale comparative data remain limited. This study compared 30-day and 6-month outcomes between primary OAGB and SADI using a national bariatric registry. METHODS: A retrospective cohort study was conducted using the 2023 MBSAQIP database. Adult patients undergoing primary, non-revisional OAGB or SADI were included. Outcomes included 30-day and 6-month complications, percent total weight loss (%TWL), absolute weight loss, BMI change, and comorbidity resolution. Inverse probability of treatment weighting (IPTW) was used to adjust for baseline differences. RESULTS: A total of 2,420 patients were included (OAGB n = 457; SADI n = 1,963), of whom 1,897 had complete 6-month weight data. On adjusted analysis, SADI was associated with lower odds of any 30-day complication (19.3% vs. 24.9%; OR 0.72, 95% CI 0.55-0.95, p = 0.019), driven largely by lower rates of intravenous hydration (4.0% vs. 12.7%; OR 0.31, p < 0.001). Serious 30-day complications were rare and did not differ between groups. At 6 months, no significant differences were observed in any adverse outcome. OAGB was associated with comparable %TWL (23.4% vs. 22.2%; β - 0.94%, p = 0.042), with no significant differences in absolute weight loss or BMI change. OAGB demonstrated greater early resolution of hypertension (49.3% vs. 32.1%; OR 0.59, p = 0.003) and obstructive sleep apnea at 6 months (50.0% vs. 28.9%; OR 0.51, p = 0.001). CONCLUSION: Both procedures demonstrate comparable safety profiles with rare serious complications. At 6 months, OAGB was associated with greater early resolution of hypertension and obstructive sleep apnea, though these findings are preliminary and require longer follow‑up. Safety profiles were comparable except for a higher readmission rate after SADI.