SADI-S is a new operation for morbid obesity based on the biliopancreatic diversion in which a sleeve gastrectomy is followed by an end-to-side duodeno-ileal diversion. The preservation of the pylorus makes possible the reconstruction in one loop, which reduces operating time and needs no mesentery opening.
SADI-S (Single anastomosis duodeno–ileal bypass with sleeve gastrectomy) is a newer variant of duodenal switch surgery, which for three decades has helped obese patients control their weight. The key benefit of SADI-S is that one intestinal bypass is made, rather than two, resulting in less time in surgery and reduced risk of intestinal leakage.
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Before SADI-S Surgery
What are the potential advantages of the SADI-S procedure?
. Delivers greater weight loss than a gastric sleeve or standard gastric bypass. This is advantageous for people with a BMI above 50.
. Provides a more powerful metabolic effect than a sleeve gastrectomy or standard gastric bypass. This is advantageous for people with poorly controlled Type 2 Diabetes.
. Can be performed on people who have already had a sleeve gastrectomy. This is advantageous for people who experience weight regain or insufficient weight loss.
. Lowers the risk of diarrhea and nutritional deficiencies often encountered with a conventional duodenal switch.
. Compared to a gastric bypass or a duodenal switch, this technique aims to reduce the long-term risk of intestinal obstruction.
. The pylorus is retained above the connected loop of the small bowel. The pylorus regulates the rate that food and acid empty from the stomach into the intestines and prevents reflux of bile. This helps to reduce the likelihood of certain problems encountered with gastric bypass surgery. These issues could be: Dumping syndrome, unstable blood sugar fluctuations, food restrictions and intolerance, and marginal ulcers.
What could be potential Risks of the SADI-S procedure?
The SADI-S surgical risks are very similar to most other bariatric techniques:
. Intestinal perforation
. Anastomotic leaks
. Venous thrombosis and pulmonary embolism
. Chance of bile reflux
. In the long term it could produce a bowel obstruction
As it’s a stronger bypass, there is an increased risk of mineral and vitamin deficiencies. It is therefore essential with this operation that patients take their prescribed mineral and vitamin supplements on a regular basis and also have regular follow up and blood tests to make sure that they don’t become deficient in any minerals and vitamins. It is possible with this procedure to become deficient in certain minerals and vitamins that can cause life threatening or life changing complications.
Who is this procedure beneficial for?
The SADI is particularly beneficial for diabetic patients and has the highest resolution in type 2 diabetes. It is also beneficial for super obese patients and has a lower risk of long term weight regain. It is a good revisional procedure for weight regain after a sleeve gastrectomy. As the sleeve can often be left untouched and just connected to the distal bypass reducing the operation time and the need for the revision of the sleeve.
How to plan and prepare for SADI-S surgery
Once your SADI-S procedure is confirmed, we will send you detailed information on how to prepare for surgery. Pre-op recommendations are very similar for all weight-loss surgeries and it’s of paramount importance that you follow them closely. Your journey towards planning an SADI-S surgery might look like this:
Firstly, we’d like to talk to you to understand your current health status, what your expectations are, and how we can help you. You will speak with one of our coordinators who will also be happy to answer any questions you might have. They will confirm if you’re eligible for the treatment and will provide you with pre-op guidelines for you to prepare for the procedure.
Diet guidelines before a Single Anastomosis Duodeno-ileal Bypass with Sleeve Gastrectomy include high-protein and low-carb foods. Around 5 to 7 days before the procedure, you will have to stay on a liquid diet to keep your stomach light. You should not drink any alcohol or sodas during this time. Also be mindful about sipping water very slowly. The night before the procedure patients are advised to fasten completely.
A gastroscopy is a medical test that might be required to assess whether your stomach is ready for the procedure. It examines your oesophagus, stomach, and the first part of your small intestine (small bowel). It is performed using an endoscope that will allow the doctor to look inside your ‘food pipe’ with the help of a small camera.
During SADI-S Surgery
How SADI-S works
SADI-S surgery is a modified version of an operation that was developed 30 years ago. It was formally called Biliopancreatic Diversion with Duodenal Switch (BPD-DS). It was more simply known as the duodenal switch.
The SADI-S procedure involves two steps:
. Step one: the surgeon will perform a sleeve gastrectomy, removing about 80% of the stomach.
. Step two: the intestine is detached just below the stomach and then reattached to a loop of intestine about 2 meters downstream.
This two-step procedure effectively bypasses food from the metabolically active part of the intestine. This process lessens the total length of the intestinal loop where nutrients are absorbed. This procedure gives you a smaller appetite, restricted meal sizes, and hormonal changes that have a positive effect on metabolism.
During SADI procedure
The SADI weight loss procedure is performed using laparoscopic (keyhole) incisions first, to reduce the stomach size to that similar to a Gastric Sleeve.
The small intestine just after the stomach is called the duodenum. In the SADI bariatric surgery, the duodenum is divided just after the stomach, and a loop of the intestine is brought up and joined to this part of the duodenum.
This results in food passing through a reduced-capacity stomach (Gastric Sleeve), and then bypassing most of the duodenum as well as the next part of the intestine, called the jejunum.
The food thus enters straight into the ileum, the last half to third of the small intestine. Our SADI bariatric procedure ensures that there is at least 300cm of the ileum to absorb food intake, out of the small intestine’s total length of about 500 to 600cm.
The SADI weight loss procedure is effective due to combining both a restrictive component (the Gastric Sleeve) with a very significant metabolic or malabsorptive component (the absorption of consumed calories and nutrients is reduced).
After SADI-S Surgery
SADI-S Post-Operative Care
. Wound Care
The small keyhole incisions are all closed with dissolving stitches, which are all placed under the skin so that you will never need to see them.
We also use either tissue glue, or steristrips and waterproof dressings, to ensure the skin heals in a clean and dry environment. Patients can bathe or shower with these dressings in place, however, they should be patted dry afterwards.
The dressings are normally removed 10 days after surgery, and the incisions should have healed up nicely by then.
. Pain Management
Most patients’ post-operative discomfort has settled by the time of discharge from the hospital.
Some patients may still require a small amount of oral medication, to help manage ongoing discomfort for a week or so. This can include Panadol, Panadeine Forte, Endone or occasionally other medicines.
. Other Medicines
Routine medications can be recommenced as directed in the post-operative phase. Any blood-thinning agents that patients were previously taking will also be recommenced as directed by the medical team.
Many patients will be directed to take a PPI (Proton Pump Inhibitor) such as Nexium, Somac or Losec for a certain period after surgery, to reduce stomach acid production.
As a guide, most patients need 2-3 nights in hospital post-op, and depending on the work in which you are employed, anywhere from 3-14 days off work. Most patients can start walking within a few days, and more vigorous exercise can commence within 3 weeks.
Surgery will help patients to start their weight loss journey. However, in order to achieve successful long-term results, dietary and behavioral changes are necessary.
While each patient will be given specific dietary advice based on their personal requirements, the following is a very brief recommended guideline for your diet following SADI-S surgery.
. Week 1
. Liquid nourishment
. Weeks 2 – 4
. Pureed food
. Week 4 +
. Commencement of soft solid diet.
What are the results of the SADI-S procedure?
There are still no long term follow up results for large groups of SADI-S patients. However, the current results of this procedure are definitely very good.
The results are from an analysis of 123 patients with an average of 49.4 BMI. These patients underwent the SADI-S procedure between January 2013 and July 2014:
. 72% excess weight lost at one year
. No bowel obstructions
. One marginal ulcer
. One re-operation
To put this into perspective, prior to this, a group of patients with obesity and a similar BMI range would be expected to have lost:
. 48% of excess weight following a sleeve gastrectomy
. 55% of excess weight following a standard gastric bypass, with an expected morbidity of
. Around 2 bowel obstructions
. Around 5 marginal ulcers
. Around 5 re-operations
However, there are questions whether these excellent results will remain constant over time. Whether they will be reproducible by other units and whether larger numbers will reflect the same figures. Other units are also starting to report their experience. Another unit in the US has recently reported their first 100 cases with similar good results.