SADI-S
Single Anastomosis Duodenal-Ileal Bypass with Sleeve (SADI-S)
SADI-S is a relatively new procedure, it was first described in 2007 as a simplified version of a classic more invasive Duodenal Switch that involves biliopancreatic diversion (BPD-DS). This procedure has been approved by the American Society of Metabolic Surgery and endorsed by the International Federation for the Surgery of OBESITY AND METABOLIC DISORDERS (IFSO). We like this type of Switch better as it has lower complication risks. Being in the medical tourism industry where our patients cannot remain under our direct observation for a long time and have to travel back home soon after surgery, SADI-S makes a better choice.
PROS:
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Restriction is guaranteed as the surgery includes gastric sleeve that preserves the lower stomach sphincter, restriction feeling is stronger compared to RNY or Mini bypass.
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Highly effective for patients with higher BMI over 50 as a first time surgery or as a second step after gastric sleeve or lap band to promote further weight loss with longer-lasting results. Statistically higher weight loss compared to gastric sleeve alone, Mini or RNY bypass.
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More simple and safer compared to a traditional BPD-DS (classic Duodenal Switch).
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Good option for patients with Type 1 diabetes (insulin dosage decreases significantly) and Type 2 diabetes (resolves completely for most patients) due to malabsorption.
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Low risk of a marginal ulcer that comes with RNY or Mini bypass.
CONS:
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Not a suitable option for patients who suffer from GERD (acid reflux), esophagitis, Barrett`s esophagus as it preserves the lower stomach sphincter and thus may increase an already existing GERD or even cause new-onset reflux.
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Risk of more frequent and more loose bowel movements or even diarrhea.
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More complicated and more expensive procedure compared to gastric sleeve, Mini bypass or RNY bypass with potentially longer recovery.
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Strong malabsorption could lead to vitamin, mineral and protein deficiencies.
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As a newer procedure has only short-term outcome data.
SURGICAL METHOD
- SADI-S, as the name suggests, starts with a gastric sleeve. The side part of the stomach (the grander curvature) is dissected and removed completely. The lower stomach sphincter Pylori is preserved just like with a regular gastric sleeve.
- The small intestine is detached right below the stomach at the duodenum part and the top end is sealed with the stapler.
- The surgeon measures out about 3 meters (approximately 8-9 feet) of the small intestine from its end (ileum part of the small intestine) and connects it to the intestine right below the stomach. This is the only anastomosis that is created in the SADI-S surgery. About 4 meters on average (approximately 12 feet) of the small intestine are bypassed, food no longer passes through the duodenum and jejunum parts.
- As in any other bariatric surgery, the endoscopy is performed at the beginning and at the end of surgery. If a hiatal hernia is diagnosed, it will be repaired. If stomach polyps or signs of H. Pylori (Helicobacter Pylori) infection are diagnosed, stomach tissue will be sent for a pathology test.
For a better visual explanation, we invite you to watch the video below, courtesy of Ethicon, our trusted and well-known provider of bariatric titanium staples, staplers and other surgical instruments that we use in our procedures daily.
HOW YOU LOSE WEIGHT?
Restriction:
small sleeved stomach will hold about 2 to 4 oz of food once it is healed. For the first few months this amount may be smaller due to the inflammatory reaction. Restriction is guaranteed thanks to the lower stomach sphincter that remains intact in SADI-S.
Malabsorption:
in SADI-S on average 4 meters (or 12 feet) of the small intestine are bypassed (food does not pass through the upper part of the small intestine). Liver and pancreatic enzymes, digestive juices that are very important for food digestion continue passing through this portion of the small intestine and unite with food in a so-called common channel that is about 3 meters (or 9 feet) long and leads into the large intestine. The bypassed portion of the small intestine that consists of duodenum and jejunum decreases the amount of nutrients and calories that are absorbed.
Dumping:
since the channel that the food passes has now become shorter, the process of digestion, absorption, and hormonal response has now changed. Thus certain foods such as refined sugars, simple carbs, some fats and fried foods, and some dairy products may cause this unpleasant syndrome. Dumping usually includes nausea, sweating, rapid heartbeat, diarrhea, abdominal cramping and pain, low blood sugar and confusion. This is not a life-threatening condition although it can feel very alarming. But it can be avoided by changes in the diet that in turn keep the patient away from junk food that should not be part of the post-op diet.
Loss of appetite:
just like with a gastric sleeve surgery, removal of the greater part of the stomach decreases production of Ghrelin – the hormone responsible for the feeling of hunger, for most of the patients. This is a temporary effect and hunger will return back to normal within a few months, but usually it is less than before surgery and if following the correct diet, can be satisfied with much smaller food portions.
SURGERY TIME
HOSPITAL AND HOTEL STAY
Two days and two nights are required at the hospital for the SADI-S surgery in Tijuana, Mexico. (Please visit What to Expect in Tijuana and NEWCITY Hospital or CIBA Surgical Center for more details).
Three nights at the hotel are recommended.
Plan your trip for a SADI-S surgery in Tijuana this way:
Day 1. Arrival, pre-op testing, hotel stay
Day 2. Surgery, hospital stay
Day 3. Hospital stay
Day 4. Discharge, hotel stay
Day 5. Hotel stay
Day 6. Departure
RECOVERY TIME
- For a sedentary type of work – a minimum of 14 days off is recommended.
- If your job requires more strenuous physical activity and lifting over 15 pounds, we recommend at least 3 weeks off.
- The weight lifting restrictions are: up to 15 pounds for 2-3 weeks post-op, and up to 35 pounds for another 2-3 weeks. After 6 weeks normal weight lifting is allowed.
- For jobs that require strenuous physical activities and long working hours such as nurses, as an example, we recommend from 4 to 8 weeks off.
- Consider that you will feel very weak, lack energy, get easily tired during the first 4 to 8 weeks post-op due to a low-calorie diet and dehydration. So, it may be difficult to concentrate on work (mental or physical). Usually energy levels return after 8 to 12 weeks post-op.
IS SADI-S RIGHT FOR ME?