SADI-S : Modified Duodenal Switch Surgery

SADI-S Surgery: A Comprehensive Overview

Bariatric surgery has emerged as one of the most effective solutions for long-term weight loss in patients struggling with obesity and its associated comorbidities. Among the various bariatric procedures available, SADI-S (Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy) stands out as a relatively new and promising option. This surgery, which combines elements of sleeve gastrectomy and duodenal switch, is designed to help patients achieve significant and sustained weight loss, improve metabolic health, and enhance their overall quality of life. In this comprehensive blog post, we’ll explore all aspects of the SADI-S operation, including its indications, surgical technique, results, eligibility criteria, risks, and its role as a revisional procedure.

What is SADI-S Surgery?

SADI-S is a type of bariatric surgery that builds upon the principles of two well-established procedures: sleeve gastrectomy and duodenal switch. The operation involves creating a sleeve gastrectomy, where approximately 80% of the stomach is removed, reducing the stomach’s capacity and therefore the patient’s food intake. In the second stage of the surgery, the small intestine is re-routed to connect directly to the duodenum, bypassing a significant portion of the intestine. This limits the absorption of calories and nutrients, contributing to weight loss.

Pioneered by Dr. Murat Ustun in Turkey in 2011 

SADI-S has gained recognition for its effectiveness and lower complication rates compared to the traditional duodenal switch surgery. By reducing the number of connections (or anastomoses) from two to one, the SADI-S operation simplifies the procedure, reducing the risk of complications such as leakage and stricture formation. About Dr Murat Ustun

Indications for SADI-S Surgery

SADI-S surgery is primarily indicated for individuals who are severely obese and have not achieved significant weight loss through diet, exercise, or pharmacotherapy. It is particularly effective for patients with a high body mass index (BMI), usually over 40, or over 35 with obesity-related comorbidities such as type 2 diabetes, hypertension, sleep apnea, or hyperlipidemia.

This procedure is also indicated for patients who have undergone previous bariatric surgery (such as a gastric sleeve or gastric bypass) and have experienced inadequate weight loss or significant weight regain. SADI-S serves as a powerful revisional procedure in these cases, offering a second chance at achieving the desired weight loss and health benefits.

Surgical Technique

The SADI-S operation is typically performed laparoscopically, which means it involves small incisions and the use of a camera and specialized instruments to perform the surgery. This minimally invasive approach offers several advantages, including reduced pain, faster recovery, and fewer complications compared to open surgery.

Step 1: Sleeve Gastrectomy

The first part of the surgery involves performing a .sleeve gastrectomy. During this step, approximately 80% of the stomach is removed, leaving a small, banana-shaped “sleeve.” This smaller stomach restricts the amount of food a patient can consume, leading to reduced calorie intake. The reduction in stomach size also affects the production of hunger hormones such as ghrelin, which can help decrease appetite.

Step 2: Duodeno-Ileal Bypass

The second step involves rerouting the small intestine. The surgeon divides the small intestine about 2.5 to 3 meters from the ileocecal valve (where the small intestine meets the large intestine) and connects it to the duodenum, just below the pylorus (the valve that controls the release of stomach contents into the small intestine). This bypasses a large portion of the small intestine, reducing the absorption of calories and nutrients, which contributes to weight loss.

One of the key differences between SADI-S and the traditional duodenal switch is that SADI-S involves only one anastomosis, or connection, between the stomach and the small intestine, rather than two. This simplification of the procedure reduces the risk of complications such as leakage or bowel obstruction.

Results of SADI-S Surgery

The results of SADI-S surgery are impressive, with patients typically experiencing significant weight loss and improvement in obesity-related comorbidities. On average, patients can expect to lose 60-80% of their excess body weight within the first two years after surgery. This weight loss is often sustained in the long term, with many patients maintaining a substantial portion of their weight loss five years or more after the procedure.

In addition to weight loss, SADI-S surgery has been shown to improve or resolve many obesity-related health conditions. For instance, a large percentage of patients experience remission of type 2 diabetes, with significant improvements in blood sugar levels and reduced need for medications. Other conditions such as hypertension, sleep apnea, and hyperlipidemia also show marked improvement following the surgery.

Eligibility for SADI-S Surgery

To be eligible for SADI-S surgery, patients must meet specific criteria. These typically include:

1. Body Mass Index (BMI): Patients should have a BMI of 40 or higher, or a BMI of 35 or higher with one or more obesity-related comorbidities, such as type 2 diabetes, hypertension, or sleep apnea.

2. Failed Previous Weight Loss Attempts: Candidates should have tried and failed to achieve significant weight loss through non-surgical means, such as diet, exercise, and pharmacotherapy.

3. Psychological Stability: It’s essential for patients to be psychologically stable and free from untreated psychiatric disorders that could impair their ability to comply with postoperative lifestyle changes.

4. Understanding of the Procedure: Patients must have a clear understanding of the SADI-S procedure, including the risks, benefits, and necessary lifestyle changes required for success. 

5. Commitment to Follow-up: Patients must be committed to long-term follow-up care, including regular monitoring of nutritional status and adherence to dietary recommendations.

Non-Eligibility for SADI-S Surgery

Not all patients are suitable candidates for SADI-S surgery. Contraindications may include:

1. Severe Nutritional Deficiencies: Patients with significant pre-existing nutritional deficiencies may not be suitable candidates, as SADI-S can exacerbate these issues.

2. Inability to Undergo Anesthesia: Patients with severe cardiopulmonary conditions or other medical issues that make general anesthesia too risky may be ineligible.

3. Untreated Psychiatric Disorders: Individuals with untreated or poorly managed psychiatric conditions may not be suitable candidates due to the complexity of the postoperative care and lifestyle changes required.

4. Substance Abuse Issues: Patients with ongoing substance abuse issues may not be good candidates, as these can interfere with postoperative care and the ability to follow dietary guidelines.

Risks and Complications

As with any surgical procedure, SADI-S carries certain risks and potential complications. However, it is generally considered safer than the traditional duodenal switch due to the reduced number of anastomoses.

Common Risks Include:

– Nutritional Deficiencies: Due to the malabsorptive nature of the surgery, patients are at risk for deficiencies in vitamins and minerals, particularly vitamins A, D, E, and K, as well as calcium, iron, and protein. Lifelong supplementation and regular monitoring are essential.

– Dumping Syndrome: Although less common than in gastric bypass, some patients may experience dumping syndrome, where food moves too quickly through the stomach and intestines, causing nausea, diarrhea, and abdominal pain.

– Bowel Obstruction: Although rare, there is a risk of bowel obstruction following SADI-S surgery, which may require additional surgery to correct.

– Anastomotic Leak: A leak at the site of the anastomosis (where the stomach is connected to the small intestine) can occur, although this risk is lower with SADI-S compared to other procedures.

Health Benefits of SADI-S Surgery

The health benefits of SADI-S surgery extend far beyond weight loss. The procedure has been shown to significantly improve or resolve a variety of obesity-related health conditions, including:

1. Type 2 Diabetes: SADI-S is particularly effective in improving glycemic control and can lead to remission of type 2 diabetes in a significant number of patients. This effect is partly due to the weight loss but also due to hormonal changes in the gut that improve insulin sensitivity.

2. Hypertension: Many patients experience a reduction in blood pressure after SADI-S surgery, often allowing them to reduce or eliminate the need for antihypertensive medications.

3. Sleep Apnea: Weight loss following SADI-S can lead to significant improvements in sleep apnea, with many patients experiencing a reduction in symptoms or complete resolution.

4. Hyperlipidemia: SADI-S surgery has been shown to improve lipid profiles, including reductions in LDL cholesterol and triglycerides, which reduces the risk of cardiovascular disease.

SADI-S as a Revisional Procedure

SADI-S surgery plays a crucial role as a revisional procedure for patients who have undergone previous bariatric surgeries, such as sleeve gastrectomy or gastric bypass, but have not achieved satisfactory weight loss or have experienced significant weight regain. As a revisional procedure, SADI-S can offer additional weight loss and help patients achieve their desired health outcomes.

Revisional SADI-S is particularly beneficial because it can be performed in a minimally invasive manner, often with fewer risks than other revisional procedures. It allows patients to regain control over their weight and health, offering a second chance at achieving long-term success.

Conclusion

SADI-S surgery is a powerful tool in the fight against obesity and its related health conditions. Pioneered by Dr. Murat Ustun in Turkey in 2011, this innovative procedure offers significant weight loss, improvement in comorbidities, and long-term health benefits. However, the success of SADI-S surgery depends on the expertise of the surgeon, the quality of the hospital, and thepatient’s commitment to postoperative care and lifestyle changes.

For those eligible, SADI-S surgery provides a life-changing opportunity to improve health, reduce the risk of obesity-related diseases, and enhance overall quality of life. Whether as a primary or revisional procedure, SADI-S continues to gain recognition as a leading option in the field of bariatric surgery.