SADI-S is a very effective procedure for weight loss and resolution of co-morbidities associated with obesity, such as type 2 diabetes, hypercholesterolaemia and obstructive sleep apnea. SADI-S has shown good results as a primary and as a revisional procedure after failed previous weight loss operations.
SADI-S stands for ‘Single Anastomosis Duodeno–Ileal Bypass with Sleeve Gastrectomy’. SADI-S surgery is a modified version of an operation that was popular 30 years ago. It was formally called the Biliopancreatic Diversion with Duodenal Switch (BPD-DS).
The SADI-S is performed in 2 steps:
1. Sleeve gastrectomy is performed removing 85% of the stomach
2. The duodenum is detached from the stomach and reconnected to small bowel 2 metres downstream
Preliminary studies suggest it provides greater weight loss than a Roux-en-Y gastric bypass or sleeve gastrectomy. Adelaide Bariatric Centre is able to offer SADI-S to selected patients.
How does it work?
The SADI-S bypasses food from the small intestine. This lessens the total length of the intestine where nutrients can be absorbed. Additionally the SADI-S controls hunger and maintains restricted meal sizes.
What is achieved from the operation?
Weight loss following SADI-S ranges from around 20% EWL in the first 3 months up to nearly 100% after 2 years in some studies, demonstrating a comparable weight loss to that of Roux en Y Gastric Bypass (RYGB) in the mid-term, but showing even superior results in the long-term.
Metabolic results have been excellent, similar to those reported after any of the previously described biliopancreatic diversions. The reported overall T2D resolution following SADI-S was 60–80% (2,3,4). Hypoercholesterolaemia remitted in > 70 % of the cases, obstructive sleep apnoea in > 80 % and hypertension was controlled in > 60 % with complete remission in > 50 % of all patients.
Potential advantages of SADI-S
- Greater weight loss than the standard sleeve gastrectomy, Roux en Y gastric bypass or one anastomosis gastric bypass
- Advanced metabolic effect for patients with type 2 diabetes
- Can be performed in patients who have already had a sleeve gastrectomy and experienced some weight regain
- The pylorus or bottom of the stomach is preserved which may prevent issues such as dumping or ulcers which can be seen with traditional gastric bypasses
Potential disadvantages of a SADI-S
- Protein-caloric malnutrition with procedures such as BPD-DS is an important concern. SADI-S is an hypoabsorptive technique and these nutritional deficiencies seem to be uncommon in early studies. When compared with RYGB these issues were similar between both procedures, likely related to sufficient postoperative supplementation administered to patients in order to meet their daily requisite of vitamins, minerals and other micronutrients.
- The mean number of bowel movements after SADI-S ranges about 2.5 per day.
- Anastomotic leaks
- bowel obstruction
- Possibility of bile reflux