e, and then a LOOP of distal ileum is attached to the sleeve just after the pylorus. This loop connection is the only intestinal anastomosis that is made, rather than the Y-shaped connection of a traditional Duodenal Switch or Gastric Bypass.
Both the DS and SADI-S are typically performed laparoscopically; occasionally patients may need an open procedure for safety reasons. Both surgeries could potentially be done in stages, by performing the Sleeve Gastrectomy first, and the intestinal portion later. The advantage of two stages is that since the Sleeve is a simpler, faster operation, it is a better choice for patients who are very high risk.
After a period of initial weight loss, it is safer to proceed with the second portion of the procedure. Additionally, in patients who had originally had a Sleeve Gastrectomy, but are still candidates for additional bariatric surgery, converting to a DS or SADI-S may be more straightforward than converting to a Gastric Bypass.
The traditional DS has been performed for a longer period of time – since 1988 as an open procedure, and 1999 as a laparoscopic procedure. This means that we have more long term data on the DS.
The key difference is that only one Intestinal join is made in SADI-S, compared to two in the Duodenal Switch.
With fewer surgical connections in the intestine, the chance of an intestinal leak or blockage is reduced.
In each instance of anastomosis or surgical connection being made, two separate parts of the digestive system are brought together, whether the stomach and/or a part of the intestine. Each connection can have a chance of a leak of gastrointestinal contents, and two connections significantly increase the risk of internal herniation, trapped bowel, and bowel obstruction.
The innovation of SADI-S over the traditional Duodenal Switch is to design the surgery so that only one surgical connection is made. This results in less likelihood of surgical complications.
Weight loss after the DS and SADI-S has been reported to be greater than that of gastric bypass, although high-quality data supporting this has been lacking.
There is evidence that DS may offer better weight loss in patients with a BMI>50. On the other hand, there is strong evidence that resolution or improvement in diabetes tends to be better with the DS/SADI-S than the Gastric Bypass. A study by Buchwald in 2004, compared the results of over 4000 patients after DS, and found that either improvement or resolution of diabetes in occurred 98% of patients.
Resolution or improvement of cholesterol also is almost universal, as a result of the fact that fats are not absorbed well with either surgery. In fact, fat malabsorption can result in frequent loose stools, abdominal cramping, and foul-smelling flatulence; this can be worse if patients are not adherent to a low-fat diet. On average, patients have about 3 bowel movements per day.
Vitamin and mineral supplementation are of utmost importance since the DS/SADI-S are the most “malabsorptive” of the bariatric surgeries. Iron absorption is compromised by bypassing the duodenum; up to 10% of patients after SADI-S were found to have mild cases of anemia 1 year after surgery. Deficiencies in calcium, B12, and folate are also common if patients are not taking appropriate supplementation. Finally, vitamins A, D, E, and K are fat-soluble vitamins; since fat absorption is significantly decreased after DS/SADI-S, it is possible to develop deficiencies in these vitamins, more so than with the Gastric Bypass. Supplementation is routine. Lifelong follow-up is important as with all bariatric surgery to make sure that safe vitamin and mineral levels are maintained.
Both the DS and SADI-S are powerful weight loss tools.
They can help achieve significant weight loss and resolution or improvement of many obesity-related medical problems. The difference between the two is largely related to how the surgery is performed; long-term comparisons are still needed. Generally, surgeons will perform either the traditional DS or SADI-S, but not both. Ultimately, the most important thin