Duodenal Switch Surgery vs. SADI

duodenal switch surgery vs SADI

Duodenal switch surgery is a type of bariatric surgery used to help obese patients lose a large amount of weight and improve their overall health. Often individuals who are obese suffer from co-morbidities such as type 2 diabetes or high blood pressure that has resulted because of the excess weight they are carrying. SADI-S is also a type of bariatric surgery and is a modified version of the duodenal switch procedure. It is also referred to as stomach intestinal pylorus sparing surgery (SIPS). To better understand the differences between these two surgeries, let’s take more of an in-depth look at each.

History of Duodenal Switch Surgery

The duodenal switch was developed as an improvement on a surgery called biliopancreatic diversion (BPD) so you may see a duodenal switch referred to as DS or DS-BPD.

The biliopancreatic diversion surgery divided the patient’s stomach in half horizontally and also rerouted a portion of the digestive system. The portion of the digestive system that was bypassed was very long and many patients experienced malnutrition and dumping syndrome when food is not digested and passes from the stomach directly into the small intestine and causes a host of negative side effects. Dumping syndrome symptoms can show up as early as 10 minutes after eating or as late as 3 hours later.

The duodenal switch was created to alleviate the negative side effects of the biliopancreatic diversion.


What Is Duodenal Switch Surgery?

The duodenal switch became the modified, updated version of a biliopancreatic diversion. Instead of the stomach being sectioned off horizontally, it was reduced by 75% and shaped into a small sleeve-like pouch, same as vertical sleeve gastrectomy (VSG), or gastric sleeve. The new smaller stomach sleeve reduced the amount of food a patient could eat at one time and the intestinal re-routing was less severe allowing the ingested food to remain in the digestive tract a little longer. These modifications reduced the dumping and malnutrition side effects.

Sometimes the duodenal surgery is done in two different steps and broken up into two different surgeries to reduce the risks involved and shorten the surgical time.

  • Step 1 is gastric sleeve surgery (VSG or LGS) to reduce the size of the stomach and then after 2-3 months.
  • Step 2 is a second surgery that alters the digestive system so the food that is ingested does not stay in the digestive tract as long and not all the calories are absorbed by the body.

At IBI Healthcare Institute the two steps can be performed at the same time, with no wait time and no additional surgery.

The duodenal switch has historically led to very significant weight loss and remission of many obesity-related health issues however, due to the complexity, length, and risk associated with the surgery, a new variation has been created. This new variation, or modified duodenal switch, is called Single Anastomosis Duodenal-ileal Bypass with Sleeve Gastrectomy or SADI-S.

What Is SADI-S Surgery?

To better understand the Single Anastomosis Duodenal-ileal Bypass with Sleeve Gastrectomy (SADI-S) also called single anastomosis duodeno ileostomy, we will break down a few of the medical terms within the title.

What Is An Anastomosis?

Whenever two pieces of intestines or a section of the stomach and intestine are joined together, this is called an “anastomosis”, they can be stapled or stitched. Any time there are surgical connections (anastomosis) made between spliced intestine or intestines and the stomach, there is a risk of leakage.

What Does Duodenal-ileal Mean?

The term duodenal-ileal is referring to the two areas that are connected during the procedure. The duodenum is the first part of the intestine and the lower portion of the intestine is called the ileum.

During SADI-S surgery, similar to the duodenal switch (DS), a gastric sleeve surgery is performed first and then a portion of the digestive tract is bypassed. The big difference is that there is only one surgical connection (anastomosis) and only 1 section of the intestine that is altered using a loop.

The duodenal switch contains 2 anastomoses with a Y-shape alteration to the intestines.

Potential risks are reduced with SADI-S because there is only one anastomosis and one digestive tract alteration which means a lesser chance to experience leaking. SADI-S surgery takes less time to perform than a duodenal switch or a gastric bypass.

What Is SADI Bypass? IBI Healthcare Institute

SADI Bypass stands for Single Anastomosis Duodenal Ileal Bypass. This procedure along with lifestyle changes will help those who are obese lose 80% of their excess body weight. Those who have type-2 diabetes have that disease reversed in over 95% of the case. This procedure is not newly invented but is a variation on a traditional gastric sleeve.

SADI-S And Duodenal Switch (DS) Similarities

The majority of SADI-S and duodenal switch surgeries are done laparoscopically and can be performed in two steps if needed.

Both surgeries begin with a standard sleeve gastrectomy surgery (VSG, LSG, or GS) which is a simpler, low-risk surgery that helps control patients’ appetites and keep them from eating too much at each meal.

Some severely obese individuals that are considered “high risk” for surgery may benefit from the staged approach. Undergoing the sleeve gastrectomy portion of the two-step surgery may result in enough initial weight loss that after a few months it would be safe to continue to the bypass portion to effect further weight loss.

A sleeve gastrectomy can easily be converted to a duodenal switch or SADI-S surgery if needed.

SADI-S And Duodenal Switch (DS) Differences

The biggest difference between the two procedures is that the duodenal switch alters more of the intestinal tract and splits a portion into a Y formation. It also has two anastomoses posing more risk for post-surgical leaking and is more malabsorptive which can cause malnutrition. Duodenal switch surgery is more complicated and poses more long-term risks.

The SADI-S has only one anastomosis and one “loop-shaped” intestinal alteration which reduces the risks associated with leaks or intestinal blockages. Unlike the duodenal switch that has the Y shape dividing the bowels, there is no bowel division during SADI-S so there is no risk of bowel obstruction or hernias.

Benefits of Both Duodenal Switch and SADI-S

  • Patient’s achieve significant weight loss
  • Feel full longer
  • Portion control
  • Fewer calories are absorbed by the digestive system
  • Long term weight loss

Benefits of SADI-S over Duodenal Switch

  • Fewer digestive alterations
  • Fewer associated risks
  • Lower complication rate
  • Fewer associated GI side-effects
  • Less complicated surgery

Is Duodenal Switch or SADI-S The Best Option For Weight Loss?

The best way to determine if SADI-S or a duodenal switch would be the best weight loss surgery for you would be to set up a consultation with a highly-skilled bariatric surgeon.

At IBI Healthcare Institute we are committed to supporting your weight loss journey from determining which procedure would be the best fit for you, through the surgery and ongoing into the future. Our professional experts are dedicated to providing the support and resources necessary to benefit the health and wellbeing of the individuals who come through our doors. Call today to set up your consultation or make an appointment online.

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