[vc_row][vc_column][vc_column_text]The SADI (Single Anastomosis Duodenal Ileostomy) is the endorsed by the American Society of Metabolic and Bariatric Surgery.
However, the one-anastomosis gastric bypass (OAGB) has proven to be a safer surgical procedure, and we no longer perform the SADI operation. Some know the OAGB as the mini-gastric bypass
We no longer offer SADI.
The SADI consists of two parts.
1) – The vertical sleeve gastrectomy
This is the most common weight loss operation in the United States today. The operation consists of removing a portion of the stomach. With reduced stomach capacity, there is a decrease in the amount of hunger hormones the stomach makes. There are additional hormonal changes to the body that assist in weight loss.
2) – The Loop Bypass
Just beyond the stomach a bypass is formed; this averts all but the last 300 cm, about half the length of the small bowel, which is 600 cm long.
There have been two issues with the VSG. Some patients have developed reflux (GERD or heartburn) which can lead to changes in the esophagus. Approximately 20 percent of patients experience weight gain within a few years of the procedure.
The one-anastomosis gastric bypass is a safer procedure, where we do a loop bypass to the stomach but leave the stomach there for reversal.
The Sleeve (Vertical Sleeve Gastrectomy) Came from The Duodenal Switch
Historically the sleeve gastrectomy came about from the duodenal switch. Some patients requesting the duodenal switch were quite ill from the effects of morbid obesity. The goal was to get them to the operating room quickly.
We discovered that if we performed only the first part of the operation, removing 85% of the stomach, patients were able to lose weight and improve their co-morbidities. They would be healthy enough to return for the intestinal bypass later.
It turned out that many patients didn’t require the second part of the operation, as their health profiles improved greatly and they consistently lost weight.
The name “Vertical Sleeve Gastrectomy” was adopted and trials began to determine if the procedure would become a stand alone surgical operation. It was eventually endorsed and approved as a standard weight loss operation.
Today most insurance companies recognize that laparoscopic Vertical Sleeve Gastrectomy is a viable weight loss operation. Recent reports show that the Sleeve gastrectomy is safer than appendectomy or hysterectomy.
Revision Surgery: Converting a Sleeve
We no longer convert to a SADI or a DS, instead we find the conversion to the one-anastomosis gastric bypass safer, with just as much weight loss.
One reason vertical sleeve gastrectomy is a useful first operation for many patients is that it can be modified to a Mini or one anastomossi bypass. Reasons to modify an operation include weight regain, desire to lose more weight, or issues with GERD/heartburn/reflux.
We no longerconvert to a SADI, we do to a OAGB we do this laparoscopically which typically includes a brief hospital stay (one or two nights). Usually it is one night stay
Malabsorption Issues
While there is not as much malabsorption with a SADI versus a classic duodenal switch, there still is some which is why the OAGB is safer. It is necessary to take a vitamin supplement that contains A,D,E, and K vitamins. Our on-staff dietician assists our patients in making these choices; vitamin levels are checked when patients come into the office for follow up appointments.
In the first year, if patients get off track with their eating habits, especially with fatty or sweet foods, they’ll experience an increased amount of flatus.[/vc_column_text][/vc_column][/vc_row]