SADI
What is SADI?
Another type of gastric bypass surgery that previously fell out of favour because of malabsorption side effects. Newer versions of these operations are sufficiently safe to view them as options for some patients. The operation has two components: the first is the creation of a gastric sleeve, and the second involves changing the point where the end of the stomach (the duodenum) connects to the small bowel. It can be done at the time of the gastric sleeve or can be done later if someone has had a sleeve and regained weight.
It is called a duodenal switch because this (duodenum) is the part that is moved around (switched). Moving the connection of the stomach bypasses the small bowel, and it’s this small bowel bypass that leads to added weight loss, metabolic improvements, and nutritional risks. The magnitude of its effect is related to how much small bowel is bypassed. Longer small bowel bypasses mean more weight loss and diabetes/cholesterol improvements, but a bigger risk of malabsorption, diarrhoea, weak bones and other side effects.
How duodenal switch procedures cause weight loss
SADI itself does not make you lose weight. Overeating is limited by the new small and tight stomach. Too much food causes discomfort and vomiting. Satiety (being satisfied early in a meal) is induced by the small stomach and through the ‘switching off’ of the hormones that cause hunger. Many patients go for months before they have any recognisable hunger sensations, and they often have to remind themselves to eat.
These operations produce weight loss of a magnitude similar to a gastric bypass (25-50% total weight loss). We do not have much data about the newer, safer versions of this surgery beyond 5 years.
Am I a candidate for a SADI?
The criteria are the same as for other weight loss surgeries however, because of the more substantial risks of malabsorption, they tend to be reserved for larger patients, those with risks of developing gastric ulcers (smoking, alcohol, Aspirin-like medications), and people who have regained weight after having gastric sleeve surgery.
As with all weight loss surgeries, SADI should only be performed on people with a BMI greater than 40, or those with a BMI over 35 with other medical co-morbidities such as diabetes or high blood pressure.
Occasionally patients with BMI under 35 may also undertake this operation; however, the balance between risk and benefit is harder to gauge. Patients who are lighter than this run the risk of losing weight but at the expense of complications that can make them worse off. Other weight loss therapies should have been tried beforehand but have been unsuccessful.
Patients with eating disorders such as binge eating or a nocturnal eating disorder, and patients who habitually graze or emotionally eat, need to seek treatments for these disorders as well, otherwise, the surgery will fail after being initially successful.
Advantages of SADI
- Generally, SADI requires a short hospital stay of 2–3 days, and patients find it OK to return to work by about two weeks.
- Patients can lose up to 30 – 50% of total body weight as a result of SADI surgery. Patients have demonstrated that with this form of surgery it is easier to maintain long-term results.
- With such significant weight loss, patients will then see other health benefits as a result such as Type 2 Diabetes going into sustained remission, ease of joint pain such as knees, ease of breathing and other health benefits.
- Unlike gastric bypass operations, complications like ‘dumping’ and gastric ulcers seem very uncommon with this surgery.
Drawbacks of SADI
- As with every surgery, this operation poses risks to the patient. However, the operation is invariably performed laparoscopically which means less chance of infection and much quicker recovery times. But of course, this can vary from case to case. Most patients recommended for this surgery will fail to lose a significant amount of weight without it and can face even more serious risks to their health long term.
- SADI affects how your body absorbs the food you eat, so there is a risk of various deficiencies occurring. All patients having bypass surgery need a minimum of a daily multivitamin and at least 6 monthly vitamin B12 injections. Other items including Vitamin D, calcium and iron will be needed by many patients.
- Risk of malabsorption, diarrhoea, weak bones and other side effects.
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