Common Channel Length in Sadi-s

And the maintenance is where I ran into trouble.
I'm really hoping he says my sleeve can be tightened up....because I think that's my best chance for getting the weight off initially.
Some days I can eat more than others. Today was a giant tummy day. I picked up Popeyes for lunch today....a rare treat. I ordered two piece white meat with a side of red beans no rice. They actually gave me three pieces of chicken. A breast and two wings. I ate ALL of it except the biscuit. And I wasn't hurting either! I was shocked I could eat all of that! Perhaps that means it has stretched out to the point where it could be tightened up.

But yes....hoping I can get it off and hoping the switch part will help me keep it off.
 
It isn't weight loss that matters, it is MAINTENANCE of weight loss that matters. And that's malabsorption. And SADI doesn't have nearly the same malabsorption.

I eat far more than I did when I was morbidly obese. But I eat more often - the sleeve is NOT stopping me from eating a lot over a 24 hr period anymore, even though it keeps me from eating as much at one sitting. I'd be near 300 lbs again if not more without the malabsorption.

I eat only one meal a day. All freaking day long most of the time!

Well, that's stretching it. Truthfully though, I start craving protein...although sometimes I get confused and think I'm craving chocolate...about every two hours. If I get smart, I eat some almonds or cheese. If I get stupid, I eat candy and other junk and then FINALLY I remember that what I need is protein and THEN I eat almonds or cheese or a ribeye steak or bacon and eggs and stuff.

I had the DS nine years ago. I never got thin, but I lost 80% of my excess weight. Nine years later, after fluctuating regain, I have maintained a 70+% excess weight loss. I have zero self-control and zero committment to exercise, and if not for the onging malabsorption, I would be fatter and sicker than I was nine years ago.

My sister had the sleeve about two years ago. She, too, lost about 80% of her excess weight. She has regained to the point that she is at about the 70% EWL place. But while she is good about walking and protein drinks, she also heads for her old comfort food and all she has going for her at this point is she can't eat as much as she did before. Yet.

My hunch is that the long term SADI results will be somewhere between the DS and the sleeve...and I don't want to deal with malabsorption without the ability to fairly easily maintain maximum weight loss. Not enough bang for the buck.
 
Hi. Good Morning! I had this procedure done on 12/3/13 with Dr. Roslin in NYC and I am pleased so far. HW 268 and now 116 pounds. My CC is 150 and Dr Roslin explained why this surgery was better for me vs then the traditional DS. Dr. Roslin took the time to explain the surgery and I emailed him with any questions/or concerns. Dr Roslin responded to my emails within several hours. Dr. Roslin did mention that I can decide on the procedure the day of surgery and he will do the procedure that I felt comfortable with. I am pleased so far and am glad that I chosen the loop DS.
 
How nice to "meet" someone with this procedure :). I hope you'll hang around and share more of your story with us!
Hi! Thank you. I'm sorry for the delay of replying. It has been a busy weekend. I am having a great experience with my surgery. On 12/3, i will be a year out.
 
So I have to admit, malabsorption kind of scares me. I get the idea - reduce the amount of small bowel, reduce the overall calorie absorption. However, you also reduce the amount of nutrient absorption; and fat, for all it's evil connotations, is an essential macro nutrient (just not nearly in the amounts we ingest). Don't you also affect how some medications are absorbed?

However, after talking it over with my surgeon, it does seem like some kind of malabsorptive component is going to be essential for me - as much as that concerns me, I have to accept that. If I simply has a sleeve gastrectomy I would likely not achieve the kind of weight loss I need (my BMI is about 55 and my ideal total weightloss would be about 210) and either give up ultimately or be back for a modification.

So, I listened to my surgeon and he convinced me that malabsorption was a necessary part of my plan. He, though, listened to my concerns about it and it just seemed like SADI was the middle ground. Maybe I am unnecessarily concerned about the concept of malabsorption - maybe if I came to terms with that a standard DS would be more appropriate for me. Thoughts?
 
So I have to admit, malabsorption kind of scares me. I get the idea - reduce the amount of small bowel, reduce the overall calorie absorption. However, you also reduce the amount of nutrient absorption; and fat, for all it's evil connotations, is an essential macro nutrient (just not nearly in the amounts we ingest). Don't you also affect how some medications are absorbed?

However, after talking it over with my surgeon, it does seem like some kind of malabsorptive component is going to be essential for me - as much as that concerns me, I have to accept that. If I simply has a sleeve gastrectomy I would likely not achieve the kind of weight loss I need (my BMI is about 55 and my ideal total weightloss would be about 210) and either give up ultimately or be back for a modification.

So, I listened to my surgeon and he convinced me that malabsorption was a necessary part of my plan. He, though, listened to my concerns about it and it just seemed like SADI was the middle ground. Maybe I am unnecessarily concerned about the concept of malabsorption - maybe if I came to terms with that a standard DS would be more appropriate for me. Thoughts?

I think you need to do some reading in the back threads, you'll see lots of information about malabsorption and managing what your body needs with diet and vitamin supplementation. It's not unmanageable. SADI may be a great surgery, but there aren't many long-term results yet.
 
So I have to admit, malabsorption kind of scares me. I get the idea - reduce the amount of small bowel, reduce the overall calorie absorption. However, you also reduce the amount of nutrient absorption; and fat, for all it's evil connotations, is an essential macro nutrient (just not nearly in the amounts we ingest). Don't you also affect how some medications are absorbed?

However, after talking it over with my surgeon, it does seem like some kind of malabsorptive component is going to be essential for me - as much as that concerns me, I have to accept that. If I simply has a sleeve gastrectomy I would likely not achieve the kind of weight loss I need (my BMI is about 55 and my ideal total weightloss would be about 210) and either give up ultimately or be back for a modification.

So, I listened to my surgeon and he convinced me that malabsorption was a necessary part of my plan. He, though, listened to my concerns about it and it just seemed like SADI was the middle ground. Maybe I am unnecessarily concerned about the concept of malabsorption - maybe if I came to terms with that a standard DS would be more appropriate for me. Thoughts?
I agree that you may want to read some older stuff here, and it may give you a better feel for long term DS life.

I didn't like the idea of malabsorbtion either, but knew I had a super efficient system and could maintain my weight ( up to a almost a 50 bmi) even with severely restricted calories, so knew the malabsorbtion was really all that was going to give me enough edge. I was capable of eating small meals before surgery, and that is the reason I didn't go with the sleeve. I didn't WANT to bother with a bunch of vitamins and having to adjust things in case I had bathroom issues for the rest of my life if I had the DS, but I wanted even less to risk the surgery failing me. I worried even more about needing a second surgery if the first one was wrong, and it not being possible, or having even further messed up metabolism.

Put all your research efforts into what you want before the first surgery, to avoid the possibility of a second one. Only you, not any poster here or your surgeon, know your body and tolerances like you do. Read for a while and get a feel for the different surgeries (unfortunatley, no long term peeps with SADI).
 
I am now 31/2 months out. I am quite happy with my procedure. My alimentary channel length is 300cm, which is about half. If I were to be honest, I'd say I'm about 70% compliant in my diet/supplement regime. I do work out a good amount. I had my 3 mo. check up and my vitamin levels are great, with the exception of potassium, where I was just the tiniest bit low, so I was told to drink a gatorade or eat a banana every day. I haven't had any extreme hair loss or any of the other side effects of malabsorbtion. I've lost 58% of my excess weight as of this morning. So, I am a SADI success. My surgeon said that he expects this to be one of the most "durable" surgeries. He's the head of gastroenterology at Duke, so he oversees over 800 bariatric surgeries a year. He, personally is only doing sleeve, switch and SADI now. He isn't happy with the long term data on bypass and bands.
 
Thanks - I actually spoke to my surgeon today (I e-mailed him and he actually took the time to *call* and talk to me... I like). He explained some more of the reasons why he thinks it would be good for me. As it turns out, he was not suggesting SADI as an alternative to DS but as an alternative to either sleeve alone, or RNY for a number of reasons:

1) I had general concerns about side effects - particularly those associated with RNY but also with malabsorption in general.
2) Because of my BMI (~54) though, he's very concerned that I would not find success with a restrictive procedure alone. If I lost the average 60% of my excess weight with sleeve alone, I would still be obese. The prognosis with a procedure that includes a malabsortive component is more positive.
3) My insurance will only cover one lifetime procedure - so doing a sleeve and a subsequent modification would present a challenge. Out of pocket for a later modification is not out of the question... but it's a lot less likely to happen.

So, his motivation was really to encourage me to consider a procedure which has a malabsorptive element to it... and one which is done in single operation. He's done numerous sleeves and numerous bypasses as a modification. However, he does not do both the sleeve and bypass in one procedure. I didn't ask why, but I suspect it has to do with the duration and complexity of the procedure and the negative impact on outcomes that can have. On the other hand, I really do not want RNY and the negative side effects that has - so, his suggested alternative is SADI.

That is definitely a consideration for my case; with a BMI of about 53 I am a more significant surgical risk in general. Anything that reduces my time on the table is probably good for me.

Now, all that considered, while it doesn't give me any reason to trust him less, I would really like to run the "DS or SADI" question by a doctor who has done both who has done more single operation DS procedures. Anyone know of one who's open to e-mail questions... or better yet, one in the Atlanta area who I could go talk to? :cool:
 
Your last question is a good one, and I would suggest that you start a new thread with that specific question. I would also suggest, given your insurer's "one surgery per lifetime" clause (which I believe is terribly unfair and should not be legal, but clearly it is), that you seriously consider the DS, as it has documented excellent long term results, whereas SADI does not (maybe it will 5 years from now, but not at present).
As far as risks of surgery goes, certainly these are all major surgeries and all carry some element of risk. But the consideration here is not just risk, but also risk vs potential benefits, as well as risk of doing nothing. The potential benefits of the DS are well documented. The potential risks of doing nothing are also well known. The difference is that the risks associated with doing nothing are less immediate, but being MO, even with NO comorbidities, has been shown to shorten life significantly (like, about 8 years). And that doesn't even factor in the quality of life issues, which I'm sure I don't need to elaborate as you are already well aware of that aspect of being MO.
And frankly, I'm not all that impressed with the "less risk" aspect of the SADI. All the major elements of the DS are still there, including the operating on the duodenum, which is the most delicate part of the operation. The only difference in terms of risk is one less anastomosis of the small intestine. that's it.
 

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