Need to know difference between DS and SADI

[Babette]

Trying to learn the difference between the SADI (aka SIPS, aka loop DS) and the 2 anastomosis DS.

The surgeon who did my sleeve recommends the first one; she says there's less risk associated with it. What you you all think? Which did you do and how has the outcome been? Many thanks!

 

[Clematis]

Since there haven't been any long term studies regarding the EXPERIMENTAL SIPS/SADI how can she know??? Seriously, this is why I would not recommend it. There is NO DATA. The DS on the other hand had decades of research to support its efficacy. The "OMG you'll have malnutrition!!" is BS if you get comprehensive labs twice a year and adjust your vitamins accordingly. However most WLS surgeons and their nutritionists give TERRIBLE advice (this is NOT what they studied in medical school) so if their patients suffer from malnutrition it is their own damned fault, not the fault of a properly performed, two anastomoses Hess-based DS surgery itself!

Let the data be your guide. (And as a scientist, the surgeon should follow that advice too.)

PS Another piece of data: the SIPS/SADI is a faster surgery but the doc gets the same price for it as a DS. Docs net more money for time spent on the SIPS/SADI.

 

[southernlady]

I changed the title since there is only one DS, the two anastomoses one. SADI/SIPS/LoppDS is not the DS.

 

[DianaCox]

https://www.dssurgery.com/weight-loss-surgery/sadi-sips/

https://www.dssurgery.com/weight-loss-surgery/compare-procedures/duodenal-switch-compared-sadi/

 

[Larra]

Now did I, or did I not, see this coming?

The DS is a standard of care bariatric surgery with well documented, excellent long term results. It has been accepted as standard of care since, I think, 2004 or thereabouts. There are studies going out 10-15 years showing the best results of any bariatric surgery for percentage excess weight loss, for maintaining that weight loss, and for permanent (yes permanent) resolution of almost all comorbidities (gastric bypass does better for severe GERD). In addition, the long term studies show a very low rate of nutritional deficiencies, which are almost always caused by noncompliance. In other words, if you get good advice, take your vitamins and minerals as needed, eat plenty of protein, and get your labs checked regularly and adjust supplements as needed, you should be fine. I've done well with annual labs, others check more often.
OTOH, the SADI/SIPS is experimental, and not accepted as standard of care by any relevant organization or agency. It does not have well documented long term results. I appreciate that at least your potential surgeon was honest about what she's doing, others are not, and we've had some very upset and disappointed people show us their operative reports for what was called "the DS" which proved to be SADI. They couldn't understand why they weren't losing much weight by about 1 year out, and at that point, there was nothing they could do about it. I think devastated would be an accurate description.
Less risk? There is one less anastomosis with the SADI. It's the least risky part of the DS, in other words, all the higher risk parts of the operation are still done. Less risk long term? No proof. Equal benefit to the operation? Doubtful, and certainly not proven.
Risk is important, but we always need to consider both potential risk and potential benefit. You've already gone through one failed operation. Really want to try something unproven?

 

[Spiky Bugger]

Now did I, or did I not, see this coming?

The DS is a standard of care bariatric surgery with well documented, excellent long term results. It has been accepted as standard of care since, I think, 2004 or thereabouts. There are studies going out 10-15 years showing the best results of any bariatric surgery for percentage excess weight loss, for maintaining that weight loss, and for permanent (yes permanent) resolution of almost all comorbidities (gastric bypass does better for severe GERD). In addition, the long term studies show a very low rate of nutritional deficiencies, which are almost always caused by noncompliance. In other words, if you get good advice, take your vitamins and minerals as needed, eat plenty of protein, and get your labs checked regularly and adjust supplements as needed, you should be fine. I've done well with annual labs, others check more often.
OTOH, the SADI/SIPS is experimental, and not accepted as standard of care by any relevant organization or agency. It does not have well documented long term results. I appreciate that at least your potential surgeon was honest about what she's doing, others are not, and we've had some very upset and disappointed people show us their operative reports for what was called "the DS" which proved to be SADI. They couldn't understand why they weren't losing much weight by about 1 year out, and at that point, there was nothing they could do about it. I think devastated would be an accurate description.
Less risk? There is one less anastomosis with the SADI. It's the least risky part of the DS, in other words, all the higher risk parts of the operation are still done. Less risk long term? No proof. Equal benefit to the operation? Doubtful, and certainly not proven.
Risk is important, but we always need to consider both potential risk and potential benefit. You've already gone through one failed operation. Really want to try something unproven?

You saw it.

 

[Spiky Bugger]

Does your insurance even cover these experimental procdures? If they approve a DS and you end up with something else, you may find a BIG surprise when you get billed for the procedure you got.

Here's a link to the AMERICAN SOCIETY OF METABOLIC AND BARIATRIC SURGEONS ASSOCIATION website, where all approved procedures are listed. The DS is there, the others are not:

https://asmbs.org/resources/approved-procedures


I don't wanna be someone's science project.

 

[galaxygrrl]

I would do a lot os research. I don't really think the data says the DS is more risky, I would have your PCP explain that statement. What is true is with the DS have be dilgent about the blood work and get it and stay on top of your vitiman levels, and I don't think you do with the SADI's.

I think the choice come down to do you want the DS which has proven science behind it that it works long term and you are signing up for watching your blood levels for the rest of your life, vs the SADI where you don't need to watch your vitimans as much, but there is less data on the long term effectivenes, and it might not work and you are part of a study group.

I hope this helps. The DS has worked for people on this board which is why you got such a strong reaction.

 

[DianaCox]

SADI/SIPS has risk of bile reflux; DS does not.
SADI/SIPS does not have selective fat malabsorption, and you will absorb a lot more of it, especially with a much longer common channel. With the DS, about 80% of fat is malabsorbed, but only about 50% of protein.

 

[Munchkin]

I have no doubt the SADI/SIPS/LOOP is better than the standard proximal RNY. But there is no proof it is even close to the real DS.

Here's your real choice. You can get the surgery that works or one that MIGHT work. I know 1 person who has done well and someone else who never lost any weight. And success 10+ years out is what really tells the tale and there is no data. It is a fact that all these variant procedures are easier for the surgeon.

Malabsorbtion is what makes the DS work. Weightloss surgery without malabsorbtion is just another diet. And all these procedures are less malabsorbtion that the standard of care DS. Do a LOT of research and you will find out real fast there is nothing better for losing the weight and keeping it off than the DS.

Next these variant procedures are not a 2 anastomosis DS and they are experimental. Insurance will not pay for experimental procedures. If an experimental procedure is coded as the DS someone MAY be committing insurance fraud. And it could come back to haunt you down the road.

Someday there will be something better than the DS. But it's not here yet.

Think twice. Cut once!