SADI-S / Loop - Please share facts about this new procedure here.

[hilary1617]

The SADI-S/Loop, or more fully, "Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy", is an experimental weight loss procedure which involves a Vertical Sleeve Gastrectomy paired with an end-to-side duodeno-ileal diversion.

Given that the SADI/Loop (also called SIPS) is a new surgery, the long term weight loss results and other outcomes and side effects are not yet known.

I haven't been able to find an independent published study that describes results or concerns beyond 3 years out and/or with a large sample size. If anyone comes across one, please share!

There appear to only be two research articles on pub med:

http://www.ncbi.nlm.nih.gov/pubmed/20798995
http://www.ncbi.nlm.nih.gov/pubmed/24725654
​

Scholar.google.com has some limited articles as well, and may become a decent future source of information.

Surgical innovation is necessary to advance the field of medicine. Every tried-and-true procedure was initially unproven, much as every surgeon has had a first patient. Generally the risks decrease over time as experience is gained. Clinical trials are the standard for establishing the efficacy and safety of experimental procedures. As of the date of this posting, I could only find an active clinical trial at one hospital in Madrid - perhaps more will become available in the future:

http://clinicaltrials.gov/ct2/show/NCT01685177​

(Clinical trials can be found by searching http://clinicaltrials.gov ).

Note: Some surgeons refer to the SADI-S as a "Loop DS", but despite the nomenclature, the SADI-S should not be confused with the traditional Duodenal Switch. While the SADI-S and traditional Duodenal Switch procedures are both weight loss procedures which involve a Vertical Sleeve Gastrectomy, the surgeries and resulting intestinal configurations are significantly different. Accordingly, side effects, complications, long term outcomes, etc. can be expected to differ, much as they would differ from a Roux-n-Y.

I am hoping to research and add additional factual information about the SADI-S/Loop here as it becomes known and would be grateful if others would contribute to the knowledge base as it develops.

Thanks!
Hilary

(Edited to correct second link and to add new name for SADI, "SIPS")

 

[fernpoppy]

Hello Hilary,
I just had the loop DS on May 12. There is only one surgeon in my area who does this and he does not offer the regular DS. I needed to go this route since I need to be able to take NSAIDS and the surgeon said that I will be able to in a few weeks. I have to admit that I feel ridiculous at this point. Since this was my only option locally, all of my information came directly from the surgeon. I feel like I have been a little naive by not doing more research prior to the surgery but I also wasn't able to find any Websites on the subject. On another forum (after I had the surgery), I saw someone post that this was an experimental surgery and that it didn't offer the same malabsorption properties. I'm still uncertain about the experimental part because I don't think my insurance would pay for it if it were classified as experimental. I went for my first visit to the surgeon post-op and asked him about the malabsorptive question and his answer was "we don't know if it is less malabsorptive or not." If it is true, or even if it is a possibility, it would have been nice to have had that information prior to my decision. After reading more forums, I find that most everyone says not to go with the loop. I would love to be able to find out scientific facts about the differences between the surgeries also. Right now it seems that the main advantages to the loop are that there are less possibilities of hernias following the surgery, and less operating time and less risk of complications. The first link you offered was encouraging, saying that after 3 years that 94.7% of the excess weight was lost by the test population. I guess the next big question is what are the long-term weight loss results? Now, I think I wish that I had traveled and had gotten the real DS. I've heard that having regrets after surgery sometimes happens. I don't regret having WLS, but I'm wondering if I chose the right surgery. I'm positive I didn't choose the right surgeon because of another proble. I am still hopeful everything will turn out for the best. I also hope to find out more information about the loop DS if anyone has anymore information.
fernpoppy

 

[Terri]

@fernpoppy I am pre op but agree that I don't think insurance would have approved and paid an experimental surgery, which makes me wonder if it was "miscoded" when it was submitted to insurance. There are many veterans on here with years of experience and knowledge that will be able to answer your questions.

Who was your surgeon and where are you located?

 

[DianaCox]

Hello Hilary,
I just had the loop DS on May 12. There is only one surgeon in my area who does this and he does not offer the regular DS. I needed to go this route since I need to be able to take NSAIDS and the surgeon said that I will be able to in a few weeks. I have to admit that I feel ridiculous at this point. Since this was my only option locally, all of my information came directly from the surgeon. I feel like I have been a little naive by not doing more research prior to the surgery but I also wasn't able to find any Websites on the subject. On another forum (after I had the surgery), I saw someone post that this was an experimental surgery and that it didn't offer the same malabsorption properties. I'm still uncertain about the experimental part because I don't think my insurance would pay for it if it were classified as experimental. I went for my first visit to the surgeon post-op and asked him about the malabsorptive question and his answer was "we don't know if it is less malabsorptive or not." If it is true, or even if it is a possibility, it would have been nice to have had that information prior to my decision. After reading more forums, I find that most everyone says not to go with the loop. I would love to be able to find out scientific facts about the differences between the surgeries also. Right now it seems that the main advantages to the loop are that there are less possibilities of hernias following the surgery, and less operating time and less risk of complications. The first link you offered was encouraging, saying that after 3 years that 94.7% of the excess weight was lost by the test population. I guess the next big question is what are the long-term weight loss results? Now, I think I wish that I had traveled and had gotten the real DS. I've heard that having regrets after surgery sometimes happens. I don't regret having WLS, but I'm wondering if I chose the right surgery. I'm positive I didn't choose the right surgeon because of another proble. I am still hopeful everything will turn out for the best. I also hope to find out more information about the loop DS if anyone has anymore information.
fernpoppy

You need to talk to a lawyer. NOW. Performing surgery on a patient without fully informed consent is serious - it is battery. Your surgeon may have also committed fraud on the insurance company if he submitted codes for the DS and performed an entirely different surgery. Get yourself to a malpractice attorney NOW. There is a statute of limitations on malpractice claims. Don't wait.

 

[hilary1617]

Hello @fernpoppy, welcome!

I'm sorry to hear you have regrets, especially that you experienced some problem related to the surgeon. Deciding to have a weight loss surgery is hard in and of itself and then selecting which type and a surgeon and handling all the logistics is really difficult. Please don't second guess yourself now that you've made it to the other side of that very challenging process! Instead, focus on the positives, along with your healing, hydration and nutrition so that you can come out of this experience as healthy and fit as possible. I'm sure you are losing weight and hope you are excited about it!

I became interested in the SADI-S / Loop because it seems to me that people who had or are considering that procedure really don't have a lot to go on, or an established place to share experiences, advice, etc. It was really helpful for me to be able to participate in a forum where there were veterans who knew a lot about the surgery I had and could help me with questions and tips. I'm hoping that over time maybe this can become a similarly useful and welcoming place for people who have had or are considering the SADI-S / Loop.

For now, I think it is especially important for potential patients to understand that it is new and that given its novelty, there isn't a lot of knowledge or experience out there. I'm a bit worried that some patients who've undergone the SADI don't seem to have been told in advance that it is experimental and is a much different procedure than anything else out there. Every patient deserves to make a fully-informed decision. I'm going to keep gathering what information I can find and sharing it here.

Maybe some other SADI patients will join in the dialogue and you can compare notes. Stay positive!

Best wishes!
Hilary

 

[DianaCox]

Let me be clear - it may well be that the SADI is a good surgery. That's NOT the issue. The issue is that the surgeon gave you a surgery without fully informed consent. That he didn't make it clear to you that it was an experimental procedure. That he didn't make it clear that you could go elsewhere to get a non-experimental procedure. And the possibility that he committed insurance fraud in submitting a claim for an experimental procedure to your insurance company.

Now, here is something else you should know, but DON'T need to do anything about right now. Assuming he did the sleeve correctly, and cut the duodenum in the right place, I assume the SADI could be converted to a proper DS fairly easily. What gets me is why he would say he couldn't do the DS - it involves one additional cut and one additional anastomosis.

 

[MyNewLife]

Diana, off topic but love the new pic

 

[DianaCox]

Diana, off topic but love the new pic

First time I've ever had a "professional" headshot - this is for our firm's website. But I just can't be all grey suit - it's just not me - just bluish-grey pearls.

 

[hilary1617]

Some more info:

http://bariatrictimes.epubxp.com/i/130204/20

http://www.researchgate.net/publica...rectomy_(SADI-S)._One_to_three-year_follow-up



P.S. I also like Diana's picture.

 

[fernpoppy]

I apologize, I don't check this e-mail address often and just now saw these helpful messages. Thank you for taking the time to participate in this discussion.
Diana, is it a fact that Sadi DS is experimental? This may sound naive, but would a doctor really jeopardize his practice by committing insurance fraud?

The more I find out about this surgeon (Matthew Metz, Parker, Colorado), the more disillusioned I become. For instance, he leaves the drainage tube in for two weeks. I talked to two nurses who said that it shouldn't be left in for more than 1 week. It ended up getting infected. I found out from him that the true reason that he leaves it in for the additional week is that he said that he used to remove it at week 1 but that patients came into the office looking like me (I felt horrible by the time I finally got him to see me). He is afraid that it will scare off people coming in for consultations. The other gotcha is that I have a large deductible. He required that I pay him a large amount up front. I balked at first, but there was no negotiation. The insurance ended up paying him in full, so now he has the insurance payment, plus my large down payment and I haven't been able to get him to pay me back yet.

I would prefer to just concentrate on getting well and healthy, but I don't think it's fair that he continue to practice this type of misrepresentation. He told me that he has several more of these SADI DS coming up shortly. Maybe I do need to consult a malpractice attorney, or at least find out if I can file a complaint within the medical community. A consideration is, who will I go to for follow-up visits since he is the only doctor in the area who knows anything about the type of surgery he performed on me if I do file a complaint or get an attorney?

 

[DianaCox]

You have to decide what to do - and waiting, for a while, is one option. Have a consult with a medical malpractice attorney, and make SURE you know what the statute of limitations is on your claim in your state. It can vary from 1 to 5 or 6 years, usually 2-4 years. You can start preparing your complaint now, documenting what happened and how you were treated. in the meantime.

You MUST force him to repay your downpayment - that is outrageous - Rabkin does the same thing, but I got my overpayment back right away when insurance paid more than the remainder of the fee.

Consult with an attorney - call your county bar association and ask for a referral. Ask the lawyer what to do.

AND - call your insurance company, and tell them that you believe he did an unauthorized procedure on you, and that you want THEM to investigate what was done, and whether he should be paid for it. And tell them that, for now, because you are dependent on him for follow up care, that you don't want them to know that you suggested that they investigate, but that you want to receive copies of whatever they find, because this may not only be insurance fraud, it could be battery.

http://www.dayontorts.com/medical-n...tween-informed-consent-and-battery-cases.html

The Distinction Between Informed Consent and Battery Cases
The distinction between a lack of informed consent case and a pure medical battery case is set out in Blanchard v. Kellum, 975 S.W.2d 522 (Tenn. 1998). An informed consent case requires expert proof as to the standard of care (or recognized standard of acceptable professional practice) of similar medical professionals. The plaintiff must establish what information is provided to patients prior to the procedure, and how the information is disclosed to the patient, in order to prove that the professional deviated from the standard of care. In a medical battery case, on the other hand, the plaintiff must establish either that the patient was unaware that the doctor was going to perform the procedure, or that the patient did not authorize the procedure. Medical battery cases include those in which the doctor performs a surgery that has been discussed with the patient, but performs the surgery on the wrong part of the body (i.e., amputation of the wrong limb). A true medical battery case does not require expert witness testimony on the standard of care, because there is no prior consent to be judged.

 

[fernpoppy]

Thank you for all that information! I really appreciate it. I will think about everything you said - valuable information. I've read on other forums that the few other people I've found who have had the SADI-S DS also seem like they didn't really know exactly what they were getting into either. My true wish is that doctors would be much more clear about the different surgeries.

Again, thank you.

 

[southernlady]

This arrived in my email (the contact one linked with this site) yesterday:

I would like to put in my two cents but would like it anonymous.

I went to Dr Roslin who from what I had read on the internet was a pioneer in the rny to ds conversions on the east coast. When I first investigated this it was either him or dr Greenbalm and from everything I had seen Dr Roslin was by far the best.. Although he had rumored to be "brusk" and even though I am sensitive I said I want the best even if his bedside mannor leaves something to be desired.

At my first appointment nothing was said at all about any kind of "different ds". I went to him for a ds I said I wanted a ds and nothing was said about anything different.

I went through all the insurance appoval and got to my final check appointment and the paperwork he wanted me to sign said DS but actually had the description of an RNY.. when I asked I was told this was just a generic form about bariatric surgery and was just for you to sign saying you are aware of the complications from bariatric surgery.. By this time I had learned from other bariatric online groups about this loop ds thing and that people were waking up having had this surgery instead of the one they expected. SOOOO I asked him to describe the surgery he planned on doing. He did so in MEDICAL terms I did not understand. So I asked again (he clearly was getting annoyed with me at this point).. He drew a picture which clearly looked like a sleeve thing but did not look like the two limps and common channel of a ds.. SOOOO I point blank asked him. Are you doing 2 limbs and a common channel.. He said No I was going to do a loop... Well I said I do not want a loop. I want the ds. He said well if that's what you want but it is a more complicated procedure. I said I understand. I want the real ds I need the malobsorption really bad. He was clearely upset and started rambling on about how people on the internet seem to think they know things that are not true and how it does not matter loop or no. I did not have the heart to tell him it was info HE posted on the internet I was reading..

My surgery is in 3 days and I still cannot guarantee he is going to do the full ds. He was clearly upset and I am afraid he is going to do the loop and make up some excuse as to why he could not. This is clearly upsetting to me but due to having to travel to do this and I do not drive and I have family responsibilities I have to take care of it is either do this now or not do it. I plan on making sure once more that he understands I want the full ds and that the paperwork I sign for authorization clearly says that..

But I feel I was clearly mislead. I do not feel the loop ds is a ds at all. I feel if a Dr plans on doing the loop ds (I dunno how they can call it a ds in the first place) he should clearly call it the loop ds. If he had said that upfront the first appointment there could have been discussion and I would not have all this worry right now.

I know this is more than you asked for but I feel if you are going to talk to people about it an a, b, c or d answer is not adequate..

thanks for doing this as I agree it is a serious problem and only going to get worse as this "loop" thing gets more popular...

 

[Elizabeth N.]

I am so bummed that Dr. Roslin has taken this turn. I hope the patient explicitly refused a loop procedure in the consent.

 

[JackieOnLine]

oy, and they are going forward with this surgeon?! hope they get what they want....