SADI-s out 2 weeks 2 Days.........needing some feedback

[DianaCox]

"I also worry about more risk of a bowel twist, because of the T shape join, which is unnatural to my mind."

OK, I have a lot of problems with the SADI and how it is being touted, but I don't understand how T shaped is that much different from Y (as in our own RNY ileoileal anastomosis.

 

[Sheanie]

Well, I'm not a scientist. I never went to college. Never took an anatomy class. But to my admittedly uneducated mind, the Loop in the SADI just looks like it would allow the contents to back up the wrong way. The DS is more of a Y configuration, so again, in my (again uneducated) mind, it doesn't look like it would encourage the same action.

I could be wrong. I'm no surgeon. No degrees past high school. But I have excellent common sense, I found the Duodenal Switch without any kind of on-line "forum" input to help me research my options. I looked at things, again with my uneducated mind, and made (I think) an excellent decision. I even saw through my surgeons BS about "paint peeling, room clearing flatulence" and raised my hand and made him clarify how to simply avoid fartogenic foods. But I'm admittedly famous for flunking sex education in high school, when I was painfully too shy to ask questions.

Quite often I am asked my opinion by family and friends when they need someone with a fresh perspective. I have a unique ability to think outside the box, to come up with solutions nobody else thinks of.

A really good instance of this is years ago at a dental conference I attended on Collections. The speaker cornered me at the lunch break after I had asked a question during the morning. She pumped me through the lunch hour on my collection practices, which I found oddly flattering. Imagine my surprise when, in the afternoon session, she ditched her slides and lectured from notes. And presented MY ideas. My office manager was there at the time, and said I should have sent her a bill. Same speaker later included my ideas in software for the dental office she developed.

But again, I'm not college educated. Just a simple person.

 

[DianaCox]

I'm pretty sure the peristaltic action of the gut keeps things moving in one direction - otherwise, all the loops of bowel would end up with stagnant food in them at the gravitational bottom. I think the LOCATION of the T junction - immediately below the pylorus - might be of some concern, especially if there is any sort of narrowing/stricture/scar tissue/irregularity of the junction itself preventing the smooth flow of food/chyme released by the pyloric valve to navigate the turn - it could back up in both directions of the T junction. In the DS, that junction has only one way it can go - downstream (well, or backing up to the pylorus if there is a stricture - but that backup would NOT contain bile, so no bile reflux possible).

Common sense is FAR more valuable than book learning - but facts help too.

Here's a thought - I wonder if an endoscopic ERCP is possible with a SADI? It is not with a DS: http://en.wikipedia.org/wiki/Endoscopic_retrograde_cholangiopancreatography

 

[Larra]

@DianaCox
No on the ERCP, because the duodenum is still divided proximal to the entry of the common bile duct and pancreatic duct. I suppose, in theory, you could advance a scope through the small bowel all the way back through the jejunum to the duodenum going retrograde (backwards) but from the diagrams I've seen that would be a long, long way.

 

[DianaCox]

@Larra - yes, but with SADI you only have to go back half as far - with the DS, you'd have to go all the way DOWN the alimentary limb, and THEN all the way back UP the BP limb to the top. I know that using the "double balloon" technique, ERCP can be used on an RNY patient (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3424474/), so once the endoscopist negotiates the turn (which is only a few cm below the pylorus), it would seem like the length of the instruments would be the main limitations in the SADI. But length of the instruments may be an un-overcomable limitation, since it would be HUNDREDS of cm to get up to the top of the BP limb.

 

[Kiekerdepiekske]

I did ask Dr. Himpens about the SADI and he's not in favour. He said that the operation in itself is simpler but that any complications that might come up after surgery can be much more serious. I don't know what complications he was referring to, as I was already sort of set on having the DS, so I didn't ask. But I regard Dr. Himpens as one of the best surgeons in Europe so I'll gladly take his word on this.

 

[Larra]

@DianaCox I think the distance involved with gastric bypass would be much less than with SADI. I'm not saying it would be absolutely impossible for a very experienced and skilled gastroenterologist with a really long scope, but I think it would be at best, quite the challenge.
Most bariatric surgeons advised their gastric bypass patients to consider ERCP as something they will not be able to get post-op because of the technical difficulty and how few docs would be trained to use the special techniques necessary and have the necessary equipment. I think this would be even more the case with SADI.
But since this is also an issue with DS, I don't see this as a reason for one operation or the other. It's the unknown longterm results and what would seem like much less malabsorption that worry me.

 

[DianaCox]

@Larra - I was trying to find SOMETHING positive to distinguish the SADI from the DS - while doubting it.

I could see the SADI, at BEST, being a surgery for people with a BMI between 30-40, who are younger and have not messed up their metabolisms with multiple starvation diets.

 

[Sheanie]

I understand the supposed one-way action of peristalsis. I also know that in my own mother's case, it was faulty after her first bowel obstruction surgery. The surgeon told us that sometimes the intestine loses it's ability to contract after surgery. In her case, she had repeat BO's in the same section, which were each time removed due to necrosis.

The only other thing I can compare my preoccupation with the T shaped SADI join is the female dog's uterus, which has two horns. When my yorkie whelped her second litter (and last), the puppy went up the other horn instead of coming out, necessitating a surgical birth. Not in any way relevant to this conversation, I realize. But just something that can happen in nature, which I find intriguing.

 

[DianaCox]

OK, I can see how those two things taken together can suggest the possibility of food and bile going up the wrong branch of the T - and I know that that is what at least one surgeon (dammit, I can't remember who it was) suggested as well.