Self pay, deciding between DS vs SADIS due to complication concerns -

[TheRealist]

I agree it makes sense that there should be similar complication rates, but at least from research thus far people are claiming less? For example: web.duke.edu/surgery/2017BariatricMasters/yurcisin_current_status_of_the_sips.pdf. Of course again, not a lot of research on this (compared to DS), but that is where I was getting the idea that complication rate was less.

Also thanks Larra, didn't realize a shorter common channel was not possible with SIPS. So I guess the choice then is DS with 150cm (or a cm determined by the Hess method, if the surgeon will do it) or SADIS with 300cm.

This does make me wonder why early research says SADIS and a normal DS have roughly equivalent weight loss outcomes, given the differences in common channel lengths. Makes me think SADIS won't hold for long-term (10+ years) in terms of keeping the pounds off. And thus is pushing me into the DS camp.

 

[Larra]

That's just it - no one knows how well the SADI will hold up long term. And let's face it, MO is a chronic disease and we need to think long term.
I've seen posts from some people who are doing well with SADI short term. I've seen others where even short term the results were no where near what they expected, or perhaps I should say were led to expect. We've also, sadly, seen people who were led to believe they were getting "the DS" who actually got the SADI and are now bitterly disappointed. Your potential surgeon is being honest about what he's doing, some are not.

 

[hilary1617]

I agree it makes sense that there should be similar complication rates, but at least from research thus far people are claiming less? For example: web.duke.edu/surgery/2017BariatricMasters/yurcisin_current_status_of_the_sips.pdf. Of course again, not a lot of research on this (compared to DS), but that is where I was getting the idea that complication rate was less.

Also thanks Larra, didn't realize a shorter common channel was not possible with SIPS. So I guess the choice then is DS with 150cm (or a cm determined by the Hess method, if the surgeon will do it) or SIPS with 300cm.

Interesting presentation. Thanks for sharing!!!! Hopefully results for the SADI pioneers will be favorable when their outcomes are known and we will have information to improve both DS and SADI once large scale, long term studies with statistically sufficient sample sizes become available. I am particularly keen to see long term weight loss of full DS with common channel of 100 vs. Hess Method full DS vs SADI 250 vs SADI 300, for the BMI > 45-50 populations.

One thing that is news to me, and while this may not be the only approach, is the following mention which indicates there it is more complex to reverse a SADI/Loop/SIPS than it is to reverse a DS. I hadn't really thought about this.

"Revision of ”Loop” DS
• Convert to standard DS then perform DS reversal
• Lengthen/ Shorten Common Channel
• Described by Cottam et al. SORD 2017
• Divide DI anastomosis then Braun entero-enterostomy 15cm from loop anastomosis site and more proximal DI anastomosis

Also of note are mentions of afferent loop syndrome and "twisting of anastomosis (volvulus)" as "perceived disadvantages" of SADI/SIPS/Loop in addition to bile reflux. I don't think these have been commonly discussed possiblities in early studies I've read.

All the best!

 

[Susan in Tennessee]

Esquerra/Mexico DS patient here, I was extremely happy and I had fears you did, about what if I had complications afterwards but the additional time spent in hosp there made me very confident and the others are right, the surgeon really isn't needed after first little while. Someone will correct me if I'm wrong, but if you developed a hernia or a blockage/obstruction a year or two into the 5 years, I doubt anything would be paid for, other than by you! Keep your mind open, please!

 

[Clematis]

If you developed a hernia, the insurance company has to prove it was from WLS! People who never had WLS get hernias ALL THE TIME for all kinds of reasons. Ditto with blockages. (I've had neither.)

 

[DianaCox]

https://www.dsfacts.com/SADI-SIPS-Loop-DS-not-same-as-duodenal-switch.php

 

[Spiky Bugger]

Hey! Well, screw all y'all...I still go to my DS surgeon...12 years later!

 

[Susan in Tennessee]

If you developed a hernia, the insurance company has to prove it was from WLS! People who never had WLS get hernias ALL THE TIME for all kinds of reasons. Ditto with blockages. (I've had neither.)

What I meant was that the surgeon wouldn't be doing his work for free(I doubt)even though he gives the 5 yr follow up.

 

[Clematis]

Right, @Susan in Tennessee. I was addressing his concern that an insurance company wouldn't cover anything related to WLS no matter how far down the road. Many things that might go wrong are conditions that others without WLS get too so insurance can't prove WLS was the cause.

 

[Spiky Bugger]

Right, @Susan in Tennessee. I was addressing his concern that an insurance company wouldn't cover anything related to WLS no matter how far down the road. Many things that might go wrong are conditions that others without WLS get too so insurance can't prove WLS was the cause.

Yup...I may have to retrain my new PCP. She included "post-bariatric surgery" for every blood test and that has me concerned.

 

[Whit]

I still see Dr K. 5 years after surgery. He receives a copy and reviews all of my blood work as well.

 

[southernlady]

I still see Dr K. 5 years after surgery. He receives a copy and reviews all of my blood work as well.

If I had had Dr. K, I would do the same but many of us don't have a surgeon who cares as much as he does way after the fact.

 

[Spiky Bugger]

If I had had Dr. K, I would do the same but many of us don't have a surgeon who cares as much as he does way after the fact.

I think he has given up on sleeping.

 

[galaxygrrl]

I'm A Esquerra/Mexico DS patient too. I was very, very concerned about after care also. I found a PCP who knew all about the DS - in fact she had it and has had 20 to 30 patients with it and it's been fine. I go to the local DS surgeon's support group and he treats me like one of his patients at the group (It's Dr. Rabkin).

I thought MX was as good as an experince as it could have been. It was worth saving the money in the end. You stay in the hosiptal with a priviate room and round the clock care for 5 days. I had 3 Drs visit me twice a day for a few days after the surgery.

As for the DS and the SADI, I just really felt, I wanted one and done and I want this to work. DS has a proven track record.

Good luck

 

[CaitlynR]

One thing to verify if you go with him for the DS is how long a common channel. There is one group in NC doing the DS with 300 cm common channels but which group escapes me at the moment. I know it isn’t Sudan and his partners at Duke but can’t remember who it is.

Just wanted to let you know, that Dr. Guerron from Duke said that the surgical group has decided on 200-300 cm CC. He agreed to a 100 but if I hadn’t insisted it would have been much longer. I don’t know if Dr. Sudan differs from the rest of the group in this way.