Single Anastomosis Duodeno-Ileal Bypass ("Loop DS") vs a Proper DS

[DianaCox]

The SADI or LoopDS is NOT a DS. Do NOT be fooled or misled. ALWAYS make sure that when you sign your consent form, you know EXACTLY what you are agreeing to, and NOTHING else.

This is the loop DS:

There is only one cut, no alimentary track/common channel - just a straight bypass of the first half of the small intestine; concerns include food backing up into the bypassed limb; bile reflux; the fact that you have in essence a 250 cm common channel with no alimentary limb - the downstream portion of the intestine after the pylorus is all fully absorbing everything (except of course the vitamin and mineral absorption that normally occurs in the distal duodenum and jejunum).

IT IS NOT A DS. It has no selective fat malabsorption. It has 250 cm of fat ABSORPTION. Nothing like the "fat is essentially free" diet of a proper DS. And it has ONLY 250 cm of protein absorption.

This is an EXPERIMENTAL procedure. It is not covered by insurance. It should only - in my opinion - be offered as part of a proper clinical trial, and NOT NOT NOT as a "cheaper, but just/almost as good" surgery offered to self-pays only. I have serious concerns about the ethics of doing that.

Note that there is another so-called "variant" of the DS being offered by a few surgeons, which is even further from a proper DS, and which in my opinion should not even be referred to using the term "DS" - the biliopancreatic diversion with bipartition" - it has a STOMA!

 

[slimshady]

Seems to me SADI is a setup for:

1. Persistent bile reflux into the stomach (one of the joys of DS)
2. Hypoproteinemia (and subsequent third-spacing of fluids (edema))
3. Pooling of food in the proximal small intestine in patients with intestinal motility disorders (and maybe everyone to a degree)
4. Less fat malabsorption compared to DS with common channel less than 250cm (most DSers)
5. Less complex carb malabsorption (more contact time with pancreatic enzymes)
6. Suboptimal weight loss
7. Lesser resolution of diabetes type 2 compared to DS.

The only potential benefits I can see are less risk of fat-soluble vitamin deficiency and possibly less GI side effects.

And I cannot for the life of me understand the bipartition. Does the stoma act as a large sinkhole (dumping syndrome?)? Does the pressure of stomach peristalsis preferentially cause food to exit the stoma versus a competent pylorus? So much for ever taking NSAIDs again due to the risk of marginal ulcers.

It is scary to even begin comparing these surgeries. They will end up giving DS a bad reputation if a distinction is not made due to poor outcomes.

 

[Elizabeth N.]

Can the people who know A&P explain how the DS addresses the potential for bile reflux? (Compared to any non-DS intestinal bypass configuration, not necessarily just this one?)

 

[slimshady]

With SADI, bile passes right by the pylorus and can easily reflux back into the stomach and esophagus. Our DS configuration introduces bile into the common channel which is far removed from the pylorus. Bile would have to travel up the entire length of the alimentary limb to reach the stomach which is virtually impossible. Also, because bile is introduced so far down in the small intestines, very little of it is reabsorbed hence fat malabsorption and lower lipid levels as well.

 

[Elizabeth N.]

Ahhhhh, so the distance factor is the main protection against bile reflux for us....

 

[DianaCox]

And add to the list of surgeons who seem to be selling SADI as a bargain basement DS to self-pays, Cooper in NY (as well as Ponce de Leon, Cottam (?), Gagner and Roslin (?)). I am very uncomfortable with this practice.

 

[DianaCox]

Apparently, the Cooper patient didn't even know what she got ....

 

[Elizabeth N.]

IMNSHO that should be fucking CRIMINAL.

 

[Taterweight]

As a self-pay myself, this is scary as hell stuff! I think I'm in good hands with Dr. K...but I will be asking questions and reading fine print!

 

[Elizabeth N.]

As a self-pay myself, this is scary as hell stuff! I think I'm in good hands with Dr. K...but I will be asking questions and reading fine print!

Dr. K. won't do that to you. He's better than that. But by all means ask, and let him educate you about the differences .

 

[DianaCox]

Stop saying the F word

Are you a moderator? Because if you're not, perhaps you should familiarize yourself with the TOUs (http://bariatricfacts.org/help/terms), in particular these points:

1. Don't be an asshat.

9. Don't be a forum nanny. Everyone will hate you. No really, they will hate you because you come across as an impotent whiny little bitch. If you don't like it here - move on.

 

[southernlady]

@Gary A Hunt, I AM one of the admins...
DO NOT BOARD nanny...If you would like to report something, do so but do not try to tell others how to act on here.

IF people want to use the work fucking here in describing an action...that is their prerogative.

 

[Will2014]

Thanks for this warning. I have a frantic call out to my Dr. in Mexico now to confirm I'll be getting the correct DS procedure. I'm using Dr. Jose Rodriguez Villareal in Juarez. Has anyone used him?

 

[Larra]

Thanks for this warning. I have a frantic call out to my Dr. in Mexico now to confirm I'll be getting the correct DS procedure. I'm using Dr. Jose Rodriguez Villareal in Juarez. Has anyone used him?

Welcome, Will2014!
I have never heard of this surgeon doing any kind of DS. I Googled him and found lots of stuff on him doing the sleeve, but not DS. I also checked his OH page and he lists every procedure EXCEPT DS. Now of course his page might not be up to date, but still.

the only DS surgeons most of us would recommend in Mexico are Dr. Ungson and Dr. Aceves. Both definitely do the DS, with Dr. Ungson having done it for years and Dr. Aceves having started doing it more recently (and with Dr. Ungson initially working with him). Both are very well regarded, and the hospitals where they operate get good reports also. The best advice I can give you is to switch surgeons. If, however, you are firm on Dr. Villareal at the very least ask about his experience with the DS - NOT his experience with bariatric surgery in general, which he definitely has, but with the DS - and also whether or not he's doing a true DS vs. the experiemental (IMHO) loop/SADI DS. Ask about complication rates - again specifically for the DS. And if you, as someone recently did on OH for a different surgeon in Mexico, get told that he's done "thousands" and that his complication rate is "less than 1%" or something equally impossible, run far and run fast.

One last suggestion - start a separate thread asking about your tentative surgeon. See if you can find anyone who has had the DS with him. But I still think you'd be better off going with a surgeon with known DS experience.

 

[southernlady]

@Will2014
And I second what Larra said