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

[harrietvane]

There is no other place, @Ellie Mae. This thread *is* the place.

 

[Susan in Tennessee]

I think she means here on this very website where we are conversing.

 

[Ellie Mae]

There is no other place, @Ellie Mae. This thread *is* the place.

Oh I see. Someone had made it sound like it was somewhere else so I really hadn't looked through these pages. This seemed like more of a traditional DS support page so I didn't know if this would be the place to learn about the SADI.....in case it turns out it's my only option bc my insurance seems to only cover docs that do this. And because I want to start losing soon and in the crazy chance that my insurance approves me with the doc I am with now, I wanted to know if it was worth starting over with someone else.

Does anyone know if you get approved for the DS with one doctor, does the approval count for any doctor who is on your plan or do you have to start over?

 

[southernlady]

Oh I see. Someone had made it sound like it was somewhere else so I really hadn't looked through these pages. This seemed like more of a traditional DS support page so I didn't know if this would be the place to learn about the SADI.....in case it turns out it's my only option bc my insurance seems to only cover docs that do this. And because I want to start losing soon and in the crazy chance that my insurance approves me with the doc I am with now, I wanted to know if it was worth starting over with someone else.

Does anyone know if you get approved for the DS with one doctor, does the approval count for any doctor who is on your plan or do you have to start over?

The thing is, even if your insurance only covers surgeons who offer this, I will bet dollars to donuts that they do NOT cover the new lookalikes.

So yes, it will be more than worth the effort to find a surgeon who does the traditional DS.

 

[hilary1617]

Can you send it to my inbox?

@Ellie Mae - I was trying to say that this place - this very board and this very thread - is intended to be a place where patients can talk to people about SADI/Loop DS/SIPS. There is nothing to send, but rather I was suggesting that if you have a question or comment you could post it here.

 

[Amy S]

I

Thanks for saying that, marissamast. Your comment has encouraged me to make one of my own:

I've read all of the threads on SIPS - I'm all for balanced views and candor, and I really appreciate folks who do their research on newer procedures. Furthermore, my heart goes out to those on these threads who feel their surgeon didn't given them good info (or worse, misled them) prior to surgery. That is never, EVER ok.

Even so, I have to be honest and say that reading most of these posts regarding SIPS has felt like watching a witch hunt unfold. Now some folks here are pretty open minded, but the venom coming from others feels like a giant "my surgery was the best and only valid surgical choice" popularity contest, all dressed up in misinformation or huge amounts of conjecture about the unknown, which is a contest that a newer procedure could never hope to win.

I gave some thought about whether to even join so I could post this, since the environment for folks who opted for anything other than a traditional DS has seemed such that it doesn't really feel like a place someone like me could come for support. But I thought it was at least worth saying to all the folks on here. Candor and passionate advocacy are great. But so is kindness, support and authenticity. I mean no disrespect to anyone here, I just felt it was an issue worth raising. Thanks for hearing me out, and good luck with all of your journeys!

Agree wholeheartedly about the witchhunt remark

 

[Amy S]

Diana.. Please quit being a downer.. What people want does not directly affect you and you need to take a step back and realize that.

 

[Amy S]

Hi @MyNewLife, Glad you are doing well! I echo your sentiment with the exception that Amy, as a SADI/SIPS/Loop DS patient, will need to follow a low fat diet (and low carb diet) in order to maintain weight loss over the long term given the SADI does not provide for the selective fat malabsorption provided by the traditional DS.

Wrong.. It does provide for fat malabsorption, Hillary.. Shows in the toilet Everytime I eat it.

 

[Amy S]

Where is your surgeon located? Houston has very few who do the SADI.

@Gunner2014 ... Lexington, KY

 

[Amy S]

Stat update...9 mos out..-52 lbs. Not following an overly strict eating plan.. Just trying to eat healthy and indulging when I'd like but not overdoing it.

 

[hilary1617]

@Amy S, I was talking about *selective* fat malabsorption and the specific mechanics of the procedure. Happy you are losing and hope you have decent long term results. Let's keep it polite, please.

 

[DianaCox]

Diana.. Please quit being a downer.. What people want does not directly affect you and you need to take a step back and realize that.

You talking to ME? Because it DOES affect me, and even if it didn't, you have ZERO right to tell me or anyone else how to post on this board.

It affects me because I care about what happens to people who are subjected to MEDICAL AND ETHICAL MALPRACTICE, and because I spend many many hours of my life helping people get the best bariatric surgery possible. And when doctors tout an experimental and unproven surgery as "just like the DS, only better," commit insurance fraud submitting it as a DS and then give a subpar surgery instead, and patients who have the surgery don't realize what they have had done to them or how to managed their VERY DIFFERENT EXPERIMENTAL SURGERY, then it matters to me. And when their deliberate attempts to call a VERY VERY DIFFERENT experimental procedure "just like a DS, only better," their LOUSY results taint the reputation of the PROPER, STANDARD OF CARE DS, and makes it harder for patients in the future to get the DS, because the insurance companies use the LOUSY results of the EXPERIMENTAL procedure to dismiss the benefits of the proven surgery.

Oh, and by the way: https://www.ncbi.nlm.nih.gov/pubmed/28602793

Surg Obes Relat Dis. 2017 Apr 27. pii: S1550-7289(17)30214-9. doi: 10.1016/j.soard.2017.04.027. [Epub ahead of print]
The single anastomosis duodenal switch modifications: a review of the current literature on outcomes.
Topart P1, Becouarn G2.
Author information

Abstract
BACKGROUND:
The single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) was designed in 2007 to reduce the side effects of biliopancreatic diversion with duodenal switch (BPD-DS) by replacing the Roux-en-Y construction with a single duodeno-ileal anastomosis and combining the common channel with the alimentary limb. Several variants using different channel lengths were published. The objective of this study was to identify the published cases of SADI-S and variants and assess the results regarding potential benefits on side effects and revisions.

METHODS:
PubMed, ClinicalTrials.gov, and the databases of 3 relevant surgical journals were searched for any publication from 2007 to date.

RESULTS:
In all, 19 studies were analyzed. After identifying overlaps, 1,041 patients among 9 institutions were identified: 304 with SADI-S, 667 with stomach intestinal pylorus sparing surgery, and 70 with single anastomosis duodenojejunal bypass with sleeve gastrectomy. There were no postoperative deaths and the early complication rate was 7.3% (range 1.6-14%). The mean operative time was 100.8 minutes (range 69.9-181.7 min). The mean 1-year percentage of excess weight loss (%EWL) was 78.7% (range 61.6-87%) and percentage of total weight loss (%TWL) was 36.8% (range 32.7-41.1%). Two studies reported a 2-year %TWL of 38.7% and a single study reported a 5-year %TWL of 37%. A total of 50% of patients had biological data at 1 year. One retrospective study found no difference between BPD-DS and SIPS for vitamin deficiency at 2 years, but there was less severe diarrhea and malnutrition after SIPS. The revision rate increased from 2% to 7% after SADI-S between 2- and 5-year follow-up.

CONCLUSION:
There are still limited long-term data available for single anastomosis duodenal switch. In the absence of published prospective randomized trials, no evidence exists in favor of this variant of the BPD-DS despite a possible trend in less malabsorption side effects.
​

And this one, by one of the biggest pushers of the SADI/SIPS (tried to claim credit for "inventing" the SIPS variant with Roslin) and offenders of the informed consent requirements (just ask those who are looking to sue him - and check out the misleading informed consent agreement that one of his potential patients posted) - even he had to admit that weight loss, even at just 2 years, was inferior with the SIPS (and would be expected to get worse over time, since there is no selective fat malabsorption):

​

https://www.ncbi.nlm.nih.gov/pubmed/28089438

Surg Obes Relat Dis. 2017 Mar;13(3):415-422. doi: 10.1016/j.soard.2016.11.020. Epub 2016 Dec 2.
A retrospective comparison of biliopancreatic diversion with duodenal switch with single anastomosis duodenal switch (SIPS-stomach intestinal pylorus sparing surgery) at a single institution with two year follow-up.
Surve A1, Zaveri H1, Cottam D2, Belnap L1, Cottam A1, Cottam S1.
Author information

Abstract
BACKGROUND:
The traditional duodenal switch is performed using a Roux-en-Y configuration. This procedure has proven to be the most effective procedure for long-term weight loss and co-morbidity reduction. Recently, stomach intestinal pylorus sparing surgery (SIPS) has been introduced as a simpler and potentially safer variation of the duodenal switch (DS). It is a single anastomosis end-to-side proximal duodeno-ileal bypass with a sleeve gastrectomy. In this study, we compare our outcomes between biliopancreatic diversion with duodenal switch (BPD-DS) and SIPS at 2 years.

SETTING:
This is a retrospective analysis from a single surgeon at a single private institution.

METHODS:
We analyzed data from 182 patients retrospectively, 62 patients underwent BPD-DS while 120 other patients underwent SIPS between September 2011 and March 2015. A subset analysis was performed comparing data from both procedures to evaluate weight loss and complications.

RESULTS:
Of 182 patients, 156 patients were beyond 1 year postoperative mark and 99 patients were beyond 2 year postoperative mark. Five patients were lost to follow-up. None of our patients had complications resulting in death. BPD-DS and SIPS had statistically similar weight loss at 3 months but percent excess weight loss (%EWL) was more with BPD-DS than SIPS at 6, 9, 12, 18, and 24 months. Patient lost a mean body mass index (BMI) of 23.3 (follow-up: 69%) and 20.3 kg/m2 (follow-up: 71%) at 2 years from the BPD-DS and SIPS surgery, respectively. However, patients who had undergone SIPS procedure had significantly shorter operative time, shorter length of stay, fewer perioperative and postoperative complications than BPD-DS (P<.001). Interestingly, even though BPD-DS patients lost slightly more weight, the actual final BMI for SIPS group was lower than BPD-DS group (25.6 versus 26.9) (P<.05). There was no statistical difference between 2 groups for postoperative nutritional data such as vitamins D, B1, B12, serum calcium, fasting blood glucose, glycosylated hemoglobin (HbA1C), insulin, serum albumin, serum total protein, and lipid panel.

CONCLUSION:
The SIPS is a simplified DS procedure. The SIPS eliminates one anastomosis and compared with BPD-DS has fewer perioperative and postoperative complications, shorter operative time and length of stay, and similar nutritional results at 2 years. However, weight loss was more with BPD-DS. A fair criticism is that the vast majority of BPD-DS cases were done before the SIPS cases. As a result, experience and learning curve cannot be completely dismissed when viewing postoperative complications.
​

"Interestingly, even though BPD-DS patients lost slightly more weight, the actual final BMI for SIPS group was lower than BPD-DS group (25.6 versus 26.9) (P<.05)." Well, DUH if they cherrypicked lower BMI patients for his experimental SIPS with far far less malabsorption!

Oh, and again, no long-term data. Even RNYers do OK for the first 3-5 years - and then regain.

 

[southernlady]

Diana.. Please quit being a downer.. What people want does not directly affect you and you need to take a step back and realize that.

@Amy S, Diana has a right to post her views here. You do too. BUT no one other than me gets to tell people how to post.

 

[John]

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")

I had the SADi with Dr Roslin in Nov 2014 (9 years ago), a few months after this post. I was looking for the DS at first but after speaking with Dr Roslin it was clear he is flat out incredible expert on WLS. My outcome is pretty close to being able to eat virtually anything I want, and have a zero fat lean muscle only body. Prior to the surgery I would get broken bones in my foot from being too fat. I couldn't do 4 pushups in grammer school for the gym class presidents challenge. I'm well into my sixites now and thanks to Dr Roslin and the SADi DS, I am actually fit and able to do nearly any physical activity a human being can do.



If you want to know about the SADi or Dr Roslin, find experience not gossip.

 

[hilary1617]

I had the SADi with Dr Roslin in Nov 2014 (9 years ago), a few months after this post. I was looking for the DS at first but after speaking with Dr Roslin it was clear he is flat out incredible expert on WLS. My outcome is pretty close to being able to eat virtually anything I want, and have a zero fat lean muscle only body. Prior to the surgery I would get broken bones in my foot from being too fat. I couldn't do 4 pushups in grammer school for the gym class presidents challenge. I'm well into my sixites now and thanks to Dr Roslin and the SADi DS, I am actually fit and able to do nearly any physical activity a human being can do.



If you want to know about the SADi or Dr Roslin, find experience not gossip.

At the time I started this thread, there was not much experience, thus the request that as experience was gained, that it be shared here. While I must point out that I do not appreciate the gossip remark and hope this remains civil, I do thank you for sharing your personal experience. I am also glad to hear that you are happy with the results.