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

[hilary1617]

I wonder if some of the difference in results observations / perceptions is attributable to: (1) experience of surgeon with SADI, given that Dr. Sánchez Pernaute has done roughly 200 SADI's over 7 years, whereas most U.S. surgeons who have started doing SADI's have done so very recently and for a very limited number of patients; (2) variations in common loop length - I'm seeing 300 a lot in the U.S. and it is 250 in Spain; and (3) volatility in results due to limited sample size.

I appreciate that Dr. Sánchez Pernaute has an approach to surgical innovation which includes both fully informed consent and proper experimental design / research / publication. While these would seem to be basic ethical obligations, unfortunately it appears to me that certain U.S. surgeons are not applying these basic principles of good patient care.

 

[Elizabeth N.]

BLESS HIM for providing such a detailed response and making himself available.

 

[Elizabeth N.]

There is a Turkish surgeon who is doing a Loop procedure, with whom I've been corresponding, who seems very open and willing to share info with anyone who asks. https://www.facebook.com/op.dr.tugrul.demirel?fref=pb_other

 

[DianaCox]

I'd like to know what the SADI surgeons are recommending dietarily. Are they providing low fat, low carb, high protein recommendations? In other words, the usual life-long diet?

 

[Munchkin]

50 patients are more than 5 years postop. Want to see that data!

 

[hilary1617]

@DianaCox, low fat, low carb, high protein is what my traditional DS surgeon advised. I'm guessing that the surgeon/nutritionist community won't tailor requirements for SADI v. DS any more often than we see different recommendations for DS vs. RNY...

What *should* be advised for DS and SADI is a different matter. If you are alluding to a suspicion that in practice the SADI patients will not be able to maintain their weight loss successfully if they eat the copious amounts of fat traditional DS'ers can consume without penalty, only time will tell, but my guess is that will prove to be the case. I think the odds favor free rein with fat being a traditional DS-only benefit.

 

[Sheanie]

So Dr. Pernaute is performing the SADI with informed consent, while the ones in the U.S. seem to be performing the SADI and calling it the DS. In my mind, the main and only advantage of the SADI is the ease for the surgeon. I don't see any advantage for the patient over the DS. It's an easier surgery for the surgeon.

 

[hilary1617]

(1) The theoretical advantage to the individual SADI patient, *if long term results are equivalent to the DS and there are no new complication exposures*, would be access to a pyloric-preserving, band-free bariatric surgery with a reduced operating time /less anesthesia and one less anastomosis with the potential to leak, and less surgeon fatigue, so perhaps some increased safety. Over time, there may also be some theoretically-reduced risk of nutritional challenges.

(2) The theoretical advantage to the MO, SMO, SSMO population at large would be increased access to a pyloric-preserving, band-free bariatric surgery. The vetted DS surgeon list is currently short because it is a difficult procedure which requires significant skill and experience. If the SADI is easier for the surgeon, perhaps more surgeons will be willing and able to perform it well. This, to me, is the biggest benefit. Accessibility.

(3) The risks to the SADI patient are: (a) limited information - both about long term success/failure rates and complications (theoretical bile reflux possibility), (b) a theoretical potential need for future reoperation to convert SADI into traditional DS at a later point if weight loss is not successful over the long term, (c) limited experience with the procedure by most surgeons given it is so new, and (d) some of the doctors appear to be not providing appropriate disclosures for SADI, which calls into question, in my mind, the ethics of those specific surgeons.

 

[Sheanie]

Well, for the record, I'm bowing out of this discussion. I seem to be the only one who thinks this is a really bad thing. When that happens, I find it best to fade to black and make like the Cheshire Cat.

 

[hilary1617]

@Sheanie I'd rather you stay. I hope I'm not making you uncomfortable. I'm just trying to stay neutral and ensure a balanced view. I want to understand why you think it is a really bad thing.

SADI is definitely new and there is limited information and that is a concern, but I personally don't have enough information at this time to gauge whether the SADI procedure itself is equivalent to, better than, or worse than traditional DS for patients. I just want to gather the facts.

To be clear, I think it is horrible when patients aren't properly and fully informed (1) about what procedure they are having and (2) about their surgeon's inexperience with a new procedure. I have a real issue with the reported bait and switch type scenarios which might be happening with some U.S. surgeons, particularly where self-pays are seemingly targeted for experimentation. This is not the case everywhere, though. When patients are informed, know the risks and are willing to be part of a test group for a new procedure and it is performed within the context of a formal study, I think of that as a positive.

Anyway, I hope you will stick around. Your view matters.

 

[fernpoppy]

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

It does seem that doctors are being vague and not disclosing the differences between duodenal switch and the sad-i loop DS. My surgeon was definitely not explicit about the fact that is a different surgery with possibly different weight loss outcomes, among other differences. I would imagine that they prefer the loop (sad-i) for a couple of reasons: 1) the surgery is much less complicated (this is also good for the patient since there are less reported complications - according to my doctor anyway), and 2) less time in the surgery room means more to their bottom line ($$$). My doctor also said that it is less physically demanding on him.

It doesn't seem ethical that they aren't required to explicitly and clearly make distinctions between the two very different surgeries with the same name.

 

[Munchkin]

Back in the dark ages when I had surgery I remember discussing the future of WLS with Dr. Buchwald. He said it was just a matter of time till something better came along. The DS was just the best he could do today. Tomorrow, who knows. He said he personally hoped it would be a pill that would make surgery for weight loss seem barbaric. I agree with him and I hope it happens.

So along comes SADI. I fear it's not the Holy Grail. Looks like it is easier for surgeons and no one can guess how it will work long term. My best guess is a little less effective than the DS. If it was SADI or nothing, I would take it. But if it was SADI VS DS, I'll take the tried and true please. I hope SADI ends up a good thing for the folks who already had surgery. And I am angry for the patients whose Drs misrepresented the surgery.

 

[DianaCox]

From a FB page, reporting what happened at a Roslin seminar:

Well the seminar was supposed to a 1hr and a half he cut it 30 mins short. Rushed people with there questions he was like lets make this quick last question!!!!!! Before u could finish asking the questions he cut you off. He said don't read that BS from online ppl bcuz that's just one person experince, he said he hates online people writing a bunch of crap. He kept mentioning the SADI. He told me revisions are very complicated from RNY to DS. I asked him what he recommend for revision patients he told me to figure it out.​

Ain't that a kick in the pants? I'd like to know if anybody thinks this behavior is OK.

Crossposting to Roslin's surgeon review.

 

[Up2Me3]

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

Do you mind sharing who your Doctor is?

 

[Up2Me3]

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

Hilary - it is so nice to have come accross this thread and most importantly your positive take or outlook on the loop procedure. My doctor in SLC (Cottam) has done the Loop and likes it. He is not insistant one way or the other but I like you have liked what I'm finding so far. Although studies are only 3 and 5 years out the people seem to be loosing the weight quite well. You sound like you have a medical background of sorts....can you think of any BAD side effects doing the Loop compared to the DS? It seems if there were horrible negative side effects that those would have been reported in a 3-5 year time frame. While I do not want to ever have to have another follow-up surgery is does sound like a revision can be done to the original DS later......is this correct? My concern, or the reason I even mention some later revision if need be is my addiction to carbs and well just overeating in general that has put me here in the first place.....My mind keeps circling back to the thought that maybe I NEED the DS? ....and then I circle back again and think won't a Loop do? Seriously....I may drive myself to nuts before the 21st and then they can just lock me up and I won't have to actually make a decision!

I will have a follow-up question time with my Dr. but I wondered (if you know medically speaking) if having the Loop has any potential for long term problems in digestion. Does routing the small bowel differently from the DS cause any concern for what it does differently long term? Does my question even make sense LOL ....

I have tried to study the 3 different diagrams and video's on RNY, DS and LOOP. But I just don't fully grasp the implications of each. Does the Loop in your opinion offer more malabsorption than the RNY?