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

[hilary1617]

Dr. Ungson appears to be performing the SADI-S now.

http://www.prleap.com/pr/228964/mexicali-bariatric-center-introduces-sadi-s

 

[hilary1617]

Newly published study: http://www.journalacs.org/article/S1072-7515(14)00927-2/fulltext

Article Outline

1. Introduction
2. Methods
3. Results
4. Conclusions

Jump to SectionIntroductionMethodsResultsConclusions
Introduction
To compare mid-term results of LGB and single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S), a modified one-loop duodenal switch.
Jump to SectionIntroductionMethodsResultsConclusions
Methods
We performed a prospective comparison of 215 morbidly obese patients submitted to LGB (n= 115) or SADI-S (n= 89) between July 2009 and December 2012.
Jump to SectionIntroductionMethodsResultsConclusions
Results
The groups were similar in terms of age and sex. The SADI-S group had significantly higher Body Mass Index (BMI) (42.37 vs 45.34, p = 0.001) and more comorbidities (hypertension, type 2 diabetes and obstructive sleep apnea). Early complications occurred more often in LGB than in SADI-S (20% vs 8.9%; P = <0.05).The difference in severe complications did not reach statistical significance (5% for LGB vs 2% for SADI-S; P = 0.66).The mean % of Excess weight loss (EWL) for both groups during the first year after the surgery was similar. The SADI-S group presented a higher and maintained EWL at 18 months (80 ± 21.43 vs 95.47 ± 20.4; P = 0.001), 24 months (77.68 ± 19.39 vs 93.67 ± 23.14; P = 0.001) and 36 months (75.84 ± 27.88 vs 91.33 ± 29.07; P = 0.03).The SADI-S group presented more remission of hypertension (27% 39 % p 0.002) and type 2 diabetes (67% vs 85%, p<0.005).
Jump to SectionIntroductionMethodsResultsConclusions
Conclusions
Both techniques carry out a low rate of postoperative complications. Both procedures were efficient regarding weight loss and improvement of comorbidities. In the mid-term, SADI-S, a modified duodenal switch, offers a better weight loss and a better metabolic response than LGB.

 

[hilary1617]

The same publication also had this study, which doesn't relate to SADI, but which I include because I regret the absence of my gallbladder.

http://www.journalacs.org/article/S1072-7515(14)00930-2/fulltext

Article Outline

1. Introduction
2. Methods
3. Results
4. Conclusions

Jump to SectionIntroductionMethodsResultsConclusions
Introduction
Biliopancreatic diversion with duodenal switch (BPD/DS) is the most effective bariatric operation in terms of weight loss and resolution of metabolic diseases. It remains controversial whether simultaneous routine cholecystectomy should be performed in these patients or if a selective approach is appropriate. The purpose of this study is to evaluate the incidence of biliary complications in the patients who underwent BPD/DS with or without cholecystectomy.
Jump to SectionIntroductionMethodsResultsConclusions
Methods
Retrospective review of all patients who underwent BPD/DS between 2006 and 2012 at Abington hospital. Demographic data, operative details, weight loss trends were collected and incidence of biliary complications was calculated in simultaneous cholecystectomy and no cholecystectomy group.
Jump to SectionIntroductionMethodsResultsConclusions
Results
361 patients were included in the study. 97 males (26.8%), mean age 44.8 (range 20-72), mean weight 317.2 pounds (range 205-547), average BMI 50.5 (range 34-71.4), average follow-up was 31 months (12-72 months). In simultaneous chole group (n=61), no biliary complications were observed during the operation. 239 patients still had their gallbladder after the BPD/DS. Follow-up rate was 95.6% at 12 months and 92.8% at 18 months. 10 patients were lost to follow-up. Out of the 239 patients, total of 52 patients (22.7%) developed gallbladder related symptoms–13 (5.4%) in the first year, 25 (11%) in the second year and 14 (6.1%) after the second year. 40 elective laparoscopic cholecystectomies, 9 urgent laparoscopic cholecystectomies and 2 open urgent cholecystectomies were performed. One patient underwent open common bile duct exploration for cholangitis.
Jump to SectionIntroductionMethodsResultsConclusions
Conclusions
Routine simultaneous cholecystectomy with BPD/DS doesn't appear to be necessary since majority of the patients don't develop gallbladder related complications.

 

[Elizabeth N.]

This is an interesting and promising early publication. I'd like to see more breakdown of the results, like the n of each group at the follow-up intervals.

 

[Up2Me3]

Newly published study: http://www.journalacs.org/article/S1072-7515(14)00927-2/fulltext

Article Outline

1. Introduction
2. Methods
3. Results
4. Conclusions

Jump to SectionIntroductionMethodsResultsConclusions
Introduction
To compare mid-term results of LGB and single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S), a modified one-loop duodenal switch.
Jump to SectionIntroductionMethodsResultsConclusions
Methods
We performed a prospective comparison of 215 morbidly obese patients submitted to LGB (n= 115) or SADI-S (n= 89) between July 2009 and December 2012.
Jump to SectionIntroductionMethodsResultsConclusions
Results
The groups were similar in terms of age and sex. The SADI-S group had significantly higher Body Mass Index (BMI) (42.37 vs 45.34, p = 0.001) and more comorbidities (hypertension, type 2 diabetes and obstructive sleep apnea). Early complications occurred more often in LGB than in SADI-S (20% vs 8.9%; P = <0.05).The difference in severe complications did not reach statistical significance (5% for LGB vs 2% for SADI-S; P = 0.66).The mean % of Excess weight loss (EWL) for both groups during the first year after the surgery was similar. The SADI-S group presented a higher and maintained EWL at 18 months (80 ± 21.43 vs 95.47 ± 20.4; P = 0.001), 24 months (77.68 ± 19.39 vs 93.67 ± 23.14; P = 0.001) and 36 months (75.84 ± 27.88 vs 91.33 ± 29.07; P = 0.03).The SADI-S group presented more remission of hypertension (27% 39 % p 0.002) and type 2 diabetes (67% vs 85%, p<0.005).
Jump to SectionIntroductionMethodsResultsConclusions
Conclusions
Both techniques carry out a low rate of postoperative complications. Both procedures were efficient regarding weight loss and improvement of comorbidities. In the mid-term, SADI-S, a modified duodenal switch, offers a better weight loss and a better metabolic response than LGB.

@hilary1617 thanks for this post! I've been missing in action I suppose since I am now 1 week and 1 day post op! Someone please tell me my energy level will return! LOL boy ....back to work tomorrow...tired but no pain or anything like that. I am only getting in a multi vitamin and calcium morning and night and a D3 during day....and that is tough. You all were right....everything taste like crap.....I can get in only 40 minimum protein and a max so far of 60.....water intake only at 60 ish.....and I stop because I'm afraid if I push it I'll upchuck what I did get down.....

Hoping this improves as I know hydration, protein and vitamins will help me heal and feel better but boy........I'd just as soon not eat\drink anything!!

Again - thanks for this. I felt comfy with the decision but further validation always makes me breathe easier at night....when you get that little twinge and think....oh oh...hope all is well in there!!

 

[Elizabeth N.]

If you are drinking that protein, you can at least partly count it to your fluids. If you are eating that protein, you might consider drinking some of it.

 

[hilary1617]

@Up2Me3 , best wishes for a speedy recovery. Get that H20 up. Right now hydration is more important than anything. I think the 30-60-90 day protein rule of thumb is a good oneto keep in mind. (Target 30 g by 30 days post op, 60 g by 60 days post op, and 90 g by 90 days post op)

 

[BKLYN07]

Hi. Good morning! I had this procedure on 12/3/13. HW 268 and CW 116. My surgeon , Dr Roslin (nyc) suggested this procedure bc I wasn't a severe diabetic. My health issues were HBP and high cholesterol. The A1C level started to rise. I am glad I chosen this procedure. The only issue I have is low vitamin D, other than this my labs are great!

 

[Charris]

I wonder why If they believe this is l Iike a DS why didn't they compare that instead. Apples to apples?

 

[BKLYN07]

I will be a year out on 12/3. I went from 268lbs to 115lbs. I was loosing 3 -5 lbs a week. I finally slowed down with weight loss. Since August I lost 5lbs and I'm fine with this. My blood pressure is finally normal , cholesterol is normal and my A1C is normal...I'm content with my health and weight loss.

 

[DianaCox]

I found a "new" study today from Dr. Pernaute's group - it was published in June, but only just now showed up in PubMed: http://www.ncbi.nlm.nih.gov/pubmed/25543309

Surg Obes Relat Dis. 2014 Jul 10. pii: S1550-7289(14)00267-6. doi: 10.1016/j.soard.2014.06.016. [Epub ahead of print]
Single-anastomosis duodenoileal bypass as a second step after sleeve gastrectomy.
Sánchez-Pernaute A1, Rubio MÁ2, Conde M3, Arrue E3, Pérez-Aguirre E3, Torres A3.
Abstract
BACKGROUND:
After sleeve gastrectomy, many surgical options are available in patients with insufficient weight loss. Duodenal switch is typically considered the operation that results in higher weight loss, although it is, perhaps unjustly, considered technically difficult and may be accompanied by severe side effects. Single-anastomosis duodenoileal bypass with sleeve gastrectomy is a simplification of the duodenal switch that may behave as a standard biliopancreatic diversion but is easier and quicker to perform. Given its effectiveness as a primary surgery we hypothesized that it would be successful as a second-step operation. The objective of this study was to analyze the weight loss and co-morbidities resolution after a single-anastomosis duodenoileal bypass (SADI) performed as a second step after sleeve gastrectomy.

METHODS:
Sixteen patients with an initial body mass index of 56.4 kg/m2 and a mean excess weight loss of 39.5% after a sleeve gastrectomy were submitted to a single-anastomosis duodenoileal bypass with a 250-cm common channel.

RESULTS:
There were no postoperative complications. The mean excess weight loss was 72% 2 years after the second-step surgery. The complete remission rate was 88% for diabetes, 60% for hypertension, and 40% for dyslipidemia. The mean number of daily bowel movements was 2.1. One patient suffered an isolated episode of clinical hypoalbuminemia.

CONCLUSION:
SADI is a safe operation that offers a satisfactory weight loss for patients subjected to a previous sleeve gastrectomy. The side effects are well tolerated, and complications are minimal.​

I am NOT impressed with the comorbidity remission rates - they are much less than with the DS. But I can't figure out what the numbers mean without reading the paper - are they VSG -> SADI numbers, or pre-op to SADI? I have to look (thought I can't copy the paper here):

• The mean time for the second-step operation was 24 months (16–38) after the initial operation, the mean excess weight loss (EWL) at the time of the reoperation was 39.5% and the mean BMI was 44 kg/m2 (35.5–55.8).
  • So the patients were still MO
• Here is the graph of the various patients (I'm not sure this pic will show after I post it, because it is in a paper that is behind a for-pay wall)
• 
  • The longest out are 3 years after their revisions; most are far less
  • Not surprisingly, they are not losing that quickly, and are ending up on average with 72% EWL - BEFORE the regain sets in.
• This graph is even less impressive:
• 
• "The present results have to be analyzed with caution. The main limitation of the study is the absence of randomization; patients included are mostly those who have failed to an initial SG, so they should be considered to be to some extent resistant to bariatric surgery. Long-term follow-up is also necessary to know if results are maintained and if complications do not out outweigh weight loss results."

I still maintain my serious doubts that this surgery is going to be good enough for most people in the long run. However, I am CERTAIN that it is better than RNY or Crapband.

 

[DianaCox]

Can someone tell me if they can see the graphs?

 

[brooklyngirl]

Can someone tell me if they can see the graphs?

No graphs

 

[more2adore]

I can see them.

 

[DianaCox]

How about now? I deleted the links to the limited access paper, saved the graphs elsewhere and reloaded them.