marissamast
3X to small in 13 mos. Love my DS
Cottam in Salt Lake is doing SIPS exclusively
SADI-S / Loop - Please share facts about this new procedure here.
- Thread starter hilary1617
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marissamast
3X to small in 13 mos. Love my DS
Cottom in Salt Lake City is doing SIPS
SADI, LoopDS, SIPS...all the same basic surgery. The difference is so miniscule...reminds me of the difference in sleeve sizes. Is a VSG not a VSG if your sleeve is a 28 bougie and not a 36?
Hi, first time post...
I took advantage of Dr. Andres Sánchez-Pernaute's very civil offer to field questions about the SADI-S and posed the following:
My queries: "What are the criteria for length of the common channel (CC)? Should there be a single standard of length for most (or all) patients or should the length of the CC be varied? If varied, according to what criteria? Exceptions?
I would welcome any thoughts or observations you might have on the relationship between the original length of the small bowel and the post-surgical length of CC. Does that ratio reveal any patterns in outcomes?"
Response from Dr. Pernaute:
I took advantage of Dr. Andres Sánchez-Pernaute's very civil offer to field questions about the SADI-S and posed the following:
My queries: "What are the criteria for length of the common channel (CC)? Should there be a single standard of length for most (or all) patients or should the length of the CC be varied? If varied, according to what criteria? Exceptions?
I would welcome any thoughts or observations you might have on the relationship between the original length of the small bowel and the post-surgical length of CC. Does that ratio reveal any patterns in outcomes?"
Response from Dr. Pernaute:
"Thank you for your interest, and of course, you can share this information with the blog.
Original SADI-S had a common channel of 200 cm; patients did well, but there was an 8% rate of re-operations for malnutrition. That was the reason to change to 250, which I think is the better length for an appropriate weight loss. Aged people or people with bowel diseases, systemic diseases, liver diseases…., should have a longer common channel; 300 cm is adequate in my opinion. Americans do generally SADI-S with a 300 cm for everyone, but they also do a narrower sleeve gastrectomy, what means a greater restriction.
After about 200 procedures, and a close follow up of my patients over the last 8 years, I think that:
- patients with an initial BMI > 50 should have SADI-S with a 250 common channel
- patients with a BMI 40 - 50 can be submitted to SADI-S 250 or 300 depending on individual features: aged patients, longer channel; younger patients shorter common limb
- patients with metabolic disease and low BMI (< 40), SADI-S 300
- patients below 35, as a metabolic surgery, SADI-S 350
In my opinion, a wide sleeve (54 French) would not jeopardize weight loss and is safer: lower number of leaks, less problems of long term strictures and GERD. Investigations performed in the past demonstrated that for malabsorptive operations there is no need to build up a common channel in relation to the whole intestinal length.
Kind regards,
Andrés Sánchez-Pernaute"
Original SADI-S had a common channel of 200 cm; patients did well, but there was an 8% rate of re-operations for malnutrition. That was the reason to change to 250, which I think is the better length for an appropriate weight loss. Aged people or people with bowel diseases, systemic diseases, liver diseases…., should have a longer common channel; 300 cm is adequate in my opinion. Americans do generally SADI-S with a 300 cm for everyone, but they also do a narrower sleeve gastrectomy, what means a greater restriction.
After about 200 procedures, and a close follow up of my patients over the last 8 years, I think that:
- patients with an initial BMI > 50 should have SADI-S with a 250 common channel
- patients with a BMI 40 - 50 can be submitted to SADI-S 250 or 300 depending on individual features: aged patients, longer channel; younger patients shorter common limb
- patients with metabolic disease and low BMI (< 40), SADI-S 300
- patients below 35, as a metabolic surgery, SADI-S 350
In my opinion, a wide sleeve (54 French) would not jeopardize weight loss and is safer: lower number of leaks, less problems of long term strictures and GERD. Investigations performed in the past demonstrated that for malabsorptive operations there is no need to build up a common channel in relation to the whole intestinal length.
Kind regards,
Andrés Sánchez-Pernaute"
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Welcome to the site - I noticed that your profile says you have not had bariatric surgery. Are you planning to? Which procedure? Where are you located?
As for the content of this post - I STILL don't see long term results. I don't agree that patients with a BMI > 50 should have SADI at all - they need the power of a proper DS. I'm glad, he's not doing a "one-size-fits-all" type of procedure for the others. But if I had ANY metabolic disease, I'd be DS or nothing - no SADI for that.
I also don't understand what this means: "Investigations performed in the past demonstrated that for malabsorptive operations there is no need to build up a common channel in relation to the whole intestinal length." if what he's saying is that there is no need for selective fat malabsorption (and with the SADI, you DON'T get selective fat malabsorption!), I would heartily disagree - what it is needed for is to be able to eat high fat, delicious and satisfying food, and thus not feel deprived and for it to be easier to maintain weight loss LONG TERM.
He says he has 8 years of results. I'd like to see them, stratified by age, starting weight, and presence of metabolic disease. And I'd like to know what their eating and supplement recommendations are - I'm sure they are not eating what we DSers can, so I hope they are not getting DS advice. I assume he is not pulling what way too many US surgeons are doing, which is to LIE to their patients that the SADI is "just like a DS, only safer."
Hi, thanks for the welcome. I am currently evaluating my surgical options but have not finalized a decision. My location is changing, as is my insurance status, which is good because otherwise the whole thing would be no challenge at all.
I am going to decline the opportunity to either promote, criticize, or interpret Dr. Pernaute's response, though I will absolutely attest that I quoted his reply verbatim. Posting his response here seemed like fair play in so far as I had the opportunity to ask the question because others on this site contacted Dr. Pernaute and conveyed his willingness to engage (and his email address).
Seabreeze06
Member
- Joined
- Jul 22, 2015
- Messages
- 11
Exactly and as one that teaches claims processing for my company, Im not surprised to hear this, but sadden because at the end of the day its the patient, US who suffer by not being informed, and heaven forbid complications happen and you are trying to explain what is happening to you and because it was not the surgery you thought you were given .... there poses the problem! Shame on any physician who takes our life and their career so lightly!!
Just as an update ... in some of my other groups individuals who had the SIPS/SADI performed and were told it would be covered after a peer to peer call are now having insurance deny the claim months later. NC BCBS is the insurance company at issue in the instances I know of.
Seabreeze06
Member
- Joined
- Jul 22, 2015
- Messages
- 11
WOW... that is sad, because months later you have had the surgery and now you are getting a huge bill that was previously approved....Thanks for the update!
more2adore
Well-Known Member
Uh, yeah, hello lawsuit.
dani.hall
New Member
Dr. Srikanth in Washington should be added to this list. I had the SIPS/SADI-S surgery with him this past Tuesday. I came to him wanting a DS. I was a revision and already had a sleeve. He first mentioned the SADI to me in January, after returning from hearing a presentation from Dr.Roslin in New York, I believe. I was turned off. I came back a few months later, after doing more research. He feels that, since I already have a history of iron deficiency (hereditary), as well as deficiencies in vitamin D, B and zinc, SADI would give me a better long term solution (yes, I know, there is no long term data to support this assertion). I ended up choosing the SADI, with the 250cm common channel length (he routinely does 300cm). He told me that, if down the road I wanted a full DS, he would be able to do so as an out patient surgery. Time will tell if I made the correct choice.
dani.hall
New Member
I was approved for the DS, and at my pre-surgical appointment, we decided to switch to the SADI. My doctor's office was supposed to contact insurance and get everything with the SADI approved (I have Aetna). When I called the doctor's office to make sure everything was kosher, it turned out that they hadn't been able to reach my insurance company to make the change... this was four days prior to my surgery. I told them that there was NO WAY I was going to go into surgery not having my insurance approval, and then get a humongous bill down the road. The office lady said, "the insurance improved the revision, it doesn't really matter what the revision is..." Yeah. I don't think it works like that. She ended up calling me the day before surgery and said that the insurance came through and approved it. I'm telling you all right now, if that didn't happen, they will be getting a big, fat lawsuit from me. I have great respect for my surgeon. Not so much for some of his office staff.
Elizabeth N.
Herder of cats
Welcome @dani.hall 
. Very glad you were forceful about the insurance issue.
. Very glad you were forceful about the insurance issue.I am a Pioneer. Had a revision SADI LOOP this past November. I originally had a sleeve in 2011. I'm 7 weeks out and down 21lbs. Eating about 1800 calories a day. My goals are 100+ grams of Protein a day, 100- grams of Carbs a day. My surgeon has no estimates/guarantees of what I'll lose other than "it looks promising". Try and research it on the net...nothing available. So, I get to wing it and see how it goes. Both a blessing and a curse. Will answer any questions, and would love to hear from others who have done the same thing.
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