Known formally as Single Anastamosis Duodeno-Ileal Bypass – with Sleeve
SADI is probably the most effective and reliable weight loss surgical procedure we have today, with between 75-95% excess weight loss achieved and maintained. The procedure is a recent evolution of an older procedure being a Duodenal Switch. SADI can be performed as a primary single stage laparoscopic procedure which includes a Gastric Sleeve (not as tight as a normal Gastric Sleeve), or as a second stage or Revision Bariatric procedure after a previous Sleeve to deal with inadequate weight loss or weight regain.
The procedure is performed using laparopscopic (keyhole) incisions first to reduce the stomach size to that similar to a Gastric Sleeve. The small intestine just after the stomach is called the duodenum. This is divided just after the stomach, and a loop of intestine is brought up and joined to this part of the duodenum. This results in food passing through a reduced capacity stomach (Gastric Sleeve), then bypassing most of the duodenum and the next part of the intestine being the jejunum. The food thus enters straight into the ileum (the last half to third of the small intestine). We ensure that there is at least 300cm of ileum to absorb food intake (the total length of the small intestine is about 500-600cm).
The SADI is effective by combining both a restrictive component (Gastric Sleeve) as well as a very significant metabolic or malabsorptive component (absorbtion of calories and nutrients consumed is reduced).
SADI-S Surgery Pros and Cons
- Excellent weight loss success and long term maintenance.
- Ideal for very poorly controlled Diabetes or Dyslipidaemia (high cholesterol). SADI has been shown to be the most effective treatment for long established Type II Diabetes Mellitis on Insulin therapy.
- No Dumping Syndrome
- Extremely low risk of Stomal Ulcers (which can occur with a Gastric Bypass)
- At moderate to high risk of medium to long term nutritional deficiencies, so will need some vitamin and nutritional supplements long term. Deficiencies include Vitamins A, E, D, and K, as well as Iron and Protein. (Need to have 80-90gm/day protein compared to 50-60gm/day with a Gastric Sleeve).
- Will need blood tests every 3 months for the first 2 year post-surgery in order to monitor bio-chemisty.
- SADI can improve fertility in women, but slightly increased risk of pre-term and underweight birth neonates.
- Can have loose and/or more frequent bowel motions, particularly after rich or oily food.
We recommend you visit us for a consultation with our Medical Director/Bariatric Surgeon to discuss your health and lifestyle goals and determine the best surgical option for you.
SADI-S Pre-Operative Care
All patients are required to commence an Optifast based diet for a period of 2-3 weeks prior to SADI-S surgery. This diet induces a change to the patient’s metabolism putting it into a Ketotic state, known as Ketosis. During this period the patient’s diet will be restricted, with only certain additional foods allowed (your Dietitian will provide clear direction tailored to you). There are no carbohydrates, sugars, fruits or juices etc. permitted during this Optifast period.
The ketosis will result in fat stores coming out of the liver to provide the metabolic fuel your body needs. During surgery, it is necessary to retract the liver – the reduction in fat stores in the lead up to surgery allows for this to be done safely without risk of damaging or tearing the liver during the procedure.
Some patients may note that they can lose 5-10% of their body weight during this period. (It would be terrific if this were sustainable long-term, but Optifast isn’t sustainable over time).
Most medications can continue until the day of surgery, and they will be recommenced post-operatively under our direction. There are several blood thinners and anti-platelet agents which will need to be stopped 2-10 days prior to surgery depending on the particular medication. We will provide advice tailored to each patient. Fish Oil supplements should not be consumed within 14 days of surgery.
SADI-S Post-Operative Care
The small keyhole incisions are all closed with dissolving stitches which are all placed under the skin so that patients will never need to see them. We also use steristrips and waterproof dressings to ensure the skin heals in a clean and dry environment. Patients can bathe or shower with these dressings in place, however they should be patted dry afterwards.
The dressings are normally removed 10 days after surgery and the incisions should have healed nicely by then.
Most patient’s post-operative discomfort has settled at the time of discharge from hospital. Some patients may however require a small amount of oral medication to help manage ongoing discomfort for a week or so. This can include Panadol, Panadeine Forte, Endone, or occasionally other medicines.
Routine medications can be recommenced as directed in the post-operative phase and any blood thinning agents that patients were previously taking will also be recommenced as directed by the medical team.
Many patients will be directed to take a PPI (Proton Pump Inhibitor) such as Nexium, Somac or Losec for a certain period after surgery to reduce stomach acid production.
Surgery will help patients to start their weight loss journey, however, in order to achieve successful long-term results – dietary and behavioural changes are necessary.
Each patient will be given specific dietary advice based on their personal requirements, but the following are very brief recommended guidelines following SADI-S surgery.
- Liquid nourishment
Weeks 2 – 4
- Pureed food
Week 4 +
- Commencement of soft solid diet.
** For more dietary information, please speak with your Dietitian, who will provide you with a more comprehensive plan.
As a guide, most patients need 2-3 nights in hospital post-op, and depending on the work in which you are employed, anywhere from 3-14 days off work. Most patients can start walking within a few days, and more vigorous exercise can commence within 3 weeks.