Known formally as Single Anastamosis Duodeno-Ileal Bypass – with Sleeve
SADI is considered one of the most effective and reliable weight loss surgical procedures we have today. Between 75% and 95% excess weight loss can be achieved and maintained with a SADI. The BodyFree surgical team is proud to offer the SADI procedure in Sydney.
SADI is a recent evolution of an older procedure called a Duodenal Switch. The procedure 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 or Lap Band, to deal with inadequate weight loss or weight regain.
SADI Weight Loss Surgery
SADI comprises of a simple, 2-step weight loss process:
- The first step is a Sleeve Gastrectomy. Here, our surgeons remove most of the stomach.
- Then, a long segment of intestine is bypassed from just after the stomach to much further down the intestine.
By reducing your stomach capacity and skipping part of your intestine, SADI bypasses food from some of the most metabolically active parts of the intestine system.
This is what makes SADI one of the most effective Weight Loss Surgery procedures available from BodyFree.
What is a SADI procedure?
The SADI weight loss procedure is performed using laparoscopic (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. In the SADI bariatric surgery, the duodenum is divided just after the stomach, and a loop of the intestine is brought up and joined to this part of the duodenum.
This results in food passing through a reduced-capacity stomach (Gastric Sleeve), and then bypassing most of the duodenum as well as the next part of the intestine, called the jejunum.
The food thus enters straight into the ileum, the last half to third of the small intestine. Our SADI bariatric procedure ensures that there is at least 300cm of the ileum to absorb food intake, out of the small intestine’s total length of about 500 to 600cm.
The SADI weight loss procedure is effective due to combining both a restrictive component (the Gastric Sleeve) with a very significant metabolic or malabsorptive component (the absorption of consumed calories and nutrients is reduced).
SADI-S Surgery Pros and Cons
- Excellent weight loss results and long-term success.
- 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 Mellitus on insulin therapy.
- No Dumping Syndrome
- Extremely low risk of Stomal Ulcers (which can occur with a Gastric Bypass)
- A moderate-to-high risk of medium- to long-term nutritional deficiencies, so you will need some vitamin and other nutritional supplements long-term. Deficiencies include Vitamins A, E, D, and K, as well as Iron and Protein. (You need to have 80-90 gm/day of protein compared to 50-60 gm/day with a Gastric Sleeve.)
- You will need blood tests every 3 months for the first 2 years, post-surgery, in order to monitor your bio-chemistry.
- Like many other weight loss procedures, SADI can improve fertility in women, but there is a slightly increased risk of pre-term and underweight babies at birth.
- 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. We’ll discuss your health and lifestyle goals and determine the best surgical solution 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 BodyFree Dietitian will provide clear direction, tailored to you. No carbohydrates, sugars, fruits or juices are 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 the 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 great 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.
Some blood thinners and anti-platelet agents 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 you will never need to see them.
We also use either tissue glue, or 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 up nicely by then.
Most patients’ post-operative discomfort has settled by the time of discharge from the hospital.
Some patients may still 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. 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.
While each patient will be given specific dietary advice based on their personal requirements, the following is a very brief recommended guideline for your diet 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.
SADI and Weight Loss – FAQs
How Is SADI-S Different From The Duodenal Switch?
The SADI weight loss procedure is a recent evolution of the Duodenal Switch, an older procedure. The key difference is that only one Intestinal join is made in SADI-S, compared to two in the Duodenal Switch.
With fewer surgical connections in the intestine, the chance of an intestinal leak or blockage is reduced.
In each instance of anastomosis or surgical connection being made, two separate parts of the digestive system are brought together, whether the stomach and/or a part of the intestine. Each connection can have a chance of a leak of gastrointestinal contents, and two connections significantly increase the risk of internal herniation, trapped bowel, and bowel obstruction.
The innovation of SADI-S over the traditional Duodenal Swithch is to design the surgery so that only one surgical connection is made. This results in less likelihood of surgical complications.
Are SADI And SIPS Surgeries The Same?
The SADI weight loss surgery is also known by a number of other names, such as:
- Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S)
- Stomach intestinal pylorus preserving surgery (SIPS)
- One or Single anastomosis loop duodenal switch (OADS, SALDS)
- Single anastomosis duodenal switch (SADS)
- Single anastomosis duodeno-ileal switch (SADIS)
- Single anastomosis duodenal-jejunal bypass with sleeve gastrectomy (SADJB-SG)
SADI-S or SIPS surgeries are the most common names for the SADI weight loss procedure.
However, SADI-S is not the same as the duodenal switch or bilio-pancreatic diversion. The duodenal switch is the older surgery that SADI-S evolved out of, and the operation and results are different.
Single Anastomosis Duodenaljejunal Bypass with Sleeve Gastrectomy (SADJB-SG)
SADI is partially reversible. The SADI weight loss procedure has two parts: The Sleeve Gastrectomy in the stomach, which is irreversible, and the intestinal bypass, which is reversible.
Because Sleeve Gastrectomy is the removal of a section of the stomach, this part of the SADI bariatric surgery is not reversible.
However, the SADI bariatric surgery leaves the upper part of the small intestine intact. The bypass surgery simply diverts around this part of the intestine, called the duodenum and jejunum, while leaving them intact.
For this reason, the bypass of a SADI bariatric surgery can be reversed. Another surgery is needed to return the intestine to its original form. This may be advised for patients who lose too much weight following their SADI weight loss surgery.