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Single anastomosis Duodeno Ileal Bypass with Sleeve

Single Anastomosis Duodeno–ileal bypass with Sleeve Gastrectomy SADI-S is a recently- developed type of bariatric surgical procedure with single anastomosis for treating morbid obesity A recently- developed method, SADI-S can be performed by laparotomy or laparoscopy.

This surgical technique is aimed at reducing the intestinal loop. As in sleeve technique, a small gastric sleeve is created by sectioning the greater curvature of the stomach. A duodenum-intestinal anastomosis is carried out, from the Tulp's valve, thereby the length of the common channel, where nutrients are absorbed, becomes 2.5 meters.

SADI-S is usually performed under a general anesthetic by keyhole (laparoscopic) surgery. The surgery has two steps. First, a gastric sleeve is made by removing some of the stomachs to make it smaller and into a tube shape. Then, the first part of the small intestine is shortened and joined to the last part of the small intestine. The procedure is permanent. However, there are cases in which steps were performed in two separate operations. The aim is to reduce the size of the stomach and small intestine to reduce the amount of food that is absorbed by the body. After surgery, patients have to eat a low-calorie diet. Multivitamins, calcium, and iron supplements are prescribed when needed.

 Benefits and risks 

Studies have revealed that its efficacy is limited and that there are several complications with the procedure. The three studies that NICE considered had the reference of 247 patients. Generally, they showed the benefit of  weight loss was maintained for up to 5 years in some patients a decrease in blood sugar levels and diabetes

Some of the studies revealed that there are some risks in opting for  SADI-S. These risks include:
 1.leaking from the stomach or small intestine(   successful treatment is available for this leaking) 
2. Bruising of the abdomen in four people a hernia in two people
3. gallbladder in two people
4. diarrhea and constipation
5.death due to lung problems,
6.  heart attack,
7. bleeding in the stomach or abdominal cavity, an abscess in the abdominal cavity
8. Further surgery because of narrowing of the gastric sleeve,
9. Stomach ulcer and sporadic vomiting, each in 1 person,
10. Low vitamin A levels in about 50% of patients in one of the studies conducted.


Risks associated with the surgery are influenced by factors such as age, weight, previous reaction to anesthesia, the presence of disease, heart condition, pre-existing lung conditions, Smokers, sleep apnoea, diabetes or hypertension.

Some risks associated with bariatric surgery include Deep vein thrombosis (pain in calf, swelling),pulmonary embolism , pneumonia, acute respiratory distress syndrome, splenectomy (injury to spleen), Post-operative bleeding / infection, small bowel obstruction, Late formation of gallstones,, Nausea and vomiting, Injury to organs near stomach, Injury to major blood vessels

 
Advantages


The SADI-S is a single anastomosis bariatric surgery. It can be a laparoscopic surgery. This procedure is very effective as a revision surgery after failed Sleeve Gastrectomy, for weight regain of insufficient weight loss or lack of remission of morbidities such as diabetes, hypertension, dyslipidemia.

 
Disadvantages


Besides analytical monitoring which is necessary to prevent malnutrition, patients will have to continue taking vitamin supplements: A, D, E, K and minerals throughout their life. Stones in the gallbladder, flatulence, and diarrhea are found to be more frequent. Intestinal perforation, anastomotic leaks, infection, abscess, venous thrombosis and pulmonary embolism are some of the surgical risks. In the long run, it can produce a bowel obstruction. The possibility of bile reflux than a traditional duodenal switch also exists. As of 2018, it is still classified as experimental by all insurance companies and has no long-term follow-up data.

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Dr.Nikhilagnihotri