SADI-S
SADI-S
There is a constant need to improve bariatric surgeries and make them more effective since the harms of obesity are numerous. Therefore, Dr. Ahmed Abd El Salam, Assistant Professor of General and Laparoscopic Surgery and Consultant in Bariatric Surgery, Kasr El-Ainy Faculty of Medicine, was keen to implement the SADI-S procedure in Egypt and the Middle East. SADI-S surgery aims to lose weight safely, healthily, and without complications. It is an internationally recognized procedure due to its various advantages, which include a reduced possibility of gaining weight again or experiencing dumping or reflux syndrome. This process combines the advantages of Gastric Sleeve and Gastric Bypass.
SADI-S (Single Anastomosis Duodenoileal Sleeve) surgery combines two types of obesity surgery to provide greater weight loss than either procedure alone. SADI-S surgery uses two bariatric surgery procedures, Gastric Sleeve surgery and Gastric Bypass surgery, to achieve the required weight loss. It is often recommended for people with a BMI greater than 40 or those who have not lost enough weight through gastric sleeve surgery alone.
What happens during SADI-S surgery?
Dr. Ahmed Abd El Salam performs a few small incisions during surgery using the laparoscope, the latest minimally invasive surgical technique. Therefore, laparoscopic SADI-S surgery results in less pain, shorter hospital stays, a lower risk of complications, a shorter recovery time, and better cosmetic outcomes. SADI-S surgery involves two steps:
First, the surgery begins as a gastric sleeve, forming a smaller tube-shaped stomach. Dr. Ahmed Abd El Salam permanently reduces the stomach size but at a lower proportion than gastric sleeve surgery, as 200 to 250 ml of stomach space is preserved, unlike gastric sleeve surgery, in which only 100 to 150 ml is kept. The remaining part, which is in the form of a tube or sleeve, can hold less food than ever before. In addition, reducing the size of the stomach also reduces the production of ghrelin, the hormone that sends hunger signals.
Second, Dr. Ahmed Abd El Salam separates the duodenum (the upper part of the small intestine) by 3–4 centimeters from the pyloric sphincter and the beginning of the duodenum. Then, Dr. Ahmed Abd El Salam connects it to the final part of the intestine, bypassing approximately 75% of the digestive system.
After the surgery, the pyloric valve preserves the food, allowing it to leave the stomach when it's ready for absorption. This valve ensures that the food remains in the stomach for sufficient time for digestion. The food stays in the stomach for two to four hours, thereby preventing the occurrence of dumping syndrome and recurrent diarrhea, which can occur during a bypass procedure due to the rapid arrival of food in the intestine by bypassing the pyloric valve.
The food then bypasses the upper part of the small intestine and goes directly to the large intestine, so the body absorbs fewer calories and nutrients, including proteins and fats, as the small intestine absorbs the calories and nutrients during the normal digestion process.
The bypassed intestine is neither inactive nor removed, but it allows bile to pass, which leads to getting rid of any bacteria. At the point where the duodenum connects, bile can join the food for the digestion process.
How does SADI-S surgery achieve the desired weight loss?
SADI-S surgery helps enhance weight loss in two ways:
• The gastric sleeve step restricts the amount of food the stomach can hold and, therefore, the calories consumed.
• It shortens or bypasses a portion of the small intestine, so there is less time and distance for the body to absorb fats and calories, reducing the amounts absorbed by the body. Since the body absorbs fewer nutrients after SADI-S surgery, you will need to take daily nutritional supplements.
The SADI-S procedure has the same safety profile as other bariatric surgeries, but it is more effective for weight control and diabetes management. Here are the differences between SADI-S and other bypass procedures:
1- The recognized SADI-S procedure vs. the unrecognized SASI procedure:
Typically, both procedures involve two main steps:
1. The first step is similar in both: performing a gastric sleeve where part of the stomach is removed, leaving a banana-shaped, smaller stomach.
2. The second step is bypassing most of the intestines, which is the core difference between the two procedures.
The SASI procedure bypasses the majority of the intestine by directly connecting the last part of the intestines to the stomach without preserving the pyloric valve. This creates two pathways for food: a natural one and a bypass one. Because of this uncontrolled food flow, the SASI procedure remains under research and lacks international recognition.
In contrast, SADI-S connects the last part of the intestines to the duodenum, leaving only one pathway for food while preserving the pyloric valve. This valve plays a crucial role in limiting long-term food intake quantities and preventing the dumping syndrome that can arise from other bariatric procedures. This is because the rapid delivery of food to the intestines, particularly with sugar intake, can cause heart rate spikes and drops due to the sudden rise in blood glucose levels and the subsequent decrease.
2- The SADI-S procedure vs. the Gastric Bypass procedure:
The SADI-S procedure involves a combination of gastric sleeve and gastric bypass. Sleeve gastrectomy provides a degree of restriction on the amount of food consumed, while the bypass reduces the degree of absorption of that food. Because the pyloric valve is preserved during the procedure, SADI-S reduces the risk of developing dumping syndrome after gastric bypass. The procedure also tolerates smoking and anti-inflammatory medications better than gastric bypass surgery. Additionally, the chances of regaining excess weight in the long term, even after years, are less than 5% with the SADI-S procedure, compared to 10% in the case of bypass.
Compared to other bariatric surgeries, the SADI-S procedure has the following advantages:
• IT is internationally recognized.
• There is no risk of stomach ulcers or bile reflux.
• Average weight loss is higher than Gastric Sleeve or Gastric Bypass.
• SADI-S is highly effective for long-term weight loss due to its ability to retain food in the stomach by preserving the stomach valve, unlike Gastric Bypass procedure, where the person may consume amounts of food close to pre-surgery levels after several years as the food passes quickly into the intestines.
• The chance of controlling diabetes is better than gastric sleeve or gastric bypass surgery. Therefore, SADI-S is highly effective in treating type 2 diabetes and other associated medical conditions.
• The preservation of the pyloric valve reduces the incidence of dumping syndrome.
• It is a great option for patients who have already undergone gastric sleeve surgery and aim to lose more weight.
Are there any risks to the SADI-S procedure?
Like any procedure involving a change in the anatomical pathway, there is a risk of developing vitamin and mineral deficiencies. Therefore, patients must take the prescribed vitamin and mineral supplements regularly after this and other similar procedures, and undergo regular follow-up and blood tests to ensure no vitamin or mineral deficiency.
Who benefits from the SADI-S procedure?
The SADI-S procedure is particularly beneficial for the following groups:
• For diabetic patients, this procedure provides the highest degree of control and accuracy in managing type 2 diabetes.
• Obese patients with a body mass index (BMI) higher than 45.
• It is considered a corrective procedure to restore ideal weight after a previous sleeve gastrectomy.
• Because of the gastric sleeve step, the SADI-S procedure is recommended for those without significant esophageal reflux, whereas esophageal reflux patients should undergo Gastric Bypass.
Is SADI-S surgery suitable for you?
SADI-S surgery is one of the many weight-loss procedures offered at Dr. Ahmed Abd El Salam's clinics to help people lose weight safely and effectively. The SADI-S procedure combines the full benefits of the gastric bypass with the advantages of the SASI. You and Dr. Ahmed Abd El Salam will discuss the optimal procedure for you based on your medical history and weight loss goals.
Reasons for the lack of popularity of SADI-S:
The SADI-S procedure has the same safety degree as other bariatric surgeries, but it is more effective in weight control, diabetes management, and avoiding complications that may occur with other bariatric surgeries. SADI-S may be less well-known as it is relatively new and requires unique technical expertise done by Dr. Ahmed Abd El Salam, an assistant professor of general and laparoscopic surgery and a bariatric surgery consultant at the Faculty of Medicine, Kasr El-Ainy.
SADI-S (Single Anastomosis Duodenoileal Sleeve) surgery combines two types of obesity surgery to provide greater weight loss than either procedure alone. SADI-S surgery uses two bariatric surgery procedures, Gastric Sleeve surgery and Gastric Bypass surgery, to achieve the required weight loss. It is often recommended for people with a BMI greater than 40 or those who have not lost enough weight through gastric sleeve surgery alone.
What happens during SADI-S surgery?
Dr. Ahmed Abd El Salam performs a few small incisions during surgery using the laparoscope, the latest minimally invasive surgical technique. Therefore, laparoscopic SADI-S surgery results in less pain, shorter hospital stays, a lower risk of complications, a shorter recovery time, and better cosmetic outcomes. SADI-S surgery involves two steps:
First, the surgery begins as a gastric sleeve, forming a smaller tube-shaped stomach. Dr. Ahmed Abd El Salam permanently reduces the stomach size but at a lower proportion than gastric sleeve surgery, as 200 to 250 ml of stomach space is preserved, unlike gastric sleeve surgery, in which only 100 to 150 ml is kept. The remaining part, which is in the form of a tube or sleeve, can hold less food than ever before. In addition, reducing the size of the stomach also reduces the production of ghrelin, the hormone that sends hunger signals.
Second, Dr. Ahmed Abd El Salam separates the duodenum (the upper part of the small intestine) by 3–4 centimeters from the pyloric sphincter and the beginning of the duodenum. Then, Dr. Ahmed Abd El Salam connects it to the final part of the intestine, bypassing approximately 75% of the digestive system.
After the surgery, the pyloric valve preserves the food, allowing it to leave the stomach when it's ready for absorption. This valve ensures that the food remains in the stomach for sufficient time for digestion. The food stays in the stomach for two to four hours, thereby preventing the occurrence of dumping syndrome and recurrent diarrhea, which can occur during a bypass procedure due to the rapid arrival of food in the intestine by bypassing the pyloric valve.
The food then bypasses the upper part of the small intestine and goes directly to the large intestine, so the body absorbs fewer calories and nutrients, including proteins and fats, as the small intestine absorbs the calories and nutrients during the normal digestion process.
The bypassed intestine is neither inactive nor removed, but it allows bile to pass, which leads to getting rid of any bacteria. At the point where the duodenum connects, bile can join the food for the digestion process.
How does SADI-S surgery achieve the desired weight loss?
SADI-S surgery helps enhance weight loss in two ways:
• The gastric sleeve step restricts the amount of food the stomach can hold and, therefore, the calories consumed.
• It shortens or bypasses a portion of the small intestine, so there is less time and distance for the body to absorb fats and calories, reducing the amounts absorbed by the body. Since the body absorbs fewer nutrients after SADI-S surgery, you will need to take daily nutritional supplements.
The SADI-S procedure has the same safety profile as other bariatric surgeries, but it is more effective for weight control and diabetes management. Here are the differences between SADI-S and other bypass procedures:
1- The recognized SADI-S procedure vs. the unrecognized SASI procedure:
Typically, both procedures involve two main steps:
1. The first step is similar in both: performing a gastric sleeve where part of the stomach is removed, leaving a banana-shaped, smaller stomach.
2. The second step is bypassing most of the intestines, which is the core difference between the two procedures.
The SASI procedure bypasses the majority of the intestine by directly connecting the last part of the intestines to the stomach without preserving the pyloric valve. This creates two pathways for food: a natural one and a bypass one. Because of this uncontrolled food flow, the SASI procedure remains under research and lacks international recognition.
In contrast, SADI-S connects the last part of the intestines to the duodenum, leaving only one pathway for food while preserving the pyloric valve. This valve plays a crucial role in limiting long-term food intake quantities and preventing the dumping syndrome that can arise from other bariatric procedures. This is because the rapid delivery of food to the intestines, particularly with sugar intake, can cause heart rate spikes and drops due to the sudden rise in blood glucose levels and the subsequent decrease.
2- The SADI-S procedure vs. the Gastric Bypass procedure:
The SADI-S procedure involves a combination of gastric sleeve and gastric bypass. Sleeve gastrectomy provides a degree of restriction on the amount of food consumed, while the bypass reduces the degree of absorption of that food. Because the pyloric valve is preserved during the procedure, SADI-S reduces the risk of developing dumping syndrome after gastric bypass. The procedure also tolerates smoking and anti-inflammatory medications better than gastric bypass surgery. Additionally, the chances of regaining excess weight in the long term, even after years, are less than 5% with the SADI-S procedure, compared to 10% in the case of bypass.
Compared to other bariatric surgeries, the SADI-S procedure has the following advantages:
• IT is internationally recognized.
• There is no risk of stomach ulcers or bile reflux.
• Average weight loss is higher than Gastric Sleeve or Gastric Bypass.
• SADI-S is highly effective for long-term weight loss due to its ability to retain food in the stomach by preserving the stomach valve, unlike Gastric Bypass procedure, where the person may consume amounts of food close to pre-surgery levels after several years as the food passes quickly into the intestines.
• The chance of controlling diabetes is better than gastric sleeve or gastric bypass surgery. Therefore, SADI-S is highly effective in treating type 2 diabetes and other associated medical conditions.
• The preservation of the pyloric valve reduces the incidence of dumping syndrome.
• It is a great option for patients who have already undergone gastric sleeve surgery and aim to lose more weight.
Are there any risks to the SADI-S procedure?
Like any procedure involving a change in the anatomical pathway, there is a risk of developing vitamin and mineral deficiencies. Therefore, patients must take the prescribed vitamin and mineral supplements regularly after this and other similar procedures, and undergo regular follow-up and blood tests to ensure no vitamin or mineral deficiency.
Who benefits from the SADI-S procedure?
The SADI-S procedure is particularly beneficial for the following groups:
• For diabetic patients, this procedure provides the highest degree of control and accuracy in managing type 2 diabetes.
• Obese patients with a body mass index (BMI) higher than 45.
• It is considered a corrective procedure to restore ideal weight after a previous sleeve gastrectomy.
• Because of the gastric sleeve step, the SADI-S procedure is recommended for those without significant esophageal reflux, whereas esophageal reflux patients should undergo Gastric Bypass.
Is SADI-S surgery suitable for you?
SADI-S surgery is one of the many weight-loss procedures offered at Dr. Ahmed Abd El Salam's clinics to help people lose weight safely and effectively. The SADI-S procedure combines the full benefits of the gastric bypass with the advantages of the SASI. You and Dr. Ahmed Abd El Salam will discuss the optimal procedure for you based on your medical history and weight loss goals.
Reasons for the lack of popularity of SADI-S:
The SADI-S procedure has the same safety degree as other bariatric surgeries, but it is more effective in weight control, diabetes management, and avoiding complications that may occur with other bariatric surgeries. SADI-S may be less well-known as it is relatively new and requires unique technical expertise done by Dr. Ahmed Abd El Salam, an assistant professor of general and laparoscopic surgery and a bariatric surgery consultant at the Faculty of Medicine, Kasr El-Ainy.
