SADI-S

Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy (SADI-S)

The Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy (SADI-S) is also known as a One Anastomosis Duodenal Switch (OADS). This is a recent (2007) procedure that modifies and combines both “Bileopancreatic Diversion (BPD) (an old established operation 1979)” with a “Duodenal Switch (DS) (established in 1986).

SADI-S (2007) essentially simplifies the “two” anastomosis (performed in BPD and DS) into “one”. This join is in a form of a “loop”. This procedure joins the duodenum (just passed the stomach) to the loop of ileum, which is about 200cm from the origins of the large bowel. This creates a significant malabsorption.

Advantages of SADI-S

• One anastomosis (join)

• Preserved pylorus and therefore less gut function disturbance (theoractical)

• Good weight loss maintained

• Laparoscopically performed

• A good option for revision of other operation types

Disadvantages of SADI-S

• Probable higher risk compared to gastric bypass- bleeding, nausea, anastomotic leaks

• Malabsorption of fat soluble vitamins, micronutrients, iron, calcium and protein

• Frequent bowel movements, flatulance and fatty stools

• Dumping syndrome

• Mandatory requirement for multivitamin supplementation and testing for metabolic deficiencies

• Lacking robust data (follow up and long term data).

Position statement by IFSO 2018

• Currently considered as an “Investigational” procedure and NOT a recognised “Main-stream” procedure.

• The procedure is considered “safe” and “efficacious” in the current form (SADI-S0.

• Current concerns of insufficient long term data on nutritional issues.

• Insufficient prospective or comparative data compared to the standard Bileopancreatic diversion or Duodenal Switch