Laparoscopic SADI (Single Anastomosis Duodenoileal bypass) procedure

Laparoscopic SIPS (Stomach Intestine Pylorus Preserving Surgery)

Ideal patients

  • BMI over 50
  • diabetes
  • high cholesterol/lipids
  • failure of sleeve gastrectomy

The SADI procedure, also known as SIPS (Stomach Intestinal Pylorus Preserving) procedure has the greatest weight loss of all the commonly performed weight loss procedures.  It has the longest lasting effects, with less late weight regain which is becoming noticeable in patients who have had sleeve gastrectomy in the past.

 

What is a SADI/SIPS procedure, and who does it suit?

 Overview

The SIPS procedure is an operation incorporating a sleeve gastrectomy with bypassing part of the intestine. It is a weight loss operation that provides the most dramatic amount of weight loss relative to all the currently performed procedures with no increase in side effects. It has the greatest effect on improving medical disorders associated with obesity such as diabetes, hypertension and high lipids and cholesterol. As such it is generally reserved for patients with a very high BMI (BMI>45) and those with significant medical complications due to obesity.

As with all weight loss procedures it is a laparoscopic (keyhole) procedure performed under a general anaesthetic.  The operation involves two parts: Firstly part of the stomach is removed making a smaller stomach similar to a sleeve gastrectomy.  Then the first part of the intestine (duodenum) is divided just below the stomach and anastomosed (reattached) to a loop of intestine about 2 metres further downstream. This has the effect of decreasing appetite, restricting meal sizes, and bypassing food away from the metabolically active part of the intestine resulting in beneficial hormonal changes which have a positive influence on the body’s metabolism.

The important thing to know about this procedure is that the bowel is divided below the pylorus.  The pyloric valve and its function is preserved unlike in the gastric bypass or mini-gastric bypass.  The pyloric valve has an important role in regulating the rate at which food & acid enters the intestine from the stomach.  It also prevents bile from refluxing from the duodenum back up into the stomach which can cause stomach irritation.  The preservation of the pylorus in the SIPS procedure maintains it’s important function. The problem of bile entering the stomach which can occur with the mini-gastric bypass is therefore prevented in the duodenal bypass.

The preservation of the pyloric valve in the SIPS procedure also eliminates the dumping syndrome which can occur with standard gastric bypass procedures.  The glucose fluctuations after a meal do not occur after this procedure. There is also a dramatic reduction in the formation of ulcers forming at the anastomosis site which can happen in standard gastric bypass.

 

Since the procedure does involve bypassing part of the small intestine there is a potential for patients to develop deficiencies in vitamins, minerals, protein & trace elements similar to a gastric bypass.  Therefore it is important for patients to maintain ongoing surveillance and annual blood tests.

 History

This procedure has evolved over many years.  It is a modification of the original Duodenal Switch (DS) operation, and as it has been refined over many years it is known by various names.  The problem with the DS operation was that such a long segment of intestine was bypassed; it led to many patients having malnutrition and vitamin deficiencies.  Many patients also had loose bowel motions as a result.  In 2007 a Spanish surgeon Dr Antonio Torres developed the loop technique, reducing two anastomosis down to one, and bypassed less intestine.  This became known as the Single Anastomosis Duodeno-Ileostomy (SADI) procedure.  Subsequently this made the operation safer, with less effects of malnutrition, diarrhoea and vitamin deficiencies.  Further on, a couple of American Surgeons; Dr Mitch Roslin and Dr Daniel Cottam refined the technique slightly further; bypassing the intestine even less; thus even further decreasing the potential to have long term problems.  This became known as the Stomach Intestine Pylorus Preserving Surgery (SIPS).  The results of these pioneering surgeons demonstrating extremely good weight loss and extremely low complication rates has led to its popularity.  The SIPS procedure is now performed at many specialist weight loss centres throughout the world.

SADI/SIPS following sleeve gastrectomy

The procedure is becoming increasingly useful for patients who have had a prior sleeve gastrectomy and either have not had as much weight loss as expected, or have lost weight and regained weight later on.  In the past these patients have often had their sleeve gastrectomy converted to a standard gastric bypass, however evidence shows that this also may not provide robust long term weight loss.  The SADI/SIPS procedure is showing extremely promising results after previously failed sleeve gastrectomy.

 

 

 

The SIPS procedure has been developed to such an extent that it provides the most weight loss, the longest lasting weight loss, and the most beneficial effect on medical problems associated with obesity, compared to all other procedures.  It has been refined to the point at which the long term problematic issues have been minimalised making it an extremely safe and effective operation.

 

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