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procedures
SADI-S
SADI-S (Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy) is a bariatric procedure that combines a sleeve gastrectomy with an intestinal bypass, reducing the size of the stomach and altering nutrient absorption to promote weight loss.
Quick Facts
| Weight loss | Between 75-95% of excess body weight is lost within 18 to 24 months. |
| Surgery time | 1 to 1.5 hours |
| Hospital stay: | 2 days |
| Recovery time: | 2-4 weeks. |
Find answers to your questions
Consult our Frequently Asked Questions to obtain detailed information and clarify your doubts. We are here to help you make informed decisions.
Introduction
Obesity is a chronic disease of multifactorial origin that affects a large number of individuals worldwide (WHO, 2021). One of the treatment options for severe obesity is bariatric surgery, which includes different surgical techniques such as gastric bypass, sleeve gastrectomy and the SADI-S bariatric procedure (Sánchez-Pernaute et al., 2017). The latter is a relatively new technique that has been shown to be effective and safe for weight loss and treatment of comorbidities associated with obesity. This article focuses on the SADI-S bariatric procedure, its indications, surgical technique, outcomes and complications.
Definition and rationale of the ODS-S procedure
The SADI-S (Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy) procedure is a mixed surgical technique that combines a sleeve gastrectomy with a single-anastomosis duodeno-ileal bypass (Sánchez-Pernaute et al., 2010). The idea behind this procedure is to reduce the size of the stomach and modify intestinal transit to decrease the absorption of nutrients and calories (Sanchez-Pernaute et al., 2017).
Indications
The SADI-S procedure is indicated for patients with severe obesity, i.e., those with a body mass index (BMI) equal to or greater than 45 kg/m², or a BMI equal to or greater than 30 kg/m² associated with comorbidities (ASMBS, 2021). It is also considered an option in patients who have experienced insufficient weight loss or have regained weight after other bariatric surgeries (Rebibo et al., 2019).
Contraindications
Contraindications for performing the SADI-S procedure include inflammatory bowel diseases, short bowel syndrome, and advanced liver disease (Sanchez-Pernaute et al., 2017). In addition, each patient's situation should be carefully evaluated and psychiatric disorders, addictions, and medical conditions that may increase the risk of postoperative complications should be ruled out (ASMBS, 2021).
Surgical technique
The surgical technique of the SADI-S procedure is performed in two steps: first, a sleeve gastrectomy is performed, in which part of the stomach is removed, leaving it in the form of a tube (Sánchez-Pernaute et al., 2010). Subsequently, a duodeno-ileal bypass is performed using an anastomosis between the duodenum and ileum 250-300 cm from the ligament of Treitz (Sanchez-Pernaute et al., 2017). This creates an alternate route for food, bypassing a large part of the small intestine and thus decreasing nutrient and calorie absorption (Rebibo et al., 2019).
Results and complications
Several studies have demonstrated the efficacy of the SADI-S procedure in terms of weight loss and improvement of obesity-related comorbidities, such as type 2 diabetes, arterial hypertension, dyslipidemia, and sleep apnea (Sánchez-Pernaute et al., 2017; Rebibo et al., 2019). In addition, the SADI-S technique has shown a lower rate of complications compared to other bariatric surgeries, such as Roux-en-Y gastric bypass (Sánchez-Pernaute et al., 2017).
However, like all surgery, the SADI-S procedure is not without risks and complications. Short-term complications can include bleeding, infection, leakage, and deep vein thrombosis (Sanchez-Pernaute et al., 2017). Long-term complications may include nutritional deficits, dumping syndrome, and bowel obstructions (Rebibo et al., 2019).
Postoperative care and follow-up
Postoperative follow-up and care are essential to ensure optimal results and prevent complications after the SADI-S procedure. Patients should follow a progressive, personalized diet under the supervision of a nutrition specialist and adhere to a regular physical exercise program (ASMBS, 2021). In addition, long-term medical follow-up is required to monitor possible nutritional deficits, adjust medication for comorbidities, and prevent regain of lost weight (Rebibo et al., 2019).
Conclusion
The SADI-S bariatric procedure is an effective and safe surgical technique for the treatment of severe obesity and its associated comorbidities. By combining a sleeve gastrectomy with a single-anastomosis duodeno-ileal bypass, this technique allows significant weight reduction and improvement of related medical conditions. However, adequate postoperative follow-up and care is essential to ensure optimal results and minimize potential complications.
References
ASMBS (2021). Clinical guidelines for metabolic and bariatric surgery. American Society for Metabolic and Bariatric Surgery. Retrieved from: https://www.asmbs.org/guidelines
WHO. (2021). Obesity and overweight. World Health Organization. Retrieved from: https://www.who.int/es/news-room/fact-sheets/detail/obesity-and-overweight
Rebibo, L., Gerin, O., Verhaeghe, P., & Dhahri, A. (2019). Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) for the treatment of morbid obesity: 5-year outcomes. Obesity Surgery, 29(8), 2389-2396. https://doi.org/10.1007/s11695-019-03850-2.
Sánchez-Pernaute, A., Rubio, M. Á., Conde, M., Arrue, E., & Torres, A. (2010). Duodenoileal bypass technique with vertical gastrectomy for the treatment of morbid obesity and type 2 diabetes. Spanish Surgery, 88(6), 379-386. https://doi.org/10.1016/j.ciresp.2010.07.009.
Sánchez-Pernaute, A., Herrera, M. A. R., Pérez-Aguirre, M. E., Talavera, P., & Cabrerizo, L. (2017). Single-anastomosis duodenoileal bypass with sleeve gastrectomy: metabolic improvement and weight loss in first 100 patients. Surgical Endoscopy, 31(9), 3521-3527. https://doi.org/10.1007/s00464-017-5399-9.
CONSULT
You may be a candidate for weight loss surgery.
You may be a candidate for weight loss surgery if you meet any of the following criteria:
Overweight
He weighs more than 20 kilos above his ideal body weight.
BMI
You have a Body Mass Index (BMI) greater than 30 kg/m².
Health
You suffer from obesity-related health problems, such as hypertension or diabetes.
Diets
You cannot achieve a healthy body weight, even with medically supervised diets.
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