SADI-S Adelaide

The SADI procedure is a combination restrictive, hormonal and malabsorptive procedure. It involves both a sleeve gastrectomy along with intestinal bypass although unlike gastric bypass procedures the bypass is between the duodenum and ileal parts of the small bowel. Obviously patients have restriction from the sleeve component of the procedure but also have an element of malabsorption and hormonal changes which can enhance weight loss and is more effective at stopping weight regain in the long term. The advantage of having the bypass between the duodenum and the small intestine is that SADI patients have an intact pylorus so are less likely to experience dumping but more importantly they do not suffer from ulcers typically seen in gastric bypass procedures. This means that SADI patients are able to have medications like anti-inflammatories which are generally contraindicated in gastric bypass patients. Like sleeve gastrectomy laparoscopic gastric bypass also alters some of the hormones involved in appetite control and hence helps to control appetite as people lose weight.

Probably the biggest group to benefit from the SADI procedure are diabetic patients. Bypassing the first part of the small intestine changes gut hormones directly involved in glucose control. Around 80% of non-insulin diabetic patients will leave hospital following their surgery without any diabetic medication. For many type 2 diabetics who are insulin dependent they are able to stop their insulin which dramatically improves their ability to lose weight.

One of the most interesting facts when it comes to bypassing the small intestine is the greater variation in intestinal length between individuals . Perhaps considering how different we are both physically and in other aspects of our biology such as height maybe we shouldn’t be so surprised but weight loss surgeons will not always take this into consideration when deciding how much intestine to bypass. For instance most surgeons who perform gastric bypass have a set amount of small intestine to bypass, normally around 150-200cm of bowel. For most individuals this works well but because there are large variations in overall length this is not always the best for the individual patient. Small intestine lengths can vary from as little as 400cm to over 1200cm in intestine with most people having around 600 to 800cm. A gastric bypass involving 200cm of small intestine could cause significant and drastic malabsorption in a patient with only 400cm of intestine while in a patient with 1200cm the amount of malabsorption would be minimal. Since we introduced Single Anastomosis Gastric Bypass to our practice 8 years ago we have been interested in total small intestine length and how this can influence outcomes (both good and bad) with weight loss surgery. This interest further intensified with the introduction of the SADI procedure 3 years ago. Understanding the significant benefits of preserving the pyloric valve we are now performing the SADI procedure on lower BMI patients who may benefit from bypass but who do not need as much malabsorption by bypassing less small intestine. These procedures are correctly known as Duodenal-Jejunal bypasses but can produce excellent results. It is important for surgeons to remember that everyone individual is different and we should consider the overall length of the small intestine.