Diabetes Surgery (SADI-S) | Koru Hospital | Koru International Medical Center

The duodenal switch and biliopancreatic diversion surgeries, popularly known as the Scopinaro procedure, have been integral components of the obesity treatment landscape in the United States for nearly two decades. These surgical techniques have garnered recognition as highly effective methods for addressing morbid obesity, primarily due to their profound metabolic impacts. The unique aspect of these procedures lies in their ability to induce weight loss not only through restrictive mechanisms but also by altering the intricate metabolic processes within the body.

SADI-S Surgery: A Novel Approach with Reduced Risks

In the realm of bariatric surgery, the SADI-S procedure emerges as a promising alternative, sharing similarities with the conventional duodenal switch.

However, what sets it apart is its innovative approach to mitigating risks by incorporating a single anastomosis, forming a direct connection between the stomach and the intestine. This modification minimizes potential complications, enhancing the safety profile of the surgery while retaining its effectiveness in promoting weight loss and metabolic improvements.

The Intricacies of SADI-S Surgery

Delving into the intricacies of the SADI-S method, the surgical process begins with the transformation of the stomach into a tube-like structure. Subsequently, the last 250 centimeters of the small intestine, out of the approximately 6.5-meter total length, are intricately connected to the exit of the stomach. This strategic configuration enables ingested food to bypass a substantial portion of the small intestine where the initial stages of digestion occur. The undigested food is then directed to a specific segment of the large intestine, where absorption functions are limited.

This meticulous rerouting not only curtails the absorption of a defined portion of calories and fats but also instigates a cascade of metabolic effects. The interaction of undigested food with the final segments of the small intestine triggers the release of hormones, including GLP-1. This hormone plays a pivotal role in stimulating the satiety center, resulting in a significant reduction in the desire to eat. Thus, the primary outcome of SADI-S surgery extends beyond mere restriction imposed by stomach size reduction, encompassing the intentional diversion of undigested food to the connected small intestine.

Metabolic Enhancements and Candidate Criteria

One of the notable advantages of the SADI-S surgery lies in its capacity to augment pancreatic insulin production and alleviate insulin resistance. Comparable to other metabolic surgeries like the duodenal switch and ileal interposition, this enhancement is facilitated by incretins, hormones of intestinal origin. These metabolic effects are not only instrumental in weight management but also contribute to the overall improvement of metabolic syndrome parameters.

Candidate Criteria and Universal Standards

As with any obesity surgery, the eligibility criteria for SADI-S surgery adhere to universal medical standards. Individuals aged 16 to 65 who meet the indications for obesity surgery may be considered candidates. The criteria set forth by the World Health Organization and the World Obesity and Metabolic Surgery Federation stipulate a BMI of 40 or more, or a BMI of 35 or more with associated diseases such as type 2 diabetes, sleep apnea, joint disorders, fatty liver, coronary artery disease, hypertension, or hyperlipidemia.

Unraveling the Advantages of SADI-S Surgery

The advantages of SADI-S surgery are multifaceted, contributing to its growing popularity as a preferred bariatric intervention:

Enhanced and Sustainable Weight Loss: SADI-S surgery is renowned for providing more effective and sustainable weight loss compared to restrictive methods.
Appetite Reduction Beyond Restriction: Post-surgery, patients experience not only physical restriction but also a substantial decrease in appetite, augmenting the overall effectiveness of the procedure.
Metabolic Boost through Hormonal Regulation: The surgery's impact on pancreatic insulin production and the reduction of insulin resistance significantly contribute to metabolic improvements, aligning it with other successful metabolic surgeries.
Avoidance of Dumping Syndrome: In contrast to certain gastric bypass surgeries, SADI-S surgery preserves the pyloric muscle, preventing complications such as severe vomiting, hypotension, and fainting, commonly referred to as "Dumping Syndrome."
Mesentery Preservation: Unlike Roux-en-Y type surgeries where the mesentery, the structure feeding the intestine, is divided, SADI-S surgery minimizes the risk of future abdominal hernias by avoiding mesenteric openings.

Comprehensive Insights into Disadvantages and Complications

Despite its efficacy, SADI-S surgery does present certain drawbacks and potential complications that necessitate thorough consideration:

Anatomy and Physiology Disruption: The surgery is acknowledged for causing more significant disruptions to anatomy and physiology compared to sleeve gastrectomy, highlighting the importance of careful patient selection.
Nutritional Deficiencies: Post-surgery, patients may experience deficiencies in iron, calcium, folate, B12, and fat-soluble vitamins, emphasizing the need for diligent postoperative monitoring and supplementation.
Temporary Gastrointestinal Changes: Due to the accelerated passage of the intestine, patients may encounter temporary diarrhea in the initial days post-surgery, gradually diminishing as the intestine adapts.
Odorous Stool: An absorption disorder may lead to malodorous stool, necessitating awareness and potential adjustments in diet and lifestyle.

Postoperative Considerations for Optimal Outcomes

The success of SADI-S surgery is contingent upon meticulous postoperative care and adherence to specific guidelines:

Modified Nutrition Plan: A tailored nutrition system is implemented, starting with a liquid diet for the initial 15 days, followed by a puree phase. Early introduction of solid food is discouraged to ensure optimal recovery.
Weight Loss Progression and Lifelong Control: The rate of weight loss is directly linked to excess weight, emphasizing the surgical goal of lifelong weight control rather than rapid shedding. The SADI-S surgery is anticipated to provide extended weight control based on experiences with Duodenal Switch surgeries.
Regular Monitoring for Nutrient Deficiencies: Given the surgery's impact on absorption, regular checks for deficiencies in iron, calcium, folate, B12, and fat-soluble vitamins are imperative. Protein deficiency, if identified, necessitates a protein-rich diet and, if necessary, supplements.

In conclusion, the SADI-S surgery stands as a nuanced and innovative approach to bariatric intervention, combining effective weight loss with metabolic enhancements. While it offers numerous advantages, careful consideration of eligibility, potential complications, and postoperative care is paramount to ensuring optimal outcomes and long-term success for individuals seeking a transformative solution to morbid obesity.