Duodenal Switch Vs. SADI, SIPS, Loop DS

Posted On : October 23, 2017

Written by Ara Keshishian, MD, FACS, FASMBS
Last updated: October 23, 2017

The well-known standard Duodenal Switch (DS) operation is a clearly defined operation. It is assigned a specific CPT code (43845), which defines precisely that anatomy. SADI, SIPS and Single anastomosis Loop DS are not equivalents of the standard DS operation. In fact, from a physiologic perspective, the dissimilarities are more notable than the similarities when it comes to the theoretical weight loss mechanisms that are involved. The most critical information, however, is that the scientific data for SADI, SIPS and Single anastomosis Loop DS are very limited and thus far, short-term only. At the time of the publication of this summary, there is a research study that is looking into the efficacy, safety and the short- and mid-term outcome of the procedures. This is while some surgeons are offering these procedures as a substitute (or an alternative) of the standard DS, and claiming that it is an equivalent to the standard DS. This position has simply not been proven, nor is it likely to be true.  

	Duodenal Switch	SADI-SIPS, Loop DS
Proven Long term outcome	Yes, with over 20 years outcome- (reference)	No Long Term outcome. An Experimental procedure being studied (reference)
Technical ease	Hard	Easy
Laparoscopic	Yes	Yes
Bile Reflux	Not anatomically possible	Possible complication
Long term weight loss	Best outcome (reference)	No long-term data. The expectation would be that the weight loss will be much less than that of the Duodenal Switch with the potential of significant regain.
Potential nutritional deficiencies	Possible – (reference %) corrected with supplementation	Inadequate data
Individually tailored	Yes if the common and alimentary bowel lengths done as percentage of the total length (Hess Method)	Every patient gets the same operation
Diet for best outcome	Broad healthy non restrictive	No long term data
Variable a surgeon can adjust for the best outcome	1-stomach size 2-Common Channel 3-Alimaentary channel	1-stomach size 2-Common and Alimentary limb (are the same)
Selective Fat Malabsorption	Yes- negligible fat absorption in the Alimentary limb	No-The Alimentary the common channel are the same – no selective fat malabsorption
Selective nutrient absorption	Yes- The Alimentary and common channels are separate.	No-The Alimentary ad Common Channels are the same. Much higher increase in caloric absorption.