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SADI-SIPS

Single Anastomosis Duodeno-Ileostomy (SADI) and Stomach Intestinal Pylorus-Sparing (SIPS) surgeries are not the same as the Duodenal Switch (DS) procedure.

Any suggestion that SADI or SIPS  are the same as the Duodenal Switch is misleading and inaccurate. Long-term studies on the outcome of the SIPS and SADI procedures are not in existence. The only anatomical similarity between these procedures and Duodenal Switch is the presence of the pyloric valve as a functional part of the post surgical anatomy. The small bowel portion of the SIPS-SADI is different than that of the duodenal switch. In the duodenal switch operation, the absorption of the fat is primarily limited to the common channel, which is usually 10% of the total length (if the surgeon performing the duodenal switch bases the common and alimentary limb lengths as a percentage of the total length as described by Dr. Hess). The combined alimentary/common channel of the SADI-SIPS procedure is closer to 40-50% of small bowel length.  Additionally, bile reflux, internal hernia, inadequate weight loss and even weight regain are all possible complication that are much more likely with the SADI-SIPS than with the DS. I would also like to make the point that revisions of the SADI-SIPS may not be as simple as some suggest. The Length of the small bowel, location of the anastomosis in relation to the colonic mesentery, and the length of the duodenal stump all are factor in dictating how easy or difficult the revision of the SADI-SIPS to DS will be.

Duodenal Switch operation has by far the best long-term outcome of all weight loss surgical procedures. There isn’t long-term data available for SIPS and SADI and their alimentary/common channel lengths. It is critical that patients are very well informed (informed consent) as to the exact operation that is being performed on them. As stated above, Duodenal Switch procedure is not the same as SADI or SIPS. The notion that these procedures can be interchanged is anatomically and medically inaccurate.

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