Traditional DS or SADI loop

I had a fantastic surgeon and I was self pay so i could get any option, and the surgeon still recommended the hess DS over the SADI because of long term results. I have been very happy with my results so far. I am about 7 months out and about 70% to goal. 

The SADI isn't necessarily a bad procedure.  I would suggest it, with reservations, if you don't want the traditional DS, because I still think it's better for a higher BMI than the other options long term. I have read all the research on it, and it looks good so far from a short-term standpoint.  I would recommend it (with the below reservations) to people seeking advice from me.  If I did not have access to a DS I might consider it myself, however there are also ways around that, too, particularly if you are willing to travel.

Having said that, there are some issues that complicate it, though.  

There is no CPT code extant for the SADI under US insurance.  This means most policies consider it experimental.  In order to get reimbursement, the majority of the time they are billed as a DS or as a combination of procedures.  This means it's possible (however likely is another question) that complications might not be covered since it's regarded by the FDA as still being experimental.  I am always That Person who has the rare 1% complication.  My insurance (BCBSIL HMO) has stated they would not cover complications for experimental procedures.  The last surgery I had in 2005 prior to my VSG was routine outpatient hernia repair in the #2 hospital in the state, with the lowest MRSA rates.  Predictably, I was the lucky winner and got horrible and hideous necrotic MRSA.  Insurance was billed for almost $200,000 USD after a month in the hospital.

The results for the SADI in Europe are very promising, it's true.  I suspect the SADI will eventually replace the bypass, particularly for high BMI patients.  The problem is we do not have many large studies.  Most of the studies have small cohorts, and they are also for people being watched for the study.  this provides a confound: often the studies likely provide the healthcare and supplements.  

It is not the same as you or I getting the study outside of research, because the experimental environment is artificial to some degree.  I have both conducted, and participated in as a researcher, many clinical trials.  We try to account for this in experiments, but when people know they are in a study, they change their behavior.  Often they are more compliant, which skews the results.  So, the results for the SADI EWL are very good - typically 95% or more, which beats pretty much all the data on all other WLS.  The problem there is that it is usually only 3-5 year data.  10 year data is what is more vital for WLS, because well, we live our lives longer than 5 years hopefully!  It's easy to lose a crapload of weight in 3 years.  Maintaining it for 10?  There's the hard part.  So far only the DS has the most reliable and effective 10 year data.  

We do not yet understand the malabsorption of the SADI - some may go away long-term.  This is both a blessing and a curse.  Part of why the DS performs so well is that if we are super morbidly obese, we pretty much will need a permanent caloric deficit to lose - or even maintain - weight because of the effects on our devastated metabolisms.  Also, we, well.  We just eat more, period.  The DS allows us to eat more.  It has a better and more profound metabolic benefit, and it also compensates for behavior more than other procedures.

The DS is more technical to perform because it involves much acute dissection.  Still, even the SADI is equally technical to perform, however, because of its nature.  My theory is that it's complicated by the fact care teams do not want to deal with the liability because of the long-term DS care. 

 

Please see this link:


https://www.dssurgery.com/category/sadi/


Dr. Kara Keshishian wrote a blog about this very issue warning patients against it. In the first line she writes "buyer beware".

Now I will say my surgeon now does the SADI, but I'm afraid the one fact to determine if it's a viable surgery (replacement to the DS) is time, and not enough time has passed. If you want to wait another 5 to 10 years to see some long term results then I'd say go for it.

Scott

Thank you, everyone, for your responses.  I had a consult with the first surgeon's colleague yesterday, and while he has great credentials, he has only done TWO of the loop procedures and NONE of the DS surgeries.  He did say he'd be willing to do the DS on me, although I'd be his first!  I have to say, that surprised me.  Maybe a bit of surgeon pride? 

Bottom line is I have not yet ruled out the SADI procedure but am going to make an appointment with the one surgeon in Washington state who has extensive experience with the DS (yes, there's only one!) and that's Dr. Myur Srikanth.  This will make WLS consult #4 but I don't want to mess around with my body.  I get one shot at this!

Best of luck.  You can never learn too much or research too much.

That's not true at all. I had the DS in WA state by a surgeon who does several a year. 

Hi, K.P.! Who was your surgeon, if you don't mind sharing? The surgeon I spoke to said that Dr. Srikanth is the only DS surgeon in Washington. Would love to have the name of another. 

She previously posted that she used Dr. Troy Houseworth at Franciscan Medical in Federal Way.

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My surgeon trained at the University of Chicago where they do the DS, is very familiar with it, and still refused to do it (even though he had a lot of experience in his residency) because he feels it is a very technical procedure.  I would be reluctant to be a surgeon's first DS outside of a large medical procedure.  

Some things are worth traveling and time for.  The DS is one of those things. You absolutely don't want it done poorly or haphazardly.