Single Anastomosis Duodeno-ileal Bypass

SADI is experimental.  Hasn't been enough done to rate it or have any idea of long term results.  I believe very few, if any are more than a year out.

Your doc is right.  The sleeve alone won't get your weight down to where you want to be.  And your diet postop sleeve would be pretty much starvation level to keep the weight off.  If I was in your position, I would have the DS.  It's your best shot to get the weight off and keep it off.

SADI is experimental. If your insurance is covering it, it's because someone at the surgeon's office has figured out what existing codes to use to get it covered, and not because it's a "standard of care" operation, which it isn't. Maybe it will pan out, maybe it won't. Maybe the "lower risk" is significant, maybe it isn't. The lower risk is only because there is one less small intestinal anastamosis. Is that really enough of a benefit to compensate for losing out on the documented, excellent results of the classic DS? I don't know, but then again, your surgeon doesn't know either.

I appreciate that he was honest with you and agree with him completely that the sleeve alone probably won't get you where you need to be, but I don't understand why he wouldn't also offer you a real DS unless it's because he just doesn't do the DS. I've been on this forum, and others related to the DS, for over 9 years and have never seen him mentioned as someone who does the DS. But we've seen so many people outright misled about what they were getting, or never informed of all their options, that his honesty really is refreshing.

I also agree with the people who pointed out that whatever weight you would end up with a sleeve, you would have to spend the rest of your life on a strict diet to stay at that weight. These are tough decisions and require us to be honest with ourselves. Are you someone who could stick to a low calorie, low carb, low fat diet for the rest of your life? I wasn't, but I can't answer that question for you. Unless the answer is yes, a purely or nearly purely restrictive operation isn't going to work for you longterm. Even gastric bypass has a higher failure rate and more problems with weight regain than most people realize. the DS, and I mean the real, full DS, has the best statistics of any bariatric operation for percentage excess weight loss, for maintaining that weight loss, and for resolution of almost all comorbidities. With SADI you have less malabsorption and unknown longterm results. To me, having one less anastamosis doesn't compensate for less weight loss benefits and unknown longterm results.

I would recommend a consultation with a surgeon who offers a full DS.

Larra

Read these:

http://www.dssurgery.com/procedures/compare-weight-loss-surg ical-procedures.php

http://blog.dssurgery.com/2014/06/single-anastomosis-duodeno ileal-bypass.html

Please don't get the idea that you are unwelcome here.  I want you to know the back story.  More than a couple patients were told/understood/knew they were getting the DS and they ended up with the SADI.  We have no idea if the doc or the patients were at fault.  All we do know is these people feel very betrayed and are angry.  I don't think they are getting great results either.  So far it seems like the SADI is an easier surgery for the doc to do and the results are not that impressive.  But remember we haven't seen many of these yet.

I don't think your doc was involved in any of this.  And I like the fact that he was honest with you about the sleeve and explained the SADI.  However it is experimental and I would bet money those CPT Codes are some kind of a workaround.  But that's just my opinion.

Please think very carefully about this!

I really want to get this discussion back to where I started it.  I know some of you have posted your same opinions on this thread and all the other SADI threads I have read here.  I do appreciate your input, but I feel my surgeon has informed me properly about the procedure and he has no problem getting insurance to pay for it.  If that is a work around or whatever matters not to me.  I know some of you have advocated the traditional DS, but none of the surgeons at the hospital where I want to have my operation do traditional DS as a first procedure. 

As stated in my original post, I would simply like to ask some questions of those who have HAD this procedure.  I've read the stats from several different studies, but there is nothing like asking questions from people who have experience with this procedure.  This is a BIG decision for me and I want to be as informed with facts as I can be.  

On a separate note, my surgeon did inform me that he has performed this procedure as a second step or revision to VSG with good results also.  He said that if I chose the sleeve and didn't get the expected results he could do the SADI as a revision.  My thoughts at the moment are why bet against the odds?  I think I should go ahead and get the SADI.  IF it causes problems or I don't lose as much as I would like, I can always have it reversed back to "normal" sleeved anatomy or revised to traditional DS.  That is where I am at right now.  

Thanks again to all who have posted and to those who have sent private messages.  I value your input in helping me make this life changing decision.

Dude…I think you may need to check your attitude a little bit? It looks as though your posts are pretty intense and so focused on keeping everyone “on track” that you already have yourself convinced and really don’t need any advice? I’m new on here and learn something every day by reading things that deviate from ones pre-concieved ideas, especially my own! So what if some opinions goes outside your “Box”, that’s how you and everyone else learn. For example, I don’t even know the difference between the SADI and the BPD-DS and spent the last ½ hour trying to learn about it. Fact is, there is virtually NOTHING out there to read, so if I were you, I would chill a bit, read everything you can on EVERYTHING and be thankful that these folks are trying to help you.

I definitely was not trying to put forth an attitude.  If my comments were perceived that way, I apologize.  Opinions are fine and as I said, I do appreciate those who have given their opinion.  The problem is that for some reason a handful of folks on these OH forums have shared opinions that have been proven incorrect or they seem to look down on the procedure because it is not a traditional DS (with no facts to back up their opinions).  I have received several messages from folks who have had this procedure but are unwilling to post in this thread for fear they will be made to feel inferior for not having a traditional DS.  Those types of issues are counter-productive to any discussion here on OH.  

I appreciate those who have shown concern about my Dr. committing insurance fraud or not giving me all the truth etc.  Hopefully, my comments have put to rest those issues.  The truth is that my surgeon is one of the most respected in the area, he started the first private practice bariatric clinic in the area, performed the first gastric bypass in the area, performed the first sleeve in the area, performed the first lap band in the area, has performed the most bariatric procedures in the area, and the list of accolades goes on.  I am confident that he would not risk his hard-earned reputation trying to cheat an insurance company that gives him "in-network status" or by offering me a procedure that he had not fully vetted and was not confident would produce the results that I want, etc.

You are right, there is not a lot of literature out there.  The literature that is out there suggests that this procedure is showing great results.  The opinions I have read from various doctors on the subject all point to this being a great choice for someone like me.  I have not read one qualified medical opinion that suggests anything different.  What I have not seen much of are individual stories of patients who have undergone the SADI surgery.  As stated, at this point, my main objective is to gather as many facts and data points as possible.  I am mainly interested in hearing from folks who have actually had this procedure so that I can ask them questions about issues that are specific to this surgery.  I want to know what kind of weight loss these folks have experienced.  I want to know about the side-effects they have experienced.  I want to hear their stories.  A number of folks have written me messages to share their experience with this procedure...and I am thankful.  

With all that said, my due diligence with the research is leading me to choose this procedure over a stand-alone VSG.  I have read nothing but positive comments and results from actual patients and doctors.  Yes, the study population is small at this point.  As best I can tell from my research, the procedure was first done in 2007.  I would suspect that if problems were prevalent with the SADI-S, we would see some of that in the literature by now.  In all the reading I have done, the only negative comments I have read are from folks posting things like insurance won't cover it, the chance of bile reflux is there, the results are not as good as traditional DS, it is too new/experimental, etc.  None of those things were posted by doctors or patients *****ceived this procedure. 

Again, if my desire to gather facts has come off as me having an attitude, please understand that is not my intent.  I am a scientist by trade and as such I have spent my life and career focusing on facts and giving less weight to opinions.  It makes me feel good knowing that if I do undergo this procedure, I will be able to participate in a study to help determine the long term effectiveness of this surgery.  Remember that DS, VSG, RNY, Lap-Band, etc. were all considered investigational at some point.  From what I have read in the literature, doctors' opinions, and patient stories, I believe that we will see this procedure become as mainstream as RNY, VSG, etc.  

Thanks again to all who have shared.  If you would like to share your SADI-S story, please send me a message or post here.

Just my 2 cents:  if it was my situation I'd go with a proven procedure over an experiment. I'm sure your docter & hospital is excellent however there are other qualified DS surgeons that will be of greater benefit to your future. Your decision should include 2 - 3 years from now. DS has those proven facts......the Sadi Loop doesnt. Think twice cut once 

James, thxs for your civil response. I apologize too if I was a little harsh, but, I got about 20 yrs on you and sometimes I still have to tell myself to just shut up and listen!!! LOL…

My point is, I also have a really bad habit of convincing myself of something and I have been humbled so many times by how wrong I was. ALL I’m asking you is, don’t limit yourself or your responses because sometimes the answers you seek can be found reading something else, or they start another thought process and raise more questions, that’s the way science works as well.

Yeah, you’ll spend extra time reading and filtering through a lot of BS, but then you’ll discover that one piece of info that made it worthwhile, that’s all I’m saying. INMHO, either procedure would be good for you, so go with your gut feelings after it’s all said and done, just don’t settle for the VSG only. I think everyone’s in agreement on that. I wish you the best!!

Let me also say that the "experimental" nature of this procedure does not scare me.  As a scientist, I understand the value of research and the thought processes that occur before the first "experiment" is ever conducted.  I am sure the Drs who came up with this procedure thought through the entire process and outlined both the possible strengths and weaknesses of this surgery.  This procedure has been around since at least 2007, so if it were unsafe, it would not be in clinical trials here.  My main concerns are about the side effects.  Based on those I have talked with and the things I have read in published data, the side effects are about the same as other weight loss surgeries.  My other concerns are about how much weight loss can be expected with this procedure.  Given the small population of the studies so far, the EWL approaches 100%.  One study showed an average of 108% EWL at year 3.  Quite frankly, the thought of weighing in the 130s scares me almost as much as not losing enough and ending up in the 250s.  

The bottom line is this.  Traditional DS is not really an option for me given my insurance, location, Dr preference, desire to not travel, etc.  I'm confident that if I do indeed have the loop DS, I will lose a significant amount of weight and my health will improve dramatically.  We could argue all day long about whether I would lose more weight with the traditional DS.  The truth is even if I only ended up losing 105lb (50% EWL), that would make a huge improvement in my health and how I look and feel.  At the end of the day, if that is all I lost, I would be happy to be able to walk without pain in my feet/ankles.  I would be able to get down on the floor and play with my daughter.  I'd be able to fit comfortably in any restaurant booth or airplane seat.  I would be able to buy clothes at most of the local stores instead of being forced to shop at high priced "fat boy" places or online.  When all is said and done, aren't those the goals that matter more than a number on a scale?   

I agree that a procedure has to start somewhere, and one of the posters on this thread is a  physician, just so you know.  

I hope that at least by PM, you've gotten some people to reflect experiences with.  My concern is still with insurance fraud, though.  The DS has been around since 1988, and it wasn't less than 10 years ago that it was more broadly accepted as a viable procedure by "most" insurance co's.   SADI-S is in it's infancy, by comparison.  Just to put that thought to rest, call your insurance company and ask them specifically about SADI-S.  Like it was suggested earlier, someone in the business office of the surgeon has figured out a way around actually asking for SADI-S to be covered.  Are you ready to be part of that deception?  It's nothing but deception, no matter how you try to justify it.  Otherwise, they would file for that procedure.  

Things to think about, and really - think about this and plan for it.

• Are you ready to pay out of pocket for it if your insurance denies it?
• If it's new and experimental - why are they charging you at all to be part of a study?
• If your surgeon relocates (it's happened with Husted and his Vergito procedure) - where would you get help?  This is a valid concern because even after nearly 30 years, there aren't enough medical professionals that know enough about the DS yet and we can be hell-bent if there isn't one close by.  Many surgeons don't want to deal with another surgeon's mess, and being an experimental procedure, you'll be at a total loss.
• Is your PCP comfortable with treating you afterwards?  Be ready to provide full documentation and information to them.  Some are more open to new things than others.