SADI-S, SIPS etc VS traditional DS - why docs are saying Yes!
Reposted from a reply I made to an older thread.
Ok - after researching by writing some doctors I got a name for why some of the SADI pioneers are preferring it to traditional DS and giving it a 300 cc common channel.
Short Bowel Syndrome.
They've lengthened the channel by 50cc over the standard SADI 250 up to 300cc (or half the original intestine if less than 6 meters) to mitigate the potential for SBS as it was still showing up in some SADI 250 peeps. With the increase it is now not a factor.
Eventually the SADI 250 people came back up in deficiencies but they are trying to mitigate it all together as it is a tough thing to tackle. A lot of traditional DS no matter how vigilant on vitamins will suffer from it and it's a constant battle.
Do some research on SBS. It's a scary thing. To me just as scary as being fat. It also increases your future cancer risk like crazy.
Additionally, the concensus is that every WLS has 18 months to loose and after that it becomes harder. The benefit of loosing half the intestine acts the same as a smaller channel in the short term of that time period. Some say better because you are getting more vitamins. This is the kicker - no statistical difference at all in the short term - it acts the same. Everyone's 18 month post op diet should be pretty strict and focusing on a new lifestyle so during this 18 month period the fight over which is better is just noise.
So what about mid term?
As time goes on SADI patients appear to have better luck with maintenance by continuing a low sugar diet. Fat doesn't matter as long as sugar/carbs remain low. Traditional DS have the advantage of a less healthy diet being able to maintain weight loss.
Long term. Theoretically, It all comes comes down to short bowel syndrome.
That's why these docs are doing it who have never been willing to do traditional DS. Yes it's an easier surgery but surgeons like challenges so that's not the factor. The issue is they think they finally have an answer that makes them think it's a good option for the patient. Most of these doctors have never advocated the traditional DS because of the SBS issue. They didn't see a reason for it over the RNY given the extra risks of the DS post-operatively which statically have higher hospital stays as a result.
Hope that helps some of you. And hope it makes the bashers a little sheepish for calling people stupid or guinea pigs. BTW all the docs I talked to felt that in 5 years the traditional DS will only be performed on insulin diabetics over 50 bmi. Everything else will be SADI if the data holds up. Pretty impressive I think.
I don't really care what people choose as long as they make an informed choice. It's fine that you think the SADI
is a better option but I'm not sure the arguments you've presented really make the case. I also would never call
someone choosing the SADI any names. It is still more of a case where some people (Doctors / surgeons) think it
is better in the long run - OK - everyone has an opinion and Docs are no different. That is not the same as studies
proving the difference. Which doesn't imply they are wrong - it is what it is - you take your pick and take your chances.
As far as I can tell every WLS has it's pros and cons - nothing is perfect yet.
I'm a little unclear why the panic over SBS. A quick Google search gave me this definition:
People with short bowel syndrome cannot absorb enough water, vitamins, and other nutrients from food to sustain life.
In my own experience this doesn't represent 99.9% of people with a standard DS. I was tempted to add a few more 9's
at the end but I'm sure you get the point. It's just not clear to me that the shortened bowel of a standard DS poses a
risk.
Also, I'm not sure what point your making about every weight loss having an 18 month window (although my surgeon
puts it at 24 months). It was the stats on total weight loss and weight regain that pushed my surgeon and myself to the
DS.
Lastly, I think experienced surgeons have a very good idea of their skill level and would avoid the DS for that and many other
reasons - some of which are valid and others may be rooted in just ignorance. Here we are at tradeoffs again.
No reason not to be excited about something new. That doesn't take away from those of us with a standard DS doing well.
HW 552 CW 198 SW 464 4/15/13 - Lap DS by Dr. Philip Schauer - Cleveland Clinic.
SBS or not - I see a bigger overall problem in surgeons, docs and nutritionists lacking the knowledge to keep DSers healthy long-term, and even with a longer common channel, for those SADI patients that listen solely to the nutritional advice of the surgeon's staff, I forecast similar deficiencies.
They offer a RNY schedule with extra ADEK if you're lucky and pose the "let's wait and see" attitude. They don't pay attention to downward trends and you're left holding the bag with malnourishment, and it can take a year or more to get those levels back to par once they start the downward spiral. This has been happening for YEARS and 99% of the surgeons and their high paid nutritionists still aren't taking note of it.
One thing I've noticed is that those who start out of the gate on Vitalady's schedule aren't reporting nearly as many deficiencies. This regimen came over her own years of struggles and actually working with DSers long-term. She saw trends with us and herself (as a distal RNY) and addressed them proactively. It took a private person buying bulk vitamins for her local support group to start paying attention, which is why I respect her and the business she's built around that.
So that being said - I'm very curious to see how a basic SADI patient does on their own surgeon's recommendations and not on ours. The DSers thrive nutritionally outside of the doc's recommendations. Those who follow instructions are the ones who struggle most over the years.
End Rant (steps off soapbox)
Valerie
DS 2005
There is room on this earth for all of God's creatures..
next to the mashed potatoes
The sales pitch sounds great and honestly it's time for medicine to come up with something 'better'.
Not at all sure the SADI is it. Speaking as a long term DSer with a 75CC, the battle for me is NOT SBS, it's regain. Just the same as all the other surgeries. The DSers usually do better short and mid term than the others but regain is a factor for many.
Now if I had a 250 to 300CC I would have no chance at all to stay thin. Or even relatively normal. And I have never had any deficiencies.
The sales pitch is it's a kinder and gentler DS. OK. I'm sure it still beats the heck out RNY. But it's not going to deliver the same weight loss and maintenance as the DS.
Hi. Good morning! I had the SADI on 12/3/13. I believe I have either a 36/38 French bougie and the CC is 150. My surgeon, Dr Roslin suggested this surgery because I wasn't a diabetic. My A1C level started to creep up but my sugar levels were normal. Dr Roslin felt that he would only recommend the DS for someone who is a severe diabetic. I had really bad HBP and cholesterol which are booth resolved. HW 268 and I am 116, now! I feel great! Enjoy your day!!!
That's great news. Sounds like a good decision for you and you have done great. Congratulations!! 
If you wouldn't mind I would love to know what your vitamin regimen looks like
and actually since I am already being nosy typical # of bowel movements per day now
that you are passed the one year mark.
Pete
Hi. Sure. I take iron , multi vitamin, high adek, folic acid, b1- 100mg daily and calcium citrate . Oh I almost forgot b12
2/4 bowl movements in the early morning and this of course depends on how much I have eaten the day before. High fiber constipates me. I do better with regular Mayo vs then light. I am still learning.
