SADI vs. Regular DS (RNY Revision/Conversion)

Are you looking for RNY revision?

I've been doing A LOT of research on this topic. This is what I've discovered so far. If you had a failed RNY, you don't have too many options. It's either a conversion to DS or a conversion to a SADI. I am excluding the experimental procedures (Apollo, ROSE, Stomaphyx, etc.) that are not covered by insurance and weight loss is poor.

I know some people here will recommend to get the original DS. Conversion to regular DS has proven to be effective, but only a handful of surgeons perform this. If you don't live in CA, TX, NY, or VA, you will have to travel and stay in the city for several days. I believe is an open procedure (ouch!). Great thing is that you will lose all that extra weight (not 15-20 pounds like the procedures I mentioned above).

SADI, on the other hand, is a new procedure but do not have long term data. It's a new way of doing DS. That does not mean that is a bad procedure. However, I have read so many testimonies about it and the results are great (so far). I believe it's still considered a DS for insurance purposes.

Did you have this dilemma? Please share your experience.

Gavin, the SADI is not considered a DS "for insurance purposes". What (most) surgeons who do the SADI are doing is to either code it as a DS even though it doesn't conform to the actual language of the code, or cobble together a couple other codes for it. Either approach is deceptive, and we've seen patients find themselves stuck with the bill when their insurer figures out that the surgeon did an operation that is, at least for now, considered experimental.

Additionally, there is really no great advantage to you, the patient, in terms of making the operation significantly safer. The only difference is one less anastamosis, and it's the easy anastamosis at that. Your surgeon would still have to take apart your entire RNY, restore the original anatomy, and then do your DS, just without the connection of two parts of the small intestine. So all the difficult and risky stuff would still need to be done. And either way, it's going to be an open procedure because of the complexity of the revision.

Some insurers are starting to catch on to the fact that (some) surgeons are using the DS code incorrectly and we are beginning to see specific references to the SADI as an one of the experimental procedures they don't cover.

Larra

What Lara said plus, I have also seen some good results from SADI and I have seen total failures as well.

Being a failed RNY, why would you be willing to settle for less than a full DS? The SADI has LESS malabsorbtion than a true DS. Seems to me you need all the malabsorbtion you can get.

You need a real revision surgeon. RNY to DS or even SADI is not a simple procedure. And it's not always open either. Travel is not a reason to settle. My sister and H went to Spain for surgery and many have gone to Brazil and Belgium too. If I was in your shoes I would go to Keshishian in Cali.

Yes, I too am one of those people that think the traditional DS is your best option. However, I think the SADI while not a DS is significantly better than the RnY.

It is the fact that you want a conversion does limit the number of surgeons you might go to although I think the pool might be a little bigger than you are envisioning it's just some surgeons are better known for revisions.

I've seen posts from other revisions that were still done lap but I may be wrong about that. Are you sure the pool of surgeons willing to do a revision to a SADI is larger? It's my understanding the hard part of the revision isn't necessarily the type of switch but the issues getting your actual stomach back and any adhesions from the prior surgery.

Pete

You also want to take into consideration that this procedure is un-standardized (for the love of pete, they cannot even decide on a name). With that, it is likely that any other surgeon will reject a patient that has this. A patient may need to find assistance from another surgeon if theirs retires, moves out of state, gets sued (yes, we have one going through this on FB), etc. Nobody else will want to touch what they don't know inside.