Sadi-S or Sadi Bypass

SADI-S & SASI Bypass: Newssurgeriesof obesity in Tunisia with Dr Patrick Noël

SADI-S and SASI bypass are two fairly recent bariatric surgery techniques that are gaining increasing popularity among bariatric surgeons. Dr Patrick Noël specialized in bariatric surgery, practices these new revisional surgery techniques after sleeve failure.

In the case of SADI-S, a longitudinal gastrectomy is performed with a slightly wider probe and the first part of the duodenum is cut 2 to 3 cm after the pylorus. The terminal ileum located 250 cm from the ileocecal valve is then anastomosed with the part of the duodenum previously dissected.

In the case of SASI bypass, the intestine located 250 cm from the ileocecal valve is anastomosed with the antrum of the stomach and the duodenum is not dissected.

These two techniques of obesity surgery give excellent results in terms of weight loss and resolution of comorbidities, both as first approach techniques and especially as techniques in the event of sleeve gastrectomy failure.

In particular, the results in terms of diabetes resolution are extremely encouraging.

The idea of these interventions is to combine certain advantages of the Sleeve and the Bypass:

Bypass reduces the size of the stomach: This intervention reduces acid reflux, but makes access to the liver difficult in the event of gastroscopy;
The Sleeve aims to drastically reduce the total volume of the stomach: This is an irreversible operation. Furthermore, this intervention causes acid reflux. These refluxes prove dangerous in the long run and could cause pre-cancerous lesions. Gastroscopy checks are therefore recommended.

After these two interventions, there is a risk of:

Malnutrition
Vitamin deficiency.

For this reason, postoperative monitoring as well as vitamin supplementation are fundamental, even more than for other surgical techniques.

The SADI-S

SADI-S (single anastomosis duodeno-ileal bypass with sleeve gastrectomy) is a procedure combining a sleeve gastrectomy with an intestinal diversion. This is a recent technique that is expected to develop and become part of the arsenal of obesity surgery interventions.

Progress of the operation

We begin the operation by removing part of the stomach as we would do during a sleeve gastrectomy, then we cut the duodenum (beginning part of the small intestine), just after the pylorus (muscle which separates the stomach from the 'intestine). We locate the junction between the colon and the end of the small intestine (ileum). The length of the small intestine ensuring the absorption of food (common loop) is measured starting from the end of the small intestine.

It is between 2.5 and 3.5 meters. This length is chosen according to the characteristics of the patient (age, associated pathologies, BMI, etc.). The ileal loop is then anastomosed (connected) to the duodenum, just downstream of the pylorus.

It combines a restrictive intervention (sleeve) with a malabsorptive intervention (intestinal diversion).

There is an associated hormonal effect, acting on the cycles of hormones regulating satiety, blood sugar, etc.

It can be considered as a variant of biliopancreatic diversion (a technique currently rarely performed because it causes many post-operative nutritional complications and is reserved for rare cases of super obesity).

The SASI Bypass

The SASI consists of a revisited Sleeve. Reduction of the stomach is applied before moving up the small intestine. In this way, food reaches the intestine more quickly and the feeling of hunger disappears.

This technique achieves great results for the cure of type 2 diabetes (increased insulin secretion from the pancreas) and can resolve difficult complications such as hypertension, high cholesterol, bone diseases, etc.

Who can benefit from a SASI or SADI?

People between the ages of 18 and 65 can be candidates for these operations.

Obese patients with a BMI over 40 or over 35 with other medical conditions (hypertension, diabetes, etc.) are eligible for SASI.
The SADI is indicated in particular in the super-obese (initial BMI greater than 50) and particularly following the failure of a sleeve.

Patients who have already undergone Sleeve surgery can also consider this type of operation in the event of weight regain or problems related to the procedure (acid reflux, great difficulty eating, etc.).

Finally, in case of severe reflux or chronic liver disease, SASI is an excellent solution.

Complications related to SASI and SADI bariatric surgery

No surgery has a 0 risk. From the simplest intervention, carried out hundreds of times a year, to the most difficult, any operation can experience complications. The postoperative complication rate of these operations is similar to a Sleeve (hematoma, haemorrhage, fistula) or a Bypass (anastomotic fistula).

It is common to have diarrhea with this procedure, which indicates malabsorption. Treatment can be given to limit it.

These techniques SADI and SASI require nutritional monitoring before and especially after the operation, in order to have a balanced diet well distributed throughout the day, allowing optimum weight control and avoiding deficits.

Different causes of obesity

Several factors influence the onset of obesity. It is a multifactorial disease.

The genetic factor : many obese people have at least one parent in the same situation. A hereditary predisposition can therefore contribute to the onset of this disease.
Metabolism : from one person to another, the latter ensures that everyone absorbs food and converts it differently, for example into heat or fat.
Bad eating habits : an excess of calorie intake in relation to the body's needs leads, inevitably but differently, each person to obesity. The proliferation of overly aggressive diets can contribute to the installation of obesity.
Lack of physical exercise : an excessively sedentary lifestyle can contribute to the unfavorable imbalance of food intake.
The environmental factor : the professional, family, social and economic environment influences lifestyle and therefore contributes to the development of obesity.
Psychology : psychological disorders are frequently linked to food imbalances: Eating disorders.

Obesity and its comorbidity factors

Comorbidity factors refer to the presence of one or more disorders related to a primary disease, in this case obesity. Indeed, obesity is unfortunately accompanied by the development of other pathologies or socio-psychological disorders .

Obesity is linked to other diseases such as:

high blood pressure ;
diabetes ;
sleep apnea;
polyarthrosis;
various forms of cancer;

… but also is linked to social and psychological disorders:

self-esteem issues;
eating disorders;
difficulty coping with the gaze of others

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