SADI and Duodenal Switch

The SADI (single anastomosis duodenal ileal bypass) and the duodenal switch are weight-loss operations for patients with extreme excess weight. At Obesity Clinic Dendermonde, these procedures are only performed in people with super morbid obesity (BMI > 50). In this operation, a rerouting of the digestive system is created by connecting a long small-intestine loop to the duodenum. These procedures have a restrictive effect, a hormonal effect and a stronger malabsorptive effect.

Patients with a very high BMI who qualify for this procedure are first given a sleeve gastrectomy. As a result of this sleeve gastrectomy, the patient will lose weight well but the BMI often remains above 40 kg/m². As a second stage, a SADI or duodenal switch is then performed after 18 months. Sometimes this procedure is also carried out in one go (i.e. sleeve and intestinal rerouting together). The procedure is performed by keyhole surgery (laparoscopy) or with the robot.

Results

Studies show that after a SADI or duodenal switch, patients have very good weight loss in the long term. With regard to the disappearance of comorbidity such as diabetes mellitus, these procedures give the best results.

However, due to their malabsorptive effect, these procedures have more side effects such as diarrhoea, vitamin and iron deficiencies, and dumping compared to a sleeve or gastric bypass. That is why these procedures are only carried out in selective cases after extensive screening. Patients who undergo such a procedure must be closely followed up by a medical specialist for the rest of their lives.

Complications

Every operation can be accompanied by complications. People who are overweight have a greater chance of complications than people of a normal weight. There are standard post-operative complications that can occur after any operation, such as bleeding, infection, abscess formation, incisional hernia, thrombosis of the leg or a pulmonary embolism.

The most common risks directly associated with a SADI or duodenal switch are:

• Vitamin deficiency
• Iron deficiency
• Dumping
• Malnutrition
• Diarrhoea
• Leakage or bleeding along the staple line
• Reflux