Diabetes Surgery (SADI-S)

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Diabetes Surgery (SADI-S)

Did you know that you can get rid of Diabetes Type 2 by Diabetes surgery? The number of bariatric surgeons who have the knowledge and skill to perform the surgery is still limited nowadays. Ekol Hospitals’ all general surgeons can perform this operation safely and successfully with satisfactory results.

Diabetes surgery, single-Anastomosis Duodeno-Ileal bypass with Sleeve Gastrectomy (SADI-S) is an innovative surgical procedure designed primarily to treat morbid obesity and its associated conditions, such as type 2 diabetes.

This surgery combines two techniques: a sleeve gastrectomy and a bypass. In the first part, a significant portion of the stomach is removed, limiting food intake and reducing hunger hormone levels.

The second component involves bypassing a large segment of the small intestine, which alters gut hormones and improves glucose metabolism.

This combination not only facilitates significant weight loss but also has a profound impact on the body's ability to regulate blood glucose levels. SADI-S has shown promising results in improving or resolving diabetes, offering a potential lifeline for patients struggling with obesity-related diabetes.

The procedure, however, requires careful patient selection and lifelong medical follow-up to ensure nutritional adequacy and monitor metabolic health.

How Does SADI-S Differ From Traditional Bariatric Surgeries?

SADI-S (Single-Anastomosis Duodeno-Ileal bypass with Sleeve Gastrectomy) differs from traditional bariatric surgeries in several key ways:

  1. Combination of Procedures: SADI-S combines two surgical techniques – a sleeve gastrectomy and a duodeno-ileal bypass. The sleeve gastrectomy involves removing a large portion of the stomach to limit food intake. The duodeno-ileal bypass reroutes a significant part of the small intestine, which affects nutrient absorption and hormonal changes that influence diabetes.
  2. Single Anastomosis: Unlike other bariatric surgeries like the Roux-en-Y gastric bypass, which involves creating two connections (anastomoses) in the intestines, SADI-S requires only one. This simplification can reduce the time taken for the surgery and potentially lower the risk of complications like leaks or blockages at the surgical site.
  3. Impact on Diabetes: SADI-S is particularly effective for patients with type 2 diabetes. The alteration in the gut's anatomy and the hormonal changes due to the surgery can lead to significant improvements in blood sugar control, often surpassing the results seen with other bariatric procedures.
  4. Nutritional Considerations: The extent of intestinal bypass in SADI-S is less than in traditional duodenal switch surgery, potentially reducing the risk of severe nutritional deficiencies. However, patients still need to adhere to dietary guidelines and take supplements to prevent deficiencies.
  5. Weight Loss and Appetite Control: The combination of stomach reduction and intestinal bypass in SADI-S can lead to substantial weight loss. The hormonal changes due to the surgery also contribute to reduced appetite and improved satiety.
  6. Reversibility and Revision: While technically more straightforward than some other bariatric surgeries, SADI-S is still considered a major and permanent alteration. Reversal or revision surgeries are possible but are more complex and not commonly performed.

Each type of bariatric surgery has its own set of benefits and risks, and the choice depends on the individual patient's health profile, weight loss goals, and specific medical conditions. SADI-S represents an evolution in bariatric surgery, offering a unique approach particularly beneficial for patients with significant obesity-related diabetes.

Who is a Candidate for SADI-S?

Candidates for Single-Anastomosis Duodeno-Ileal bypass with Sleeve Gastrectomy (SADI-S) are typically selected based on a set of criteria that focus on their health status, weight, and previous attempts at weight loss. Here are the key factors considered in determining candidacy:

  1. Severe Obesity: SADI-S is usually recommended for individuals with severe obesity. This often means having a body mass index (BMI) of 35 or higher, especially if it's accompanied by obesity-related health conditions like type 2 diabetes, hypertension, or sleep apnea.
  2. Previous Weight Loss Attempts: Candidates often have a history of unsuccessful attempts at weight loss through conventional methods such as diet, exercise, and lifestyle changes. SADI-S is usually considered when these non-surgical methods have not yielded sustainable results.
  3. Type 2 Diabetes: Patients with obesity-related type 2 diabetes are prime candidates for SADI-S. The surgery has shown significant efficacy in improving or even resolving diabetes in many cases, making it a potential treatment option for those struggling to manage their diabetes with medication and lifestyle changes alone.
  4. Overall Health Status: Candidates must be in a condition suitable for undergoing major surgery. This includes having no uncontrolled psychological conditions or substance abuse issues, as these can affect the success of the surgery and the commitment to post-operative lifestyle changes.
  5. Commitment to Lifestyle Changes: Candidates must be willing and able to commit to significant, lifelong changes in their diet and lifestyle. This includes adhering to dietary guidelines, engaging in regular physical activity, and attending regular follow-up appointments for medical monitoring and nutritional support.
  6. Age Restrictions: SADI-S is generally performed on adults. While there's no strict upper age limit, the risks and benefits must be carefully weighed in older patients.
  7. Absence of Certain Medical Conditions: Certain gastrointestinal diseases, like Crohn's disease, or previous extensive abdominal surgeries might contraindicate SADI-S.

Each case is evaluated individually, and the decision to proceed with SADI-S involves a thorough assessment by a multidisciplinary team including bariatric surgeons, dietitians, psychologists, and other healthcare professionals. The suitability for SADI-S is based on a comprehensive evaluation of the patient's health, weight history, and psychological readiness.

What Are The Potential Benefits of SADI-S?

The Single-Anastomosis Duodeno-Ileal bypass with Sleeve Gastrectomy (SADI-S) offers several potential benefits, particularly for individuals struggling with severe obesity and related health conditions. These benefits include:

  1. Significant Weight Loss: SADI-S is effective in achieving substantial and sustained weight loss. The combination of reduced stomach size and altered gut hormone levels helps in reducing appetite and calorie absorption.
  2. Improvement or Resolution of Type 2 Diabetes: One of the most significant benefits of SADI-S is its impact on type 2 diabetes. Many patients experience a dramatic improvement in blood sugar control, and some may achieve remission of diabetes, reducing or eliminating the need for diabetes medications.
  3. Reduction in Other Obesity-Related Conditions: SADI-S can lead to improvements in various obesity-related comorbidities such as hypertension, sleep apnea, high cholesterol, and joint pain, thereby enhancing overall quality of life and reducing the risk of related health complications.
  4. Improved Cardiovascular Health: Weight loss and metabolic improvements following SADI-S can lead to better heart health, with reductions in risk factors for heart disease like high blood pressure and high cholesterol.
  5. Enhanced Quality of Life: Patients often experience significant improvements in mobility, self-esteem, and overall quality of life. This can include increased ability to engage in physical activities and a positive impact on mental health.
  6. Hormonal Changes: SADI-S induces hormonal changes that can improve satiety (the feeling of fullness) and decrease hunger, which aids in weight management.
  7. Reduced Risk of Certain Cancers: Obesity is a known risk factor for several types of cancer. The significant weight loss achieved through SADI-S may reduce the risk of obesity-related cancers.
  8. Potentially Less Malabsorption Compared to Other Procedures: Since SADI-S involves a lesser degree of intestinal bypass compared to traditional duodenal switch surgery, there may be a lower risk of severe nutritional deficiencies.

It's important to note that while SADI-S offers these potential benefits, it also carries risks and requires a lifelong commitment to dietary changes and medical follow-up. The suitability and potential benefits of SADI-S should be evaluated on an individual basis in consultation with a healthcare professional.

Will I Need to Change My Diet After SADI-S?

Yes, changing your diet is essential after undergoing Single-Anastomosis Duodeno-Ileal bypass with Sleeve Gastrectomy (SADI-S). This surgical procedure significantly alters your digestive system, impacting how you tolerate food and absorb nutrients. Adhering to the recommended dietary guidelines is crucial for ensuring proper nutrition, promoting healing, and achieving long-term weight loss and health goals. Here are key dietary changes and considerations post-SADI-S:

  1. Phased Diet Progression:
    • Initial Phase (Liquids): Immediately after surgery, you will start with a clear liquid diet. This typically includes broth, water, sugar-free gelatin, and decaffeinated tea or coffee.
    • Pureed Foods: After a few days to weeks, as recommended by your healthcare provider, you will transition to pureed foods. These are smooth, blended foods that are easy to digest.
    • Soft Foods: Gradually, you'll introduce soft foods like scrambled eggs, cottage cheese, and cooked vegetables.
    • Regular Diet: Eventually, you will progress to a more regular diet, incorporating a variety of nutrient-rich foods.
  2. Smaller, More Frequent Meals: Your reduced stomach size will necessitate smaller meals. Aim for several small meals throughout the day instead of three large ones to avoid overeating and discomfort.
  3. High-Protein Focus: Protein is vital for healing and maintaining muscle mass. High-protein foods like lean meats, eggs, low-fat dairy, and legumes should be a central part of your diet.
  4. Limit Sugars and Fats: Foods high in sugar and fat can cause discomfort and are not conducive to weight loss. They may also lead to dumping syndrome, a condition where food moves too quickly through the digestive system.
  5. Stay Hydrated: Drink plenty of water between meals. Avoid drinking fluids with meals to prevent filling up your stomach with liquids and displacing nutrient-dense foods.
  6. Avoid Alcohol and Caffeine: Alcohol can be high in calories and may affect your stomach differently post-surgery. Caffeine can dehydrate you and irritate your stomach lining.
  7. Vitamin and Mineral Supplements: Because SADI-S can lead to nutrient deficiencies, you will likely need to take vitamin and mineral supplements for life. This usually includes a multivitamin, calcium, vitamin D, iron, and possibly others as recommended by your healthcare team.
  8. Mindful Eating Practices: Eat slowly, chew thoroughly, and pay attention to your body's signals of fullness to avoid overeating and complications.

Remember, dietary recommendations can vary based on individual needs and the specifics of your surgery. It's important to work closely with a dietitian or a healthcare provider specializing in bariatric surgery for personalized guidance and to ensure your diet meets all your nutritional needs.

Is SADI-S reversible?

The Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) is technically reversible, but it's important to understand that reversibility does not mean it's a simple or commonly recommended option. Here are some key points regarding the reversibility of SADI-S:

  1. Designed as a Permanent Solution: SADI-S, like most bariatric surgeries, is intended to be a permanent change to aid in significant and lasting weight loss and improvement in obesity-related health conditions. The decision to undergo SADI-S should be made with the understanding that it's a long-term commitment to a new lifestyle.
  2. Complexity of Reversal: While it is technically possible to reverse the procedure, reversal surgeries are complex and carry increased risks. The complexity arises from the need to restore the original anatomy and the potential for complications such as leaks, infections, or issues with the reconnection of the intestines.
  3. Reasons for Reversal: Reversal might be considered in rare cases due to severe complications or adverse effects that cannot be managed by other means. However, this is not common and would require a thorough evaluation by a medical team.
  4. Alternative Options - Revision Surgery: In some cases where there are issues with weight loss or complications, rather than a reversal, a revision surgery might be considered. Revision surgeries adjust the original procedure to address specific issues, such as altering the length of the bypassed intestine.
  5. Lifestyle and Dietary Changes are Key: It's important to note that the success of SADI-S, like other bariatric surgeries, heavily relies on the patient's commitment to lifelong dietary changes, regular exercise, and medical follow-up. Surgery is a tool to aid in weight loss and improve health conditions, but it's not a standalone solution.

In summary, while SADI-S can technically be reversed, such a procedure is complex, risky, and not commonly performed. The decision to undergo SADI-S should be made with the understanding that it is intended as a lifelong change. Any concerns or potential complications should be discussed with a healthcare provider, and alternative solutions should be considered before contemplating reversal.

OUR DOCTORS

Prof. Dr. Ömer Yoldaş He completed his medical education at Dokuz Eylul University Faculty of Medicine between 1995 and 2001. He specialized in General Surgery at Ankara Training and Research Hospital between 2001 and 2006. He worked as a General Surgery Specialist at Ankara Training and Research Hospital between 2006 and 2008 and later at Ordu State Hospital between 2008 and 2013. In 2016, he received the title of Associate Professor in the Department of General Surgery, Faculty of Medicine, Izmir University. In 2015, he received the Turkish Surgical Association Proficiency Exam (Board) Certificate of Achievement. He is a member of Turkish Surgical Association, Turkish Colon and Rectum Surgery Association, National Endoscopic Laparoscopic Surgery Association, Bariatric and Metabolic Surgery Association, and Hepatobiliary Surgery Association. Between 2014 and 2016, he taught many undergraduate and graduate courses at Izmir University Faculty of Medicine. He has conducted many national and international studies and these studies have received many citations. Assoc. Prof. Dr.  Ömer Yoldaş speaks English fluently. He has two children.   Knowledge Domain: Obesity Surgery and Metabolic Surgery, Laparoscopic Reflux Surgery, Laparoscopic Gallbladder Surgeries, Gastric Balloon Application, Gastric filler Application, Laparoscopic Gastric and Intestinal Cancer Surgeries, Haemorrhoid Surgeries, Perianal Fistula Surgeries, Laparoscopic Abdominal and Groin Hernia Surgeries, Breast Cancer Surgeries, Thyroid Cancer and Goitre Surgeries.
Assoc. Prof. Dr. Ogün Erşen Date of birth 10.11.1987 Education and Expertise Karadeniz Technical University Faculty of Medicine Kocatepe University Ankara University Faculty of Medicine Konya Health Sciences University Professional Interests: Obesity (fatness) surgery and metabolic surgery Laparoscopic reflux surgery Laparoscopic gallbladder surgeries Gastric balloon application ERCP, EMR, ESD (Advanced Endoscopic procedures) Laparoscopic pancreatic cancer surgery Laparoscopic gastric and intestinal cancer surgeries Hemorrhoid surgeries Perianal fistula surgeries Laparoscopic abdominal and inguinal hernia surgeries Oncoplastic Breast cancer surgeries Natural cancer surgery (NOSE) Thyroid cancer and goiter surgeries. Memberships to Scientific Organizations Turkish Surgery Association Turkish Obesity Surgery Association Surgical Oncology Association National Society of Endoscopic Laparoscopic Surgery He is a member of the Bariatric and Metabolic Surgery Association. Courses and Certificates: Turkish surgical association proficiency exam (Board) certificate of achievement in 2018 He has more than 100 papers presented in national and international congresses and more than 50 articles published in international journals. Foreign language English
Opr. Dr. Özgür Kavak He completed his medical education at Osmangazi University Faculty of Medicine between 1990 and 1996, and his residency in General Surgery at Izmir Training and Research Hospital between 2004 and 2008. In 2008, he received the Turkish Surgical Association's Qualification Exam (Board) certificate of success. He is a member of Turkish Surgical Association, Turkish Colon and Rectum Surgery Association, National Endoscopic Laparoscopic Surgery Association, Bariatric and Metabolic Surgery Association. He worked as a lecturer at Istanbul Rumeli University between 2017 and 2020. He currently performs Laparoscopic Oncosurgery and Obesity Surgeries. He has many national and international studies and these studies have received many citations.   Having a good command of English, Opr. Dr. Özgür Kavak is married and has two children.   Areas of interest: Laparoscopic Sleeve Gastrectomy, Laparoscopic Full Gastric Bypass, Laparoscopic Mini Bypass, Laparoscopic Type 2 Diabetes Surgery, Gastric Balloon Application with Endoscopic Method. In Non-Surgical Obesity Treatments:  Stomach filler (Endoscopic), Laparoscopic Oncology Surgery (Colorectal, Stomach, Pancreas, Adrenal), Reflux - Gastric Hernia Surgery (Laparoscopic), Minimally Invasive Surgery, Laparoscopic Hernia Surgery, Endocrine Surgery (Thyroid - Breast Surgery), Haemorrhoid Surgery with Laser, Haemorrhoidopexy (LHP), Perianal Fistula Surgery with FILAC (Fistula Laser Closure) Method.
Opr. Dr. Attila El He graduated from Dokuz Eylül University, Faculty of Medicine. Between 1987 and 1991, he completed his specialization in general surgery at Buca SSK Hospital in Izmir. Between 1991 and 2016, he worked at Karşıyaka State Hospital, then until 2019 he worked as the General Surgery Specialist at Çiğli Training and Research Hospital. He is an active member of Turkish Surgical Association, Turkish Society of Colon and Rectal Surgery. He has experienced around 30,000 successful operations in the field of general surgery. Areas of interest: Laparoscopic gallbladder operations, gastrointestinal surgery, haemorrhoids and fissure surgeries, abdominal and inguinal hernia operations, breast cancer operations, thyroid cancer and goiter operations. Op. Dr. Attila El is married and has one child. He speaks fluent English.
Opr. Dr. Abdülkadir Korkmaz He completed his medical education at Istanbul University Cerrahpaşa Faculty of Medicine between 1986-1992. He completed his general surgery residency at İzmir Tepecik Training and Research Hospital between 1995-2000. In 2011, he received his education in the field of ERCP and Endoscopy at Afyon Kocatepe University. He worked as a specialist at Tepecik Training and Research Hospital, Karşıyaka State Hospital, Bakırçay University / Çiğli Training and Research Hospital between 2000-2021. He is a member of the Turkish Society of Surgery, Society of Endoscopic Laparoscopic Surgery, the bariatric and metabolic surgery society, and the Turkish Obesity Foundation. His special interest is Obesity Surgery. The father of 2 children, Opr. Dr. Abdulkadir Korkmaz has a good command of English. Areas of interest: Laparoscopic (closed) obesity (obesity) surgeries (sleeve – medicine stomach, gastric bypass) Gastric balloon application with endoscopic method in non-surgical obesity treatment Laparoscopic (closed) inguinal hernia surgeries Laparoscopic (closed) appendicitis surgeries Laparoscopic (closed) gallbladder surgeries Laparoscopic (closed) reflux - gastric hernia surgeries Goiter and Breast (breast cancer) surgeries Hemorrhoids treatment with laser Anescal surgery with laser
Opr. Dr. Rıza Özdemir He completed his medical education at Dokuz Eylul University Faculty of Medicine between 1995-2001. He completed his general surgery residency at Eskişehir Osmangazi University Faculty of Medicine between 2002-2007. He is a member of Turkish Surgery Association, Turkish Colon and Rectum Surgery Association, National Endoscopic Laparoscopic Surgery Association, Bariatric and Metabolic Surgery Association, Hepatobiliary Surgery Association and Endocrine Surgery Association. He has many national and international studies and these studies have been cited many times.   Fluent in English, Opr. Dr. Rıza Özdemir is married and has one child.   Areas of interest: • Obesity (fatness) surgery and metabolic surgery • Laparoscopic reflux surgery • Laparoscopic gallbladder surgeries • Gastric balloon application • Stomach injection application • Laparoscopic gastric and intestinal cancer surgeries • Haemorrhoid surgeries • Perianal fistula surgeries • Laparoscopic abdominal and inguinal hernia surgeries • Breast cancer surgeries

Frequently Asked Questions

Ekol Hospitals Obesity Clinic has experienced Professor Doctors, Associate Professors, Specialists, nutritionists and dedicated nurses & care takers. Teamwork is really imported when it comes to bariatric & metabolic surgeries and EKOL has the most experienced and Professional team working in harmony.
You will have a full check up before the operation, the results will be evaluated and your surgeon will decide to have the operation or not together with you. Full Urine Test, Blood Test, Chest Xray, Respiratory Function Test, Cardiology Consultation, Pulmonary Diseases Consultation, Internal Diseases Consultation, General Surgery consultation, anesthesia consultation, Ultrasonography. The operation ist mostly laparoscopic (closed) and takes around 1,5 – 2 hours.
SADI-S is a modified version of an operation that was developed 30 years ago, formally called Biliopancreatic Diversion with Duodenal Switch (BPD-DS) and more simply known as the duodenal switch. The SADI-S procedure involves two steps: • Step one; the surgeon will perform a sleeve gastrectomy, removing about 80% of the stomach. • Secondly, the first part of the intestine (duodenum) is divided just below the stomach and reattached (anastomosed) to a loop of intestine about 2 metres further downstream.
• Delivers greater weight loss than a sleeve gastrectomy or standard gastric bypass, which is advantageous for people with a BMI above 50. • Provides a more powerful metabolic effect than a sleeve gastrectomy or standard gastric bypass, which is advantageous for people with poorly controlled Type 2 Diabetes. • Can be performed on people who have already had a sleeve gastrectomy, which is advantageous for people who experience weight regain or insufficient weight loss. • Lowers the risk of diarrhea and nutritional deficiencies often encountered with a conventional duodenal switch. • Connecting a loop of small bowel rather than a Roux limb is anticipated to reduce the long-term risk of intestinal obstruction, compared to a standard gastric bypass and compared to a duodenal switch. • The pylorus is retained above the connected loop of small bowel and continues to regulate the rate at which food and acid empty from the stomach into the intestines and to prevent free reflux of bile into the stomach. This helps to reduce the likelihood of certain problems encountered with gastric bypass surgery such as: Dumping Syndrome, unstable blood sugar fluctuations (reactive hypoglycaemia, nocturnal hypoglycaemia), food restrictions and intolerance, marginal ulcers.
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