Revisions Options after Sleeve Gastrectomy – SADI-S (Part 2 of 3) By Edmund B. Chen on May 11, 2023


When revising a sleeve gastrectomy to a SADI-S, the existing sleeve stomach is disconnected from the first portion of the small intestine.  The sleeve stomach is then reconnected to a loop of intestine that is about 300 cm from the end of the small intestine.  In this configuration, about 40-60% of the small intestine is bypassed, leaving about 300 cm of small intestine available to absorb both calories and nutrients.  As discussed previously, 300 cm seems to be the right length of small intestine that allows for great weight loss, while at the same time, being long enough to absorb the vitamins and nutrients needed.  

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Converting a Gastric Sleeve to SADI-S surgery is an excellent revision option.

Studies have shown that conversion of a sleeve gastrectomy to a SADI-S operation results in more weight loss than with a conversion to a RYGB.  In addition to improved weight loss, conversion to a SADI-S offers superior resolution of diabetes and a greater reduction in cardiovascular risk factors than conversion to a RYGB.  The SADI-S also has better long term weight loss.  Fewer patients gain their weight back after a SADI-S than with a RYGB. 

In addition to the improved results seen with the SADI-S versus RYGB, there are also fewer issues with a SADI-S.  The incidence of dumping syndrome is extremely rare after a SADI-S operation.  In addition, the risk of ulcers is much lower after a SADI-S than versus a RYGB.  Anastomotic ulcers are the bane of the RYGB operation.  This is not a problem after a SADI-S operation. 

Importantly, patients who have a revision to a SADI-S operation seem to do just as well as patient’s who had a SADI-S operation done as their initial surgery.  Patients with a revisional SADI-S still experience the great weight loss and resolution of comorbidities.  Therefore, it is never too late to talk to your bariatric surgeon regarding any concerns you may have regarding weight regain with a sleeve gastrectomy and to consider revision to a SADI-S operation. There are numerous benefits to revision to a SADI-S operation.  However, there are also great reasons for conversion to a RYGB, which we will talk about in future posts.

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