Laparoscopic Single-Anastomosis Duodenal-Ileal Bypass (SADI-S)

ბარიატრიული პროცედურები

SADI-S

SADI-S (Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy) is a bariatric surgical procedure that represents a relatively new approach to weight loss and the treatment of metabolic disorders. This operation is an evolution of the classic biliopancreatic diversion (BPD) method and is considered highly effective because it combines mechanisms of intestinal diversion and food restriction.

Main Stages of the Procedure:

Sleeve Gastrectomy:
The procedure begins with a vertical resection of the stomach, reducing its volume by approximately 80%. This results in a narrow, tubular stomach that limits food intake and helps the patient feel full more quickly. Additionally, sleeve gastrectomy influences the release of digestive hormones, which play a role in regulating appetite and blood glucose levels.
Single Anastomotic Duodeno-Ileal Bypass:
After the vertical gastric resection, the surgeon connects the first part of the duodenum (the portion adjacent to the stomach) to the middle section of the intestine (the ileum). This bypass prevents food from passing through most of the small intestine, thereby reducing nutrient and calorie absorption.

Mechanisms and Benefits

Mechanisms of the Procedure:

Nutritional Restriction:
The reduced stomach volume limits the amount of food that can be consumed, leading to a decreased appetite and overall caloric intake.
Malabsorption:
Bypassing a significant portion of the small intestine reduces the absorption of nutrients, including fats, carbohydrates, and other substances. This mechanism plays a crucial role in promoting substantial weight loss.

Benefits:

Effective Weight Loss:
The SADI-S procedure combines significant nutritional restriction with malabsorption, resulting in considerable and sustained weight loss.
Metabolic Benefits:
This method is particularly effective in managing metabolic disorders, especially type 2 diabetes, often leading to remission or improved glucose control.
Simplified Anatomy:
With only one anastomosis (connection), the SADI-S procedure minimizes the complexity of the surgery. This can reduce the risk of intraoperative complications and sometimes leads to fewer postoperative issues.

Early Postoperative Complications

Potential Complications of SADI-S:
1. Leakage:
  A severe complication that can occur at the site where the intestine and duodenum are joined. Leakage may lead to peritonitis, a life-threatening condition requiring urgent surgical intervention and antibiotic therapy.
2. Infection and Abscess Formation:
  Postoperative infections can result in abscesses, particularly in the abdominal cavity. Treatment may involve drainage of the abscess along with antibiotic therapy.
3. Thromboembolism:
  Patients are at risk of developing deep vein thrombosis (DVT) or pulmonary embolism (PE) following surgery. Preventative measures, such as anticoagulant medications and early mobilization of the patient, are strongly recommended.
4. Intestinal Obstruction:
  Intestinal obstruction may arise due to displacement or twisting of the intestinal loops. This is a surgical emergency that necessitates reoperation.

Late Postoperative Complications

Long-Term Complications of SADI-S:
1. Vitamin and Mineral Deficiencies:
  Due to the malabsorption mechanism, the body may not absorb sufficient vitamins and minerals. Deficiencies in iron, calcium, vitamin B12, and vitamin D are particularly common. To address this, patients must take regular vitamin and mineral supplements and undergo periodic laboratory monitoring.
2. Protein Deficiency:
  Reduced nutrient absorption can lead to protein deficiency, resulting in general weakness and fatigue. This complication is managed by incorporating high-protein foods and nutritional supplements into the diet.
3. Osteoporosis:
  Impaired calcium absorption can reduce bone density, increasing the risk of osteoporosis. Patients are advised to take calcium and vitamin D supplements regularly to prevent this condition.
4. Stenosis or Anastomotic Stricture:
  Over time, the anastomotic area may narrow, leading to stenosis or strictures that disrupt the normal passage of food. Treatment typically involves endoscopic dilation, though reintervention may be necessary in severe cases.
5. Weight Regain:
  In some cases, the body may adapt by increasing nutrient absorption, potentially leading to weight regain over time. This may require further medical or dietary adjustments to address.

Conclusion

SADI-S is among the most effective methods for treating obesity and metabolic disorders. It combines the benefits of dietary restriction and malabsorption to achieve significant and sustained results. However, the procedure requires long-term postoperative monitoring and adherence to nutritional supplementation to ensure optimal outcomes and prevent complications.