SINGLE ANASTOMOSIS DUODENO-ILEOSTOMY WITH SLEEVE (SADI-S)

The primary distinction lies in the complexity and extent of the intestinal rearrangement. Traditional DS involves two major surgical components: a sleeve gastrectomy and an extensive rerouting of the intestines, creating two separate pathways (alimentary and biliopancreatic) that meet in a common channel. In contrast, SADI-S simplifies this by performing a sleeve gastrectomy followed by a single anastomosis or connection between the end of the ileum and the duodenum, thus eliminating the need for a separate biliopancreatic diversion.

Both procedures offer substantial weight loss and improvement in obesity-related comorbidities. However, SADI-S is often associated with a lower risk of nutritional deficiencies compared to traditional DS, due to the less extensive intestinal bypass. Studies suggest that SADI-S may also have a slightly lower complication rate, given the simplicity of the procedure.

Patients undergoing either surgery must commit to lifelong dietary modifications, vitamin supplementation, and regular follow-up care. However, the SADI-S procedure might require less aggressive supplementation due to its lower risk of malabsorption. Regular monitoring is essential to adjust supplementation as needed and to ensure optimal health and weight loss outcomes.

After undergoing SADI-S surgery, patients can typically expect a hospital stay of about 2 to 3 days. This duration is necessary to ensure proper recovery and to monitor for any immediate post-operative complications.

Discharge criteria typically include the ability to tolerate liquid diets, adequate pain control with oral medications, and the absence of surgical complications. Post-discharge, patients are advised to follow up closely with their surgical team to monitor their recovery process and to adjust their dietary and medication regimens as needed.

Post-SADI-S surgery, it is crucial to be aware of signs that may indicate complications. Early detection and treatment can prevent more severe issues. Seek prompt medical attention for any of the following symptoms:

• Persistent Nausea or Vomiting: While some nausea is expected post-surgery, persistent or severe vomiting may indicate a blockage or other complications.
• Severe Abdominal Pain: Any sudden or severe abdominal pain should be evaluated immediately, as it could signal internal bleeding, perforation, or other serious conditions.
• Fever and Chills: These symptoms could indicate an infection, particularly if accompanied by redness, discharge, or swelling at the incision sites.
• Inability to Tolerate Liquids or Food: Difficulty in swallowing or keeping food down might suggest a stricture or obstruction in the digestive tract.
• Unusual Swelling or Redness: Particularly around the surgical site, this could be a sign of infection or herniation.
• Changes in Bowel Movements: Severe diarrhea, constipation, or any noticeable changes in stool color (like dark, tarry stools) should be reported.
• Shortness of Breath or Chest Pain: These symptoms require immediate attention as they could indicate a pulmonary embolism or heart-related issues.

SADI-S surgery can significantly impact the absorption of medications. This effect is primarily due to the reduced surface area for absorption and changes in gastric pH levels. Patients should inform all healthcare providers, including pharmacists, about their surgery. To ensure proper management of medications, the following changes and protocols may be necessary: 

Alternative Formulations - Patients may need to switch to liquid, chewable, or sublingual forms of medication to improve absorption.

Dosage Adjustments - Some medications may require dosage adjustments. This might mean higher doses to achieve the same effect or lower doses if the drug's metabolism is slowed.

Monitoring and Adjustments: Regular blood tests to monitor levels of medications, especially for conditions like hypertension, diabetes, and thyroid disorders, are crucial. Based on these tests, doctors can make necessary adjustments to dosages.