SADI, SIPS, Loop DS not the same as the duodenal switch

Before you consent to having duodenal switch surgery, be sure to confirm with your surgeon, IN WRITING, that the procedure you are agreeing to is the standard of care duodenal switch with TWO anastomoses, and not the Investigational-Experimental procedure procedure variously known as the SADI, SADI-S, SIPS, LoopDS or even as “improved” or “safer” duodenal switch. Unfortunately, an alarming number of patients are having these procedures done, for which there is no designated insurance code, because it is easier to perform, and touting it as “just the same as a DS.”. It has also been noted that very frequently the patients were led to believe that they were having the duodenal switch operation where no distinction was made between these procedures. Lets be clear that the duodenal Switch operation is not the same as SADI, SIPS or the Loop DS. While someday, after proper experimental protocols are performed, the single anastomosis procedure(s) may be proven to be safe and reasonably effective, it is NOT THE STANDARD OF CARE PROCEDURE KNOWN AS THE DUODENAL SWITCH specified by CPT code 43845, which has two anastomoses and provides selective fat malabsorption.

These variant experimental procedures known as SADI (Single Anastomosis Duodeno-Ileal bypass), SADI-S (Single Anastomosis Duodeno-Ileal bypass with Sleeve gastrectomy), SIPS (Stomach Intestinal Pylorus-Sparing surgery), LoopDS (Loop Duodenal Switch), or other names, and in some cases even misleadingly calling the procedure a duodenal switch, have the following distinguishing features from a standard of care duodenal switch:

  1. cookie cutter measurements that are not tailored to the patient’s particular medical condition (age, gender, height, weight, metabolic disease, length of small bowel);
  2. a significantly longer alimentary tract than a proper DS;
  3. an enormously longer common channel than a proper DS
  4. no separation of digestive enzyme and bile from food in the alimentary tract, and thus NO SELECTIVE FAT MALABSORPTION; and
  5. significant risk of bile reflux, which cannot happen with a proper DS.

Moreover, despite assertions to the contrary, these single anastomosis procedures CANNOT BE EASILY CONVERTED TO A PROPER DS IF THE EXPERIMENTAL PROCEDURE FAILS.

There are a number of patients reporting that they did not understand that they were being given one of these experimental procedures, instead of the standard of care DS, until after surgery, because they were misinformed, under-informed, misled, or were given inadequate information to give fully informed consent. Some are reporting slow weight loss, bile reflux, and concerns about the specific nutritional and supplementation requirements for the procedure, which are not known or disclosed by their surgeons. Some of these patients have already returned back to their original surgeons or others for revision to the standard of care duodenal switch procedure.

A revision of SADI, SIPS, or Loop DS may be more complex than just s simple bowel anastomosis. Since the alimentary tract is created to be too long in the first place, and because the intestine manufactures more absorptive capacity in response to the initial malabsorption, in order to provide the same or even somewhat similar results, the entire intestinal portion of the procedure may have to be taken down and reconstructed, with a shorter alimentary tract. A revision to a proper DS will therefore may provide the same results as if a proper DS was done initially.

Risks include:

  1. These experimental procedures are NOT covered by the standard of care DS CPT code 43845, and there have been a number instances of insurance companies refusing to pay for the single anastomosis procedure, including after the fact when the surgical report is reviewed.
  2. Since there are no long term studies yet, proper nutritional guidelines have not been determined, much less long term results.
  3. Bile reflux – impossible with the DS – has also been reported.
  4. There is obviously significantly less macronutrient malabsorption with this intestinal configuration, but there may still be very significant micronutrient malabsorption, as food is still not touching a significant portion of the intestine where certain receptors are located; nevertheless, the procedure thus is being advertised by some surgeons as “safer” with less “malnutrition” but that may only be true with respect to protein and not all nutritional requirements.

If you want to have an experimental procedure, that is and should be your choice. Our concern is primarily that patients be given complete and accurate information enabling them to give fully informed consent to what is an Investigational-Experimental procedure, but which is not being described that way.