BPD-DS vs SADI-S for Bariatric Surgery

Of all types of bariatric surgeries, gastric sleeve is the most widely performed surgery. However, there are continuously developing and emerging techniques.

SADI-S (single anastomosis duodenal ileal bypass with sleeve gastrectomy) and BPD-DS (biliopancreatic diversion with duodenal switch) are two bariatric procedures designed to help patients with obesity lose excess body weight. They have been used as primary procedures as well as revisional surgeries for patients with inadequate weight loss after sleeve gastrectomy or gastric band. Both approaches result in higher initial and long-term weight loss, as well as comorbidity resolution than sleeve gastrectomy and gastric bypass. The recovery time is similar across all procedures.

BPD-DS was first developed as an alternative to traditional BPD, which resulted in malnutrition and dumping syndrome. Dumping syndrome occurs when stomach contents rush to the small intestine in an abnormally fast manner. The DS surgery preserves the pyloric sphincter by using a sleeve gastrectomy instead of horizontally transecting the stomach to correct dumping syndrome. The pyloric sphincter acts as a valve that allows food and gastric juices from the stomach to move to the small intestine in a regulated manner.

The most recent development of the BPD-DS procedure is the SADI-S, which utilizes a single anastomosis instead of the two used in BPD-DS. Anastomoses come with their own risks like leaks, fistulas, and strictures, so a single anastomosis cuts these complication rates in half. After the sleeve gastrectomy, a D-Loop is made, which attaches the distal end of the small intestine to the duodenum about 2 cm from the pylorus. There is discussion around the length of the common limb, varying from 200 cm to 350 cm. Too short of a limb can result in malabsorption and proteinemia, but too long of a limb could result in inadequate weight loss.