BODY MASS INDEX
The “duodenal switch and biliopancreatic diversion” surgeries which have been introduced into the medical literature by Dr. Scorpinaro and have been written in the USA for about 20 years are an alternative method used in the treatment of obesity because of their higher metabolic effects. SADI-S (Single Anastomosis Duodeno-Ileal Bypass + Sleeve Gastrectomy) surgery is a surgery which has the same effects with the classic “Duodenal Switch” surgery and at the same time they are considered less risky since they involve a single anastomosis (intestine connection).
.In this method, the stomach is conventionally turned into a tube, then the small intestines, which are 5-6 meters on average and whose main task are absorbed are bypassed. In other words, the absorption area is reduced to 2.5 meters. In this operation none of the intestine pieces are definitely removed from the body. The area where the food will contact is shortened, the left intestine remains in it’s place and it provides the gall and pancreatic’s continue to flow normally.
This surgical procedure is a method since tube stomach surgery is performed, since it restricts the taking it’s a method where the absorption is reduced. In addition to the decrease in absorption, it triggers the secretion of a hormone called GLP-1 from the small intestine that stimulates the satiety center faster. Thus, eating desire is reduced in a significant way. The point that should not be forgotten here is that the appetite center is in the brain and in addition to this hormonal mechanism, also the “psychological hunger” affects. After this method if the person’s “eating disorder” or “emotional hunger” is not controlled then she/he may have diarrhea attacks in the early period due to the wrong nutrition and malabsorption may increase further and problems due to protein and vitamin loss may occur. It should not be forgotten that in long term, failure which we can explain as weight gain can be seen.
The greatest advantage of this surgical method over other bypass types is the protection of the pylorus muscle which regulates the passage of food into the intestine at the exit of the stomach and prevents “Dumping Syndrome” which is one of our biggest fears in classical gastric bypass (RNY and Mini Gastric Bypass) surgeries. Dumping Syndrome usually begins during the meal or immediately after the meal (10 minutes later, calms down after 40-60 minutes) frequently while the patient is still sitting at the table. Vasomotor symptoms are usually dominant and they can sometimes deactivate gastrointestinal symptoms. Patients complain of sudden fatigue, fainting and dizziness and they feel the need to lie down. They complain of cold sweating and palpitations. At the same time there is a feeling of fullness and upheaval in the stomach.
Endoscopic viewing of the stomach is very important in societies where gastric cancer is common or in people who have gastric cancer family history. In Roux-n-y gastric bypass and Mini-Gastric Bypass, the area of the stomach which can not be visualized by endoscopic methods remains but this is not valid for SADI-S surgery. In this surgical method, regulation of glucose is more successful in the long term than tube stomach surgery especially in patients with diabetes.
Comparing to the tube stomach surgery, this surgical method is a surgery that disrupts anatomy and physiology more as in other types of bypass. Vitamin deficiencies can be seen but this is less than classical duodenal switch surgery. In this surgical method, as in other bypass operations, in the early period, foul-smelling diarrhea can be seen in the adaptation process of the intestine. For some cases, it’s being chosen as the first surgical method for obesity may be appropriate.