SLEEVE TO SADI-S / SASI-S REVISION

Service Description

Gastric Sleeve to SADI-S or SASI-S Revision Revising a Gastric Sleeve (VSG) to SADI-S (Single Anastomosis Duodeno–Ileal Bypass with Sleeve) or SASI-S (Single Anastomosis Stomach–Ileal Bypass with Sleeve) is a highly effective second-stage bariatric surgery. These options are typically chosen when patients experience inadequate weight loss, weight regain, or persistent metabolic disease after a sleeve. WHY CHOOSE A REVISION AFTER SLEEVE? - Insufficient weight loss: Especially in patients with BMI ≥45 or metabolic syndrome - Weight regain: Due to gastric adaptation or lifestyle regression - Unresolved type 2 diabetes or dyslipidemia: Sleeve alone may not provide enough metabolic effect - Progressive GERD: SASI-S may help; SADI-S generally not ideal for GERD - VSG ➝ SADI-S What is it? - Starts with an existing Vertical Sleeve Gastrectomy - The duodenum is divided just past the pylorus, and a loop of ileum (250–300 cm from the ileocecal valve) is connected to the duodenum - The food stream bypasses the jejunum but preserves the pylorus Key Benefits - Superior metabolic control (T2DM remission: up to 90%) - Greater weight loss (EWL: 80–90%) - Preserves pylorus → less dumping - Single anastomosis → simpler than classic DS Considerations - High risk of malabsorption if dietary compliance is poor - Risk of diarrhea, steatorrhea - Not recommended for patients with severe GERD VSG ➝ SASI-S What is it? - The original sleeve is preserved - A side-to-side connection is made between the gastric antrum (near the pylorus) and distal ileum (~250 cm) - This creates a dual pathway: 1. Natural route through duodenum and jejunum 2. Shortcut to ileum (bipartition) Key Benefits - Strong weight loss with lower malabsorption - Dual path preserves digestive continuity - Lower risk of diarrhea than SADI-S - May help with metabolic syndrome with less nutritional risk Considerations - Long-term data still maturing - Risk of bile reflux (depends on anatomy) - May require endoscopic evaluation to confirm anatomy pre-op 🧠 Summary Converting a gastric sleeve to SADI-S or SASI-S is a powerful revisional strategy that offers superior metabolic benefits, especially in cases of weight regain or diabetes relapse. - Choose SADI-S for maximum weight loss and metabolic power, but with higher risk of malabsorption. - Choose SASI-S for a gentler option with preserved digestive flow and lower long-term nutritional