The classic Biliopancreatic Diversion with Duodenal Switch (BPD/DS) has been recently modified and simplified by eliminating one of the anastomosis (intestinal connections). It is referred to by various names, including:
Single Anastomosis Duodeno Ileostomy (SADI)
Single Anastomosis Duodeno Ileostomy with Sleeve (SADI-S)
Single Anastomosis Duodenal Switch (SADS)
Loop Duodenal Switch
Stomach Intestinal Pylorus Sparing (SIPS)
This procedure resembles the standard duodenal switch very closely. It involves removing a large part of the stomach creating a Sleeve Gastrectomy and thus reducing the amount of food that the stomach can hold to about 4-6 ounces. Likewise, this procedure preserves the sphincter and the nerves of the stomach so it functions essentially like a normal stomach but is much smaller.
In addition, this procedure bypasses a significant portion, roughly about half, of the small intestines in order to limit how much food gets absorbed. Unlike the standard procedure, the single anastomosis duodenal switch procedure transects the intestine at only one point and creates only one new connection in the bowel.
We perform the sleeve gastrectomy laparoscopically or robotically, which allows for minimal pain and a very quick recovery. Just like the traditional BPD/DS. this procedure can be performed as a single procedure (one stage), or in two stages where the intestinal bypass is added to a previously done sleeve gastrectomy.
While more long-term studies are still needed, the modified duodenal switch promises to lead to less vitamin deficiencies than the traditional BPD/DS but still deliver reversal of type 2 diabetes and significant weight loss.
In 2020, the American Society for Bariatric and Metabolic Surgery (ASMBS) endorsed the single anastomosis duodenal switch through an updated position statement.
What are the main disadvantages of the modified duodenal switch?
The modified duodenal carries a risk of malnutrition and vitamin deficiencies. Life-long vitamin supplementation is mandatory and patients need to be monitored for protein malnutrition, anemia and bone disease for the rest of their lives.
It is a relatively new surgery, so it hasn’t been studied as long as other procedures.
How long will I need to recover from a modified duodenal switch?
We perform the modified duodenal switch laparoscopically and most patients can return home one to two days following surgery, as long as they are able to drink liquids comfortably and stay hydrated. Patients are encouraged to walk and stay active immediately after surgery and as tolerated. Depending upon their general health and their job, most patients are ready to go back to work within two weeks after surgery.
